Notice of Privacy Practices

Effective Date: January 30, 2026

Our Commitment to Your Privacy

Atchison Dental Associates ("we," "us," or "our") is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (PHI), provide you with this Notice of our legal duties and privacy practices, and follow the terms of the Notice currently in effect.

This Notice applies to all records of your care generated by Atchison Dental Associates, whether created by our staff or your personal dentist.

Practice Contact Information:

Atchison Dental Associates, PA
111 N 5th Street
Atchison, KS 66002
Phone: (913) 367-0212
Email: frontdesk@atchisondental.com

How We May Use and Disclose Your Protected Health Information

The following categories describe the ways we may use and disclose your protected health information without your written authorization:

Treatment

We may use your health information to provide you with dental treatment or services. We may disclose your health information to dentists, dental hygienists, dental assistants, and other healthcare providers who are involved in your care. For example, we may share your health information with a specialist to whom we refer you for treatment, or with a laboratory that creates dental prosthetics for your treatment.

Payment

We may use and disclose your health information to obtain payment for services we provide to you. For example, we may send your insurance company information about your dental treatment so they can pay us or reimburse you for your care. We may also contact you about unpaid balances or payment arrangements.

Healthcare Operations

We may use and disclose your health information for our healthcare operations. These uses and disclosures are necessary to run our practice and ensure that all patients receive quality care. For example, we may use your health information to review our treatment and services, to evaluate the performance of our staff, for training purposes, or to plan for future operations.

Appointment Reminders and Health-Related Information

We may contact you to remind you of scheduled appointments or to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Family Members and Friends

We may disclose your health information to a family member, friend, or other person you identify as being involved in your care or payment for your care. We will only disclose the health information that is relevant to the person's involvement in your care.

As Required by Law

We will disclose your health information when required to do so by federal, state, or local law.

Public Health Activities

We may disclose your health information for public health activities, including reporting diseases, injuries, and vital events, and conducting public health surveillance and investigations.

Health Oversight Activities

We may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.

Legal Proceedings

We may disclose your health information in response to a court order or administrative tribunal, or in response to a subpoena, discovery request, or other lawful process.

Law Enforcement

We may disclose your health information to law enforcement officials for law enforcement purposes, as required by law or in response to a valid legal process.

Coroners, Medical Examiners, and Funeral Directors

We may disclose your health information to a coroner, medical examiner, or funeral director as necessary for them to carry out their duties.

Research

Under certain circumstances, we may use and disclose your health information for research purposes, provided the research has been approved by an institutional review board or privacy board.

To Avert a Serious Threat to Health or Safety

We may use and disclose your health information when necessary to prevent a serious threat to your health and safety or the health and safety of others.

Workers' Compensation

We may disclose your health information as authorized by workers' compensation laws.

Military and Veterans

If you are a member of the armed forces, we may disclose your health information as required by military command authorities.

National Security and Intelligence Activities

We may disclose your health information to authorized federal officials for national security and intelligence activities.

Uses and Disclosures Requiring Your Written Authorization

We will obtain your written authorization before using or disclosing your health information for purposes other than those described above, including:

• Marketing purposes (except for face-to-face communications and promotional gifts of nominal value)
• Sale of your protected health information
• Most uses and disclosures of psychotherapy notes (if applicable)
• Other uses and disclosures not described in this Notice

You may revoke your authorization in writing at any time, except to the extent that we have already taken action in reliance on your authorization.

Your Rights Regarding Your Health Information

You have the following rights regarding your protected health information:

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your health information, including medical and billing records. To request access, submit your request in writing to our office. We may charge a reasonable fee for copying and mailing costs. We may deny your request in certain limited circumstances, and if we do, you may request a review of the denial.

Right to Amend

If you believe that your health information is incorrect or incomplete, you have the right to request that we amend it. To request an amendment, submit your request in writing, along with a reason for the amendment. We may deny your request if the information was not created by us, is not part of the records we maintain, is not available for inspection, or is accurate and complete.

Right to an Accounting of Disclosures

You have the right to request an accounting of certain disclosures of your health information. This accounting will not include disclosures made for treatment, payment, or healthcare operations, disclosures made to you, or disclosures made with your authorization. To request an accounting, submit your request in writing. The first accounting in any 12-month period is free; we may charge a reasonable fee for additional requests.

Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to your request unless you are asking us to restrict disclosures to a health plan for services you paid for out of pocket in full. To request a restriction, submit your request in writing, specifying what information you want limited and to whom.

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 work or only by mail. To request confidential communications, submit your request in writing. We will accommodate reasonable requests.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this Notice, even if you have agreed to receive it electronically. You may request a copy at any time by contacting our office.

Right to Be Notified of a Breach

You have the right to be notified if there is a breach of your unsecured protected health information.

Changes to This Notice

We reserve the right to change this Notice at any time. Any changes will apply to all health information we maintain. The revised Notice will be posted in our office and on our website. You may also request a copy of the current Notice at any time.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with our office, contact:

Privacy Officer
Atchison Dental Associates, PA
111 N 5th Street
Atchison, KS 66002
Phone: (913) 367-0212
Email: frontdesk@atchisondental.com

To file a complaint with the U.S. Department of Health and Human Services, visit www.hhs.gov/hipaa/filing-a-complaint or call 1-800-368-1019.

You will not be retaliated against for filing a complaint.

Contact Information

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