Privacy Policy & HIPAA Notice of Privacy Practices

Effective Date: January 1, 2026
Last Updated: January 1, 2026

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

1. Our Commitment to Your Privacy

Eastgate Family Dental is committed to protecting the privacy of your health information. We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices with respect to your PHI, and to notify you in the event of a breach of your unsecured PHI. We are required to abide by the terms of this Notice as long as it remains in effect.

Your "protected health information" (PHI) includes individually identifiable information about your past, present, or future health condition, the dental care we provide to you, and payment for your dental care. This Notice describes how we may use and disclose your PHI and explains your rights regarding your health information.

2. How We May Use and Disclose Your Protected Health Information (PHI)

The following describes the ways we may use and disclose your PHI without your written authorization:

Treatment

We may use and disclose your PHI to provide, coordinate, and manage your dental care and any related services. This includes sharing your health information with other healthcare providers who are involved in your treatment. For example, we may share your dental records with a specialist to whom we refer you, an oral surgeon who performs a procedure, a laboratory that fabricates a dental appliance, or another dentist who may be treating you. We may also contact you to provide appointment reminders or information about treatment alternatives or other health-related services that may be of interest to you.

Payment

We may use and disclose your PHI to obtain payment for the dental services we provide. This includes billing and collecting from you, your dental insurance plan, or a third-party payer. For example, we may need to share information about dental treatment you received at our office with your insurance company in order to process a claim, obtain pre-authorization, or determine your eligibility for benefits. We may also share your PHI with billing and collection companies, insurance companies, health plans, and other entities as needed for payment purposes.

Healthcare Operations

We may use and disclose your PHI for our healthcare operations. These activities include, but are not limited to, quality assessment and improvement activities, employee training and education, compliance programs, audits, accreditation, certification, licensing activities, business planning, and general administrative activities. For example, we may use your health information to evaluate the quality of dental care you received or to evaluate the performance of our dental team members. We may also share your PHI with third parties who assist us with our healthcare operations, such as billing services, provided they agree to appropriate safeguards for your information.

3. Other Permitted Uses and Disclosures

In addition to treatment, payment, and healthcare operations, we may use or disclose your PHI without your authorization in the following circumstances:

As Required by Law

We may use or disclose your PHI when required to do so by federal, state, or local law. This includes mandatory reporting requirements and disclosures required in the course of legal or administrative proceedings.

Public Health Activities

We may disclose your PHI to public health authorities or other entities authorized by law to receive such information for the purpose of preventing or controlling disease, injury, or disability. This includes reporting diseases, injuries, births, and deaths, and reporting suspected child abuse or neglect to the appropriate government authority.

Health Oversight Activities

We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, inspections, investigations, licensure, and other proceedings related to the oversight of the healthcare system, government benefit programs, or compliance with civil rights laws and other regulatory programs.

Judicial and Administrative Proceedings

We may disclose your PHI in the course of judicial or administrative proceedings in response to a court order, subpoena, discovery request, or other lawful process, subject to the requirements of applicable law. We will make reasonable efforts to notify you of such requests or to obtain a qualified protective order before making any disclosure.

Law Enforcement

We may disclose your PHI to a law enforcement official for law enforcement purposes as permitted by HIPAA and applicable law, including in response to a court order, warrant, subpoena, or administrative request; to identify or locate a suspect, fugitive, material witness, or missing person; about a crime victim under certain circumstances; about a death we believe may be the result of criminal conduct; about criminal conduct occurring on our premises; and in emergency situations to report a crime, the location of a crime or victims, or the identity, description, or location of the perpetrator.

Threats to Health or Safety

We may use or disclose your PHI when we believe, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, and the disclosure is made to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

Workers' Compensation

We may disclose your PHI as authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs established by law that provide benefits for work-related injuries or illnesses without regard to fault.

Organ and Tissue Donation

If you are an organ or tissue donor, we may disclose your PHI to organizations that handle organ procurement, organ or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ, eye, or tissue donation and transplantation.

Research

Under certain circumstances, we may use or disclose your PHI for research purposes, provided that the research has been approved by an institutional review board or a privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Uses and Disclosures Requiring Your Written Authorization

For any use or disclosure of your PHI not described in this Notice, we will request your written authorization before making the disclosure. If you provide us with authorization to use or disclose your PHI, you may revoke that authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your written authorization. However, we are unable to take back any disclosures we have already made with your permission, and we are required to retain our records of the care we have provided to you.

