Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice is effective June 1, 2026, and applies to all protected health information as defined by federal regulations.

Privacy Promise

At CrossPointe Dental, we are committed to treating and using protected health information about you responsibly, and in accordance with state and federal law.

Understanding Your Health Record/Information

Each time you visit CrossPointe Dental, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or dental record, serves as:

• Basis for planning your care and treatment, scheduling appointments, describing or recommending treatment alternatives
• Means of communication among health professionals who contribute to your care
• Record describing the care you received
• Means by which you or a third-party payer can verify that services billed were provided
• A tool in educating health professionals
• A source of data for medical research
• A source of information for public health officials charged with improving the health of this state and the nation
• A source of data for quality improvement and care coordination
• A tool for improving the care we render and outcomes we can achieve

Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

Patient Health Information Rights

Although your health record is the physical property of CrossPointe Dental, the information also belongs to you. You have the right to:

• Obtain a paper copy of this notice of privacy practices upon request
• Inspect and obtain copies of your health record and request an electronic copy of your health record
• Request that we use a specific telephone number or address to communicate with you
• Receive a list of instances in which we or our business associates disclosed your health information, for purposes other than treatment, payment, or health care operations, within the last 6 years
• Submit written requests on certain restrictions on our use or disclosure of your health information, as allowed by law
• Submit a written request for an amendment to your health record if you believe the record is inaccurate or incomplete. We may deny your request if the information was not created by us or in a record maintained by us, or if we determine the information is accurate and complete. If we deny your request, we will notify you in writing and you may submit a written statement of disagreement for inclusion in your record.
• Request restriction of disclosure to your health plan for self-pay services. If you pay out of pocket, in full, for a health care item or service, you have the right to request that we not disclose information about that item or service to your health plan for purposes of payment or health care operations. Unlike some other restriction requests, we are required to honor this request. The restriction does not apply if disclosure is otherwise required by law.

Our Responsibilities

CrossPointe Dental is required to:

• Maintain the privacy of your health information
• Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• Abide by the terms of this notice
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations
• Notify you of a breach. You will receive notification of a breach of your unsecured protected health information as required by law

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. We will make a reasonable attempt to notify you of the new policy before it takes effect, and we will provide you with a copy of the new policy upon request. We will not use or disclose your health information without your authorization, except as described in this notice.

Examples of Disclosures for Treatment, Payment and Health Operations

We will use your health information for treatment.
For example: Information obtained by our clinical team or office staff will be recorded in your record and used to determine the course of treatment that should work best for you.

We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health information for health care operations.
For example: Members of our dental team or our office staff may use information in your health record to assess the care and outcomes in your case and others like it. This information is used to continually improve the quality and effectiveness of the healthcare and service we provide.

42 CFR Part 2 Substance Use Disorder (SUD) Treatment Records

While it is unlikely that CrossPointe Dental will create records that relate to treatment for a SUD, it is possible that CrossPointe Dental may receive these records while coordinating care with another provider or facility. CrossPointe Dental will maintain and use these records as described above for treatment, payment, and healthcare operations. However, CrossPointe Dental will not disclose Part 2 SUD records in legal proceedings against you without your written consent, even if the records are subpoenaed.

Other Permitted Uses or Disclosures

Required by Law: We may disclose health information as required by law. Examples include, but are not limited to: compliance with a valid court issued subpoena, indications that you are a possible victim of abuse or neglect, to avert a potential threat to you or another person's health or safety, under circumstances constituting a threat to National Security, etc. In no event will we use or disclose your Part 2 SUD treatment record, or testimony that describes the information contained in your Part 2 SUD treatment record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.

Business Associates: There are some services provided in our organization through contracts with business associates. Business associates are third-parties who provide services (ex., laboratory services, aligner services, referrals, collection agencies, appointment reminders) and require your health information to perform the services. We require the business associate to appropriately safeguard your information.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

Communication with Family: Disclosure may be made to family or close personal contacts that you have given written permission to act on your behalf. You will be deemed to consent to communication with family or friends you bring to an appointment, for that appointment only.

We may disclose information to other providers (specialists, labs, etc.) that are covered entities to help complete your treatment according to HIPAA guidelines.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Contact Us

If you have questions or concerns about this Notice of Privacy Practices, please contact us: