NOTICE OF PRIVACY PRACTICES

THIS NOTICE OF PRIVACY PRACTICES (“NOTICE”) DESCRIBES HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION AND HOW YOU CAN ACCESS YOUR INFORMATION. PLEASE READ IT CAREFULLY.

ABOUT THIS NOTICE

This Notice of Privacy Practices describes how we, our Business Associates, and their subcontractors, may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO), and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected Health Information” includes demographic information, that may identify you and relates to your past, present, or future physical or mental health condition and related health care services including dental care.

We are required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and other applicable laws to maintain the privacy of your health information, to provide individuals with this Notice of our legal duties and privacy practices with respect to such information, and to abide by the terms of this Notice.

This Notice takes effect 2/16/2026. We reserve the right to make updates. Updated Notices will be available in our office as well as on our website at: https://bayleedental.com/

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Your protected health information may be used and disclosed by our office and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of our practice, and any other use required by law.

Some information, such as HIV related information, genetic information, alcohol and/or substance use disorder treatment records and mental health records may be entitled to special confidentiality protections under applicable state or federal law; we will abide by these special protections as they pertain to applicable cases involving these types of records.

• Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your care and any related services. For example, we may disclose your health information to a medical/dental specialist providing treatment to you, including referrals.

• Payment: Your health information will be used, as needed, to obtain payment for your services. Payment activities include billing, collections, claims management, and determinations of eligibility and coverage to obtain payment from you, your insurance company, or another third party.

• Healthcare Operations: We may use or disclose your protected health information as needed, to support the business activities of our practice. These activities include, but are not limited to, quality assessment, employee review, training of interns, licensing, billing services, and other business activities.

• Communications: We may also use a sign-in sheet, call you by name in the waiting room, or send reminders via phone, email, or text, related to appointments, payment, or treatment alternatives or other health-related benefits and services that may be of interest to you. You may choose to opt out.

• Imaging: We may take intra oral, facial photos, or digital scans for treatment-related purposes.

• Artificial Intelligence: We may also use authorized Artificial Intelligence (AI) programs to support clinical decision-making, enhance diagnostic accuracy, and improve your oral health outcomes. For example, we may use AI to document clinical notes or assist in analyzing dental images.

PERSONS INVOLVED IN YOUR CARE

We may share information with family members, friends, or others involved in your care if you agree or do not object.

USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION

We may use or disclose your PHI without your authorization in situations including: Disaster relief, as Required by Law, Public Health Activities, Health Oversight, Abuse or Neglect, FDA requirements, Legal Proceedings, Law Enforcement, Coroners and Funeral Directors, Research, National Security, Workers’ Compensation, and Inmates. Under the law, we must also disclose PHI when required by the Secretary of the Department of Health and Human Services to determine our compliance.

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION

Other uses and disclosures will be made only with your consent, authorization, or opportunity to object, unless required by law. We will obtain your authorization for marketing, fundraising, or research purposes. You may revoke these authorizations at any time in writing.

SUBSTANCE USE DISORDER (SUD) TREATMENT INFORMATION

In the normal course of providing treatment, you may disclose to us that you participate in SUD treatment. To the best of our ability, we will not redisclose that information.

If we receive information from a “Part 2 Program” (42 CFR Part 2) through general consent, we may use it for TPO purposes. If received through specific consent, we will only use and disclose it as expressly permitted by that consent. In no event will we use or disclose your Part 2 Program record in legal proceedings against you unless authorized by your consent or a court order.

YOUR RIGHTS

• Right to inspect and copy your PHI: Pursuant to your written request, you have the right to inspect or copy your PHI in paper or electronic format (fees may apply). Certain records, such as psychotherapy notes or information compiled for legal proceedings, may be restricted.

• Right to request a restriction: You may ask us not to use or disclose any part of your PHI for TPO. We are not required to agree, except if you request we not disclose PHI to your health plan for services you paid for in full out-of-pocket.

• Right to request confidential communications: You have the right to request communication by alternative means or at an alternative location.

• Right to request an amendment: You may request in writing that we amend your PHI. We have 30 days to reply and may deny the request if we did not create the information.

• Right to receive an accounting of disclosures: You have the right to a listing of certain disclosures made by the practice for the last six years (excluding treatment, payment, and healthcare operations).

• Right to receive notice of a breach: We will notify you if your unsecured PHI has been breached.

• Right to a paper copy of this Notice: You may obtain a paper copy upon request, even if you agreed to receive it electronically.

COMPLAINTS AND QUESTIONS

If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of Health and Human Services. You will not be penalized for filing a complaint.

Baylee Dental 16850 S Hwy 441, Suite 301

Summerfield, FL 34491

(352) 307-3006

https://bayleedental.com/

U.S. Department of Health & Human Services Office of Civil Rights

200 Independence Avenue, SW

Room 515 F HHH Building

Washington, DC 20201

www.hhs.gov/ocr