4. Your Rights Regarding Your Protected Health Information

You have the following rights with respect to your protected health information:

Right to Inspect and Copy Your Records

You have the right to inspect and obtain a copy of your PHI that is contained in a designated record set, such as your dental records and billing records, for as long as we maintain those records. To request access to your records, you must submit a written request to our office. We may charge a reasonable, cost-based fee for copies of your records, as permitted by applicable law. In certain limited circumstances, we may deny your request to inspect and copy your records. If we deny your request, we will provide you with a written explanation and inform you of your right to have the denial reviewed.

Right to Request Amendments

You have the right to request that we amend your PHI if you believe the information in your records is incorrect or incomplete. To request an amendment, you must submit a written request to our office that includes the reason you are requesting the amendment. We may deny your request if, for example, the information was not created by us, is not part of the information you would be permitted to inspect and copy, or if we determine that the information is accurate and complete. If we deny your request, we will provide you with a written explanation of the denial.

Right to an Accounting of Disclosures

You have the right to request an accounting of certain disclosures of your PHI that we have made. This accounting will not include disclosures made for treatment, payment, or healthcare operations; disclosures made with your written authorization; disclosures made directly to you; or certain other disclosures. To request an accounting of disclosures, you must submit a written request to our office specifying the time period for the accounting. The time period may not go back more than six years and may not include dates before April 14, 2003. The first accounting you request within a 12-month period will be provided free of charge. For additional requests within the same 12-month period, we may charge you a reasonable, cost-based fee.

Right to Request Restrictions

You have the right to request that we restrict or limit how we use or disclose your PHI for treatment, payment, or healthcare operations. You also have the right to request that we limit the information we disclose to individuals involved in your care or the payment for your care. We are not required to agree to your request for restrictions, except that we are required to agree to your request to restrict disclosures to a health plan if the disclosure is for the purpose of payment or healthcare operations (and is not for treatment), and the PHI pertains solely to a healthcare item or service for which you have paid us out of pocket in full. To request a restriction, you must submit a written request to our office.

Right to Request Confidential Communications

You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For example, you may request that we contact you only at your work phone number or by mail to a specific address. To request confidential communications, you must submit a written request to our office specifying how or where you wish to be contacted. We will accommodate all reasonable requests, provided you clearly state that the disclosure of all or part of your information in another manner or at another location could endanger you.

Right to a Paper Copy of This Notice

You have the right to receive a paper copy of this Notice of Privacy Practices at any time, even if you have previously received a copy or agreed to receive this Notice electronically. To obtain a paper copy, please contact our office at (616) 245-9830 or request one in person at our front desk.

5. Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We are required to provide you with this Notice of our legal duties and privacy practices with respect to your PHI.
• We are required to abide by the terms of this Notice as currently in effect.
• We are required to notify you if a breach occurs that may have compromised the privacy or security of your unsecured PHI. In the event of such a breach, we will notify you as required by law.
• We will not use or disclose your PHI without your written authorization, except as described in this Notice.
• We will not use or disclose your PHI for marketing purposes or sell your PHI without your prior written authorization.
• We reserve the right to change our privacy practices and to make the new provisions effective for all PHI that we maintain, including PHI we created or received before the changes. When we make a significant change in our privacy practices, we will revise this Notice and make the new Notice available upon request and in our office.

6. Filing a Complaint

If you believe your privacy rights have been violated, you have the right to file a complaint. You will not be penalized or retaliated against for filing a complaint.

Complaints to Our Practice

You may file a complaint with our office by contacting:

Eastgate Family Dental | (616) 245-9830
Eastgate Family Dental
2003 Burton St SE
Grand Rapids, MI 49506
Phone: (616) 245-9830

Complaints to the U.S. Department of Health and Human Services

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You may file a complaint online, by mail, or by phone:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/complaints

7. Contact Information

If you have any questions about this Notice of Privacy Practices or would like to exercise any of your rights described in this Notice, please contact us:

Eastgate Family Dental
2003 Burton St SE
Grand Rapids, MI 49506
Phone: (616) 245-9830
Eastgate Family Dental | (616) 245-9830