HIPAA Notice of Privacy Practices

Effective Date: November 5, 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.

This notice applies to protected health information maintained by Si McAninch, DDS, PA, including dental records, X-rays, treatment plans, and billing information.

Your Rights

• Access your records. You may ask to inspect or receive a paper or electronic copy of your dental records and other health information we maintain about you. We generally respond within 30 days and may charge a reasonable, cost-based fee.
• Request a correction. You may ask us to amend information you believe is incorrect or incomplete. If we deny the request, we will explain our decision in writing within 60 days.
• Request confidential communications. You may ask us to contact you at a different address or by a particular method. We will accommodate reasonable requests.
• Request limits on use or disclosure. You may ask us to limit how we use or share your information for treatment, payment, or practice operations. We generally do not have to agree. If you pay in full out of pocket for an item or service and ask us to withhold information about it from your health plan for payment or operations, we will honor that request unless disclosure is required by law.
• Ask for a list of disclosures. You may request an accounting of certain disclosures made in the six years before your request. The accounting excludes routine disclosures for treatment, payment, or operations and other disclosures exempt under HIPAA. The first accounting in a 12-month period is free. We may charge a reasonable, cost-based fee for additional requests during that period.
• Get a paper copy of this notice. You may request a printed copy at any time, even if you receive the notice electronically.
• Have an authorized representative act for you. A person with legal authority may exercise your rights on your behalf after we verify that authority. A parent or guardian may act for a minor when permitted by applicable law.
• File a complaint. You may contact our office or the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Your Choices

You may tell us whether to share relevant information with family members, friends, or others involved in your care or payment for your care, or with organizations assisting in disaster relief. If you cannot tell us your preference, we may share information when professional judgment indicates that it is in your best interest. We may also share information when permitted by law to lessen a serious and imminent threat to health or safety.

We obtain written authorization when required for marketing, the sale of protected health information, most disclosures of psychotherapy notes, and other uses or disclosures that are not otherwise permitted or required by law. You may revoke an authorization in writing, except to the extent we have already acted on it.

If we contact you for fundraising, you may opt out of future fundraising communications. If we hold substance use disorder records protected by 42 CFR Part 2 and intend to use those records for fundraising, we will give you clear advance notice and an opportunity to opt out.

How We Use and Share Health Information

• Treatment. We may use your information to provide dental care and share relevant records with other providers involved in your treatment. For example, we may send X-rays to a specialist when we refer you.
• Payment. We may share information with your dental plan to verify benefits, submit claims, or obtain payment for services.
• Practice operations. We may use information to review the quality of care, train staff, manage records, and contact you about appointments or follow-up care. Service providers that handle protected health information on our behalf must safeguard it as required by law.

Other Uses and Disclosures Allowed or Required by Law

When applicable legal requirements are met, we may use or disclose health information for public health and safety, reporting suspected abuse or neglect, health oversight, research, workers’ compensation, law enforcement, and authorized government functions. We may also disclose information in response to qualifying court orders or other legal process, to comply with state or federal law, or to assist organ procurement organizations, medical examiners, or funeral directors when applicable.

Special Protection for Substance Use Disorder Records

If we hold substance use disorder patient records protected by 42 CFR Part 2, we may use or disclose them in civil, criminal, administrative, or legislative proceedings or investigations against you only with your written consent or with both a qualifying court order and a subpoena or similar legal mandate.

Our Responsibilities

We are legally required to safeguard your protected health information, provide this notice, and follow the privacy practices currently in effect. We will notify you as required by law if a breach compromises the privacy or security of your unsecured protected health information.

Changes to This Notice

We may revise this notice and apply the revised practices to health information we already maintain. The current notice will be available on our website, at our office, and upon request.

Questions and Complaints

For questions about this notice, help exercising your rights, or to file a privacy complaint, contact our office and ask for the person responsible for privacy matters.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775, writing to 200 Independence Avenue, S.W., Washington, D.C. 20201, or visiting the HHS complaint page.