Privacy Policy

LAKE BLUFF DENTAL

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Lake Bluff Dental is required by law to:

• Maintain the privacy of your protected health information (PHI)
• Provide you with notice of our legal duties and privacy practices
• Notify affected individuals following a breach of unsecured protected health information We must follow the privacy practices described in this Notice while it is in effect.

Effective Date: February 16, 2026

This Notice will remain in effect until replaced.

We reserve the right to change our privacy practices and the terms of this Notice at any time, as permitted by applicable law. Any new Notice provisions will apply to all protected health information we maintain. If we make significant changes, we will post the updated Notice clearly and prominently in our office and provide copies upon request.

You may request a copy of this Notice at any time by contacting us using the information at the end of this document.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use and disclose your health information for the following purposes:

1. Treatment

We may use and disclose your health information to provide, coordinate, or manage your dental care. Example: We may share information with a specialist to whom we refer you.

1. Payment

We may use and disclose your health information to obtain payment for services provided. This may include:

• Billing and collections
• Claims management
• Determining eligibility or coverage

Example: We may send claims to your dental insurance plan containing certain health information.

1. Healthcare Operations

We may use and disclose your health information for practice operations, including:

• Quality assessment and improvement
• Staff training
• Licensing and credentialing activities

Specially Protected Information

Certain types of information (such as HIV-related information, genetic information, substance use disorder treatment records, and mental health records) may have additional protections under state or federal law. We will comply with all applicable legal requirements.

ADDITIONAL PERMITTED USES AND DISCLOSURES

Individuals Involved in Your Care

We may disclose information to family members, friends, or others you identify as involved in your care or payment for your care. If someone has legal authority to make healthcare decisions for you, we will treat that person as we would treat you. Disaster Relief

We may disclose your health information to assist in disaster relief efforts.

Required by Law

We may disclose your health information when required by federal, state, or local law.

Public Health Activities

We may disclose information to:

• Prevent or control disease, injury, or disability
• Report child abuse or neglect
• Report medication reactions or product problems
• Notify individuals of recalls
• Notify individuals exposed to disease
• Report suspected abuse, neglect, or domestic violence

National Security & Law Enforcement

We may disclose health information:

• To military authorities (when applicable)
• For lawful intelligence and national security activities
• To correctional institutions or law enforcement officials

In response to subpoenas or court orders

Secretary of Health and Human Services

We will disclose information when required for HIPAA compliance investigations.

Workers’ Compensation

We may disclose PHI as authorized by workers’ compensation laws.

Health Oversight Activities

We may disclose PHI to government oversight agencies for audits, investigations, inspections, and licensure.

Judicial and Administrative Proceedings

We may disclose PHI in response to court or administrative orders, subpoenas, or lawful processes.

Research

We may disclose PHI to approved researchers when privacy protections are in place.

Coroners, Medical Examiners, and Funeral Directors

We may release PHI as necessary to identify a deceased person or determine cause of death.

Fundraising

We may contact you about practice-sponsored activities. You may opt out of receiving such communications.

SUBSTANCE USE DISORDER (SUD) TREATMENT INFORMATION

If we receive records from a substance use disorder treatment program covered under 42 CFR Part 2:

• We may use and disclose those records for treatment, payment, and healthcare operations as permitted by your consent.
• We will not use or disclose these records in legal proceedings without your consent or a proper court order.

OTHER USES AND DISCLOSURES

Your written authorization is required for:

• Disclosure of psychotherapy notes
• Marketing purposes
• Sale of protected health information
• Any other use not described in this Notice (unless otherwise permitted by law) You may revoke authorization in writing at any time.

YOUR HEALTH INFORMATION RIGHTS

Right of Access

You may inspect or obtain copies of your health information (with limited exceptions). Requests must be in writing. Reasonable cost-based fees may apply.

If access is denied, you have the right to request a review.

Right to an Accounting of Disclosures

You may request a written list of certain disclosures of your health information.

Right to Request Restrictions

You may request limits on how we use or disclose your PHI. We are not required to agree, except in certain circumstances involving services paid in full out-of-pocket.

Right to Alternative Communication

You may request that we contact you in a specific way or at a specific location. Requests must be in writing.

Right to Amendment

You may request correction of your health information. Requests must be in writing and include a reason for the amendment.

Right to Breach Notification

You will be notified if a breach of unsecured PHI occurs.

Right to Paper Copy

You may request a paper copy of this Notice at any time.

QUESTIONS OR COMPLAINTS

If you have questions about this Notice or believe your privacy rights have been violated, please contact us.

You may also file a complaint with the U.S. Department of Health and Human Services. We will provide contact information upon request.

We will not retaliate against you for filing a complaint.

PRIVACY OFFICIAL CONTACT INFORMATION

Privacy Official Name: Carolyn Griffin DDS

Telephone: 414-962-1800

Fax: 414-626-7446

Address: 1720 E Lake Bluff Blvd, Shorewood WI 53211

Email: office@lakebluffdental.com