Notice of
Privacy Practices
Effective Date: 06/12/26
Last Updated: 06/12/26
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
At Charlotte Orthodontics, we understand the importance of protecting your personal health information. This Notice describes how we may use and disclose your Protected Health Information (PHI) and explains your rights regarding that information.
We are required by law to:
Protected Health Information includes information we create or receive about your health, treatment, payment for care, and identifying information such as your name, address, birth date, or insurance details.
How We May Use and Disclose Your Health Information
We may use and disclose your PHI for the following purposes without additional written authorization.
1. Treatment
We may use and share your information to provide, coordinate, or manage your orthodontic care.
Examples include:
2. Payment
We may use or disclose PHI to obtain payment for services.
Examples include:
3. Healthcare Operations
We may use PHI for business operations necessary to run our practice.
Examples include:
4. Appointment Reminders and Communications
We may contact you to provide:
Communication methods may include:
Please notify us if you prefer restrictions on communications.
5. Individuals Involved in Your Care
Unless you object, we may share relevant information with:
For minor patients, parents or legal guardians generally have access to records unless otherwise restricted by law.
6. Required by Law
We may disclose PHI when required by federal, state, or local law.
Examples include disclosures related to:
7. Public Health and Safety
We may disclose PHI to prevent or lessen a serious threat to health or safety, when legally permitted.
Examples include:
Uses Requiring Your Written Authorization
Certain uses of PHI require your written authorization.
These include, for example:
You may revoke authorization at any time in writing, except where action has already been taken based on your authorization.
Your Rights Regarding Your Health Information
Right to Inspect and Copy
You have the right to inspect and obtain copies of your health records, with limited exceptions.
Requests must be submitted in writing.
Reasonable fees may apply for copies.
Right to Request Corrections
If you believe information in your record is incorrect or incomplete, you may request an amendment.
Requests must be made in writing and include the reason for the request.
We may deny certain requests as permitted by law.
Right to Request Restrictions
You may request restrictions on how we use or disclose your PHI.
For example, you may ask us not to share information with a family member.
We are not required to agree to every request, except where required by law.
Right to Confidential Communications
You may request that we contact you in specific ways or at specific locations.
Examples include:
We will accommodate reasonable requests.
Right to Receive an Accounting of Disclosures
You may request a list of certain disclosures of your PHI made during the previous six years, excluding disclosures for treatment, payment, and healthcare operations.
Requests must be made in writing.
Right to Receive a Paper Copy
You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
Our Responsibilities
Charlotte Orthodontics is required to:
We reserve the right to revise this Notice and make revised terms effective for all PHI we maintain.
Updated notices will be posted in our office and on our website.
Questions or Complaints
If you have questions about this Notice or believe your privacy rights have been violated, please contact us.
You may also file a complaint with the U.S. Department of Health and Human Services.
You will not be penalized or retaliated against for filing a complaint.
Contact Information
Charlotte Orthodontics
13515 Steele Creek Road, Suite 201
Charlotte, NC 28273
Phone: 704-759-6960
Email: [email protected]
U.S. Department of Health & Human Services
Office for Civil Rights
https://www.hhs.gov/ocr/privacy/hipaa/complaints/
Phone: 1-800-368-1019
PLEASE REVIEW IT CAREFULLY.
At Charlotte Orthodontics, we understand the importance of protecting your personal health information. This Notice describes how we may use and disclose your Protected Health Information (PHI) and explains your rights regarding that information.
We are required by law to:
- Maintain the privacy and security of your health information
- Provide you with this Notice of our legal duties and privacy practices
- Follow the terms of the Notice currently in effect
- Notify you if a breach occurs that may compromise your information
Protected Health Information includes information we create or receive about your health, treatment, payment for care, and identifying information such as your name, address, birth date, or insurance details.
How We May Use and Disclose Your Health Information
We may use and disclose your PHI for the following purposes without additional written authorization.
