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.

Purpose & Delivery: Federal law requires us to provide this Notice to you no later than your first date of service. We will make a good-faith attempt to obtain your written acknowledgement of receipt. This Notice is available on request, posted prominently in our offices, and available on our practice websites.

Our Legal Duty: We are required by federal and state law (Colorado) to maintain the privacy of your Protected Health Information (PHI) and to notify you following a breach of unsecured PHI. We must follow the practices described in this Notice and reserve the right to change them; any changes will apply to all PHI we maintain.

I. Uses and Disclosures of Health Information

We use and disclose your PHI for treatment, payment, and healthcare operations:

• Treatment: Coordinating care with other healthcare providers (e.g., your general dentist, other dental specialists, or physicians).
• Payment: Billing and collecting payment from you or your insurance provider or any third-party payor.
• Healthcare Operations: Quality assessment, training, accreditation, facility and practice management.

Special Protections (2026 Updates):

• Substance Use Disorder (SUD) Records: Under 42 CFR Part 2, SUD records received from federal programs are strictly protected. They will not be used in civil, criminal, administrative, or legislative proceedings against you without your specific written consent or a court order.
• Reproductive Health Care Privacy: We will not use or disclose your PHI to investigate or impose liability on any person for the act of seeking, obtaining, providing, or facilitating reproductive health care that is lawful under the circumstances in which it is provided.
• Notice of Redisclosure: Once we disclose PHI to a third party per your authorization, that information may be subject to redisclosure by the recipient and may no longer be protected by federal HIPAA regulations.
• State-Specific Law (Colorado): Highly sensitive information (such as HIV/AIDS status or specific mental health records) is subject to stricter state laws in Colorado and will only be disclosed with your specific written authorization or as required by law.

Other Permitted Uses: We may disclose PHI without authorization for public health issues, law enforcement, national security, or if we believe you are a victim of abuse/neglect. We may also use PHI for appointment reminders (text, email, or phone).

II. Your Individual Rights

• Access: You have the right to inspect and copy your records. We may charge a reasonable fee for copies, processing, and mailing or transferring your records.  We will comply with your request within 7 days, per Colorado Law.
• Accounting: You may request a list of certain disclosures we have made of your PHI over the last 6 years.
• Restrictions: You may request additional restrictions on how we use your PHI. If you pay for a service in full out-of-pocket, we must honor your request to not share that information with your health insurer.
• Amendments: You may request in writing that we amend PHI, which you believe is incorrect.
• Confidential Communications: You may request that we communicate with you via alternative means or locations (e.g., a specific phone number or address).

III. Questions and Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Official or the U.S. Department of Health and Human Services. Residents of Colorado may also seek legal relief for privacy violations under their respective state statutes. We will not retaliate against you for filing a complaint.

Privacy Contact Officer: Dr. Joshua Kelly 

Severance Dental: 375 W. 4th Ave.  Severance, CO  80550
Telephone: 970-693-0080   Email: info@severancedental.com

Download

 Notice of Privacy Practices (HIPAA Privacy Practices)