HIPAA Notice of Privacy Practices

Effective date: October 21, 2026

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.

Bruce G. Jones Dentistry, 30 W Norton Ave, Muskegon, MI 49444, is required by law to maintain the privacy of your protected health information (PHI), to give you this notice of our legal duties and privacy practices, and to follow the notice currently in effect. This notice is based on the model notice published by the U.S. Department of Health and Human Services.

Your Rights

You have the right to:

• Get a copy of your dental record. Ask us in writing. We will provide a copy or a summary, usually within 30 days, and may charge a reasonable cost-based fee.
• Ask us to correct your record. If you think information is wrong or incomplete, ask us in writing. We may say no, but we will tell you why within 60 days.
• Request confidential communications. You can ask us to contact you at a specific phone number or address, for example only by mail or only at work. We will say yes to all reasonable requests.
• Ask us to limit what we use or share. You can ask us not to use or share certain information for treatment, payment or operations. We are not required to agree, and may say no if it would affect your care. If you pay for a service in full out of pocket, you can ask us not to share that information with your insurer, and we will agree unless the law requires us to share it.
• Get a list of those with whom we have shared information. You can ask for an accounting of disclosures for the six years before the date you ask. It will not include disclosures for treatment, payment, operations or ones you asked us to make. One list per year is free.
• Get a copy of this notice. Ask at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. A person with medical power of attorney or a legal guardian can exercise your rights and make choices about your information. We will confirm their authority before acting.
• File a complaint if you feel your rights are violated. Contact our office using the information at the end of this notice, or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue SW, Washington, DC 20201, by calling 1-877-696-6775, or online at hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

Your Choices

For the following, tell us what you want and we will follow your instructions:

• Sharing information with your family, close friends or others involved in your care.
• Sharing information in a disaster relief situation.
• Including your information in a patient directory, if we keep one.

If you cannot tell us your preference, for example if you are unconscious, we may share information if we believe it is in your best interest, or to lessen a serious and imminent threat to health or safety.

We will never share your information for marketing purposes or sell your information without your written permission. We do not share psychotherapy notes, and we do not use your information for fundraising.

Our Uses and Disclosures

We typically use or share your health information in these ways:

• Treat you. We use your information to provide dental care and may share it with other providers treating you, such as a specialist we refer you to or a dental laboratory making your crown.
• Run our practice. We use and share information to manage treatment, schedule, improve care, train staff and contact you with appointment reminders.
• Bill for your services. We share information with your dental plan or other payer to get paid.

We are also allowed or required to share your information in other ways, usually for the public good, such as: helping with public health and safety issues (preventing disease, reporting adverse reactions to medications, reporting suspected abuse or neglect); doing research under strict rules; complying with the law when state or federal law requires it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law; responding to organ and tissue donation requests; working with a medical examiner or funeral director; addressing workers’ compensation, law enforcement and other government requests; and responding to lawsuits and legal actions in response to a court or administrative order or a subpoena.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing.

Website and Electronic Communications

Information you submit through forms on this website becomes part of your record once received. Email and text messages are not fully secure; by asking us to communicate with you by email or text, you accept that risk. See our Privacy Policy for how the website itself collects and uses information.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office, and on our website.

Contact and Privacy Officer

To exercise any right in this notice, to ask a question, or to file a complaint, contact the Privacy Officer at Bruce G. Jones Dentistry, 30 W Norton Ave, Muskegon, MI 49444, phone (231) 780-5158, email [email protected].