1. Treatment
We may use and share your information to provide, coordinate, or manage your orthodontic care.
Examples include:
- Reviewing X-rays and digital scans
- Developing treatment plans
- Coordinating care with your general dentist or specialists
- Discussing treatment progress with other healthcare providers
- Communicating with labs regarding appliances or retainers
2. Payment
We may use or disclose PHI to obtain payment for services.
Examples include:
- Billing insurance providers
- Verifying insurance eligibility
- Collecting payment for services rendered
- Processing claims and pre-authorizations
3. Healthcare Operations
We may use PHI for business operations necessary to run our practice.
Examples include:
- Quality improvement
- Staff training
- Credentialing and licensing
- Audits and compliance reviews
- Administrative management
4. Appointment Reminders and Communications
We may contact you to provide:
- Appointment reminders
- Scheduling updates
- Recall visits
- Treatment-related information
- Billing notifications
Communication methods may include:
- Phone calls
- Voicemail
- Text message (SMS)
Please notify us if you prefer restrictions on communications.
5. Individuals Involved in Your Care
Unless you object, we may share relevant information with:
- Parents or legal guardians
- Spouses
- Family members
- Caregivers
- Individuals involved in payment or care decisions
For minor patients, parents or legal guardians generally have access to records unless otherwise restricted by law.
6. Required by Law
We may disclose PHI when required by federal, state, or local law.
Examples include disclosures related to:
- Public health reporting
- Court orders
- Law enforcement requests
- Government audits
- Regulatory investigations
7. Public Health and Safety
We may disclose PHI to prevent or lessen a serious threat to health or safety, when legally permitted.
Examples include:
- Preventing disease spread
- Reporting abuse or neglect
- Addressing safety concerns
Uses Requiring Your Written Authorization
Certain uses of PHI require your written authorization.
These include, for example:
- Most marketing communications involving PHI
- Sale of PHI
- Certain disclosures not otherwise permitted by law
You may revoke authorization at any time in writing, except where action has already been taken based on your authorization.
Your Rights Regarding Your Health Information
Right to Inspect and Copy
You have the right to inspect and obtain copies of your health records, with limited exceptions.
Requests must be submitted in writing.
Reasonable fees may apply for copies.
Right to Request Corrections
If you believe information in your record is incorrect or incomplete, you may request an amendment.
Requests must be made in writing and include the reason for the request.
We may deny certain requests as permitted by law.
Right to Request Restrictions
You may request restrictions on how we use or disclose your PHI.
For example, you may ask us not to share information with a family member.
We are not required to agree to every request, except where required by law.
Right to Confidential Communications
You may request that we contact you in specific ways or at specific locations.
Examples include:
- Call only on a mobile phone
- Do not leave voicemail
- Send mail to an alternate address
We will accommodate reasonable requests.
Right to Receive an Accounting of Disclosures
You may request a list of certain disclosures of your PHI made during the previous six years, excluding disclosures for treatment, payment, and healthcare operations.
Requests must be made in writing.
Right to Receive a Paper Copy
You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
Our Responsibilities
Charlotte Orthodontics is required to:
- Maintain the privacy of your PHI
- Provide this Notice
- Abide by the terms of this Notice
- Notify affected individuals following certain breaches
We reserve the right to revise this Notice and make revised terms effective for all PHI we maintain.
Updated notices will be posted in our office and on our website.
Questions or Complaints
If you have questions about this Notice or believe your privacy rights have been violated, please contact us.
You may also file a complaint with the U.S. Department of Health and Human Services.
You will not be penalized or retaliated against for filing a complaint.
Contact Information
Charlotte Orthodontics
13515 Steele Creek Road, Suite 201
Charlotte, NC 28273
Phone: 704-759-6960
Email: [email protected]
U.S. Department of Health & Human Services
Office for Civil Rights
https://www.hhs.gov/ocr/privacy/hipaa/complaints/
Phone: 1-800-368-1019
