HIPPA Notice
Cheyenne Family Dental Center
Notice of Privacy Practices
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.
Effective Date: February 16, 2026
This Notice describes the privacy practices of Cheyenne Family Dental Center and how we may use and disclose your protected health information (PHI).
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices regarding that information. We are also required to 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.
We reserve the right to change the terms of this Notice and to make new Notice provisions effective for all protected health information we maintain. If we make material changes, we will post the updated Notice in our office and make copies available upon request.
You may request a copy of this Notice at any time.
Uses and Disclosures of Health Information
We may use and disclose your protected health information for the following purposes:
Treatment
We may use or disclose your health information to provide, coordinate, or manage your dental care and related services. For example, we may share information with specialists, laboratories, or other healthcare providers involved in your treatment.
Payment
We may use or disclose your health information to obtain payment for services provided to you. This may include submitting claims to your insurance company, verifying coverage, or collecting outstanding balances.
Health Care Operations
We may use or disclose your health information to operate our practice. These activities include quality assessment, training, licensing, accreditation, and business management functions.
Other Permitted Uses and Disclosures
We may also disclose your health information in the following situations when permitted or required by law:
Individuals Involved in Your Care
We may share information with family members, friends, or others you identify as involved in your care or payment for your care.
Public Health Activities
We may disclose health information for public health purposes including:
- Preventing or controlling disease
- Reporting abuse or neglect
- Reporting adverse reactions to medications
- Reporting product problems or recalls
- Preventing serious threats to health or safety
Required by Law
We may disclose your health information when federal, state, or local law requires it.
Health Oversight Activities
Government agencies may require us to disclose health information for audits, inspections, investigations, or licensing purposes.
Law Enforcement
We may disclose health information in response to subpoenas, court orders, warrants, or other lawful processes.
Judicial or Administrative Proceedings
We may disclose health information in response to court or administrative orders or other legal proceedings.
Workers’ Compensation
We may disclose health information as authorized by workers’ compensation laws.
Coroners, Medical Examiners, and Funeral Directors
We may release health information to identify a deceased person or determine the cause of death.
National Security
We may disclose health information to authorized federal officials for national security and intelligence activities.
Research
We may disclose health information to researchers when approved by an institutional review board that protects patient privacy.
Uses and Disclosures Requiring Your Authorization
We will obtain your written authorization before:
- Using or disclosing psychotherapy notes
- Using or disclosing information for marketing purposes
- Selling protected health information
You may revoke your authorization in writing at any time.
Your Rights Regarding Health Information
You have the following rights concerning your health information.
Right to Inspect and Copy
You have the right to inspect and obtain copies of your health information. Requests must be made in writing.
We may charge a reasonable cost-based fee for copies.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your health information. We are not required to agree except when you pay for a service in full and request that information not be shared with your health plan.
Right to Confidential Communications
You may request that we contact you by alternative methods or at alternative locations.
Right to Amend
You may request an amendment to your health information if you believe it is incorrect or incomplete.
Right to an Accounting of Disclosures
You have the right to receive a list of certain disclosures we have made of your health information.
Right to Breach Notification
You have the right to be notified if a breach occurs involving your unsecured protected health information.
Right to a Paper Copy
You have the right to receive a paper copy of this Notice even if you have agreed to receive it electronically.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services.
You will not be retaliated against for filing a complaint.
To file a complaint with the federal government, contact:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
Privacy Official Contact Information
Practice: Cheyenne Family Dental Center
Privacy Official: Jesse Massie
Telephone: 307-634-7633
Email: cheyennefamilydental@gmail.com