Straighten Up Orthodontics
Effective Date: 2005

This Notice describes how medical and dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

OUR COMMITMENT TO YOUR PRIVACY

Straighten Up Orthodontics is committed to protecting the privacy of your health information. We create and maintain a record of the care you receive in order to provide high-quality treatment and comply with legal requirements. This Notice applies to all records of your care generated by our practice.

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI)

We may use or share your PHI for the following purposes without your written authorization:

1. Treatment

We may use and disclose your PHI to provide, coordinate, or manage your orthodontic care. This includes sharing information with:

• Your referring dentist or physician
• Dental/orthodontic labs
• Imaging centers
• Other healthcare providers involved in your treatment
• Clear aligner companies and digital workflow services (e.g., Invisalign, uLab, 3D printing labs)

Example: Sending your scans, photos, or X-rays to a lab to fabricate appliances.

2. Payment

We may use or disclose your PHI to obtain payment for services, including:

• Billing insurance companies
• Verifying coverage
• Sharing treatment information with your insurer
• Processing claims and payments

3. Healthcare Operations

We may use or disclose PHI for office operations such as:

• Quality assessment and improvement
• Training and education
• Licensing and certification
• Practice management
• Appointment coordination
• Internal auditing

These uses help ensure you receive high-quality, efficient care.

OTHER ALLOWED USES AND DISCLOSURES

We may disclose your PHI for the following purposes when required or permitted by law:

• Public health activities
• Reporting abuse, neglect, or domestic violence
• Health oversight activities
• Judicial or administrative proceedings
• Law enforcement
• Coroners, medical examiners, and funeral directors
• Organ or tissue donation
• Research (with strict protections)
• Military or national security purposes
• Workers’ compensation
• Compliance with laws and regulations

USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION

We will obtain your written authorization before using or disclosing your PHI for:

• Marketing communications not related to treatment
• Sale of PHI
• Most uses of psychotherapy notes
• Photographs used for social media, marketing, or educational publication
• Any other situation not described in this Notice

You may revoke your authorization at any time in writing.

YOUR RIGHTS REGARDING YOUR PHI

You have the following rights:

1. Right to Inspect and Copy

You may request to see and obtain a copy of your PHI, including X-rays, scans, clinical notes, and billing records.

2. Right to Request an Amendment

If you believe your record is inaccurate or incomplete, you may request an amendment.

3. Right to an Accounting of Disclosures

You may request a list of times we shared your PHI for reasons other than treatment, payment, and operations.

4. Right to Request Restrictions

You may request a restriction on how we use or disclose your PHI.
We are not required to agree, except for services you pay for entirely out of pocket.

5. Right to Request Confidential Communications

You may request that we contact you by:

• Alternative phone numbers
• Email
• Mail
• Alternate addresses

We will honor reasonable requests.

6. Right to a Paper or Electronic Copy of This Notice

You have the right to receive a paper or digital copy of this Notice at any time.

7. Right to Be Notified of a Breach

You will be notified if your PHI is ever compromised in a way that presents a risk to your privacy.

OUR RESPONSIBILITIES

Straighten Up Orthodontics is required to:

• Maintain the privacy and security of your PHI
• Provide you with this Notice of Privacy Practices
• Follow the terms of this Notice
• Notify you if a breach occurs involving your PHI
• Make updates to this Notice available to you

We reserve the right to revise this Notice at any time. Any changes apply to all PHI we maintain.