HIPAA Notice of Privacy Practices

Who Follows This Notice

This notice describes the privacy practices of Asbita Family Orthodontics PC, d/b/a Asbita Orthodontics, including Dr. Asbita, our employees, our clinical and administrative staff, and any volunteers or students working under our supervision. All of us are required to follow the terms of this notice.

We are required by federal law, the Health Insurance Portability and Accountability Act (HIPAA), and by Texas law, including the Texas Medical Records Privacy Act, to protect the privacy of your protected health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

Protected health information, referred to in this notice as “health information,” means information that identifies you and relates to your past, present, or future dental or medical condition, the care we provide you, or payment for that care. It includes your treatment records, radiographs, photographs, digital scans, models, insurance information, and billing records.

How We May Use and Disclose Your Health Information Without Your Written Authorization

Treatment

We use your health information to provide, coordinate, and manage your orthodontic care. For example, we review your radiographs and records to plan treatment, our clinical team discusses your progress at appointments, and we share information with your general dentist, an oral surgeon, a periodontist, or another provider involved in your care.

Payment

We use and disclose your health information to obtain payment for the care we provide. For example, we send claims and supporting records to your dental insurance carrier, verify your benefits and eligibility, obtain prior authorization for treatment, and share information with a third-party financing company you have chosen to use.

Health Care Operations

We use and disclose your health information to run our practice and make sure you receive quality care. Examples include reviewing our treatment outcomes, training our staff and students, evaluating the performance of our team, conducting quality assessment activities, business planning, and consulting with our attorneys, accountants, and other professional advisors.

Appointment Reminders and Practice Communications

We may contact you by telephone, voicemail, text message, email, or postcard to remind you of an appointment, confirm or reschedule an appointment, tell you your appliance or retainer is ready, or follow up on your care. If you would prefer we use a specific method or a specific number, tell our front desk and we will accommodate reasonable requests. Our text messaging program is described in our Terms of Service, and you may stop text messages at any time by replying STOP.

Treatment Alternatives and Health-Related Benefits

We may tell you about treatment options, services, or products related to your care, such as retainer replacement programs or a recommendation to see a specialist.

Individuals Involved in Your Care or Payment

Unless you object, we may share information relevant to your care with a family member, a relative, a close friend, or another person you identify as involved in your treatment or in paying for it. For example, we may discuss your treatment progress with a spouse who accompanies you to an appointment, or leave a message with the person who brings your child to visits.

Required by Law

We disclose health information when federal or Texas law requires it.

Abuse, Neglect, or Domestic Violence

Texas law requires dental professionals to report suspected abuse or neglect of a child, an elderly person, or a person with a disability. We will make those reports as required by law.

Public Health Activities

We may disclose health information for public health purposes, including reporting communicable disease, reporting adverse events or problems with products regulated by the Food and Drug Administration, and reporting to public health authorities authorized to receive the information.

Health Oversight

We may disclose health information to agencies that oversee the health care system, such as the Texas State Board of Dental Examiners, for audits, investigations, inspections, and licensure activity.

Judicial and Administrative Proceedings

We may disclose health information in response to a court order, and in response to a subpoena, discovery request, or other lawful process when the required notice and protective conditions have been satisfied.

Law Enforcement

We may disclose health information to law enforcement in limited circumstances permitted by law, such as responding to a court order or warrant, identifying or locating a suspect or missing person, or reporting a crime on our premises.

Coroners, Medical Examiners, and Funeral Directors

We may disclose health information as necessary for these officials to carry out their duties.

Workers’ Compensation

We may disclose health information as authorized by laws relating to workers’ compensation programs.

Serious Threat to Health or Safety

We may use or disclose health information when necessary to prevent a serious and imminent threat to your health or safety or to the health or safety of another person.

Military, Veterans, National Security, and Correctional Institutions

We may disclose health information as required for specialized government functions and, if you are an inmate, to a correctional institution as permitted by law.

Research

We may use or disclose health information for research when an institutional review board has approved the research and put privacy protections in place, or in other limited circumstances permitted by law.

Business Associates

We contract with outside companies to perform services for us, such as our practice management and imaging software vendors, our billing service, our text message and email communication vendors, our IT support, and our shredding service. These companies are our business associates. We disclose only the health information they need to perform their work, and federal and Texas law require them to protect it under a written agreement with us.

Uses and Disclosures That Require Your Written Authorization

Any use or disclosure of your health information not described in this notice will be made only with your written authorization. Specifically, we will obtain your written authorization before we:

• Use or disclose your health information for marketing purposes, except for face-to-face communications with you or a promotional gift of nominal value.
• Use or disclose your photographs, before-and-after images, or video on our website, on social media, in our office, or in any advertising. Your treatment does not depend on agreeing to this, and you may decline.
• Use or disclose psychotherapy notes, if any exist.
• Sell your health information. Texas law prohibits the sale of protected health information except in the narrow circumstances the law allows, such as disclosures for treatment, payment, health care operations, or as otherwise permitted by the Texas Insurance Code.

Your right to revoke. You may revoke an authorization at any time by giving us written notice. Revoking an authorization stops future uses and disclosures made under it. It does not undo a use or disclosure we already made while the authorization was in effect.

Special Notice Regarding Electronic Disclosure of Your Health Information

Except as otherwise authorized or required by state or federal law, we will obtain a separate authorization from you or your legally authorized representative before electronically disclosing your health information. That authorization is not required when the disclosure is made:

• To another covered entity for the purpose of treatment, payment, health care operations, or performing an insurance or health maintenance organization function; or
• As otherwise authorized or required by state or federal law.

Texas law also prohibits us from re-identifying health information that has been de-identified, and from disclosing your health information to certain recipients, without your authorization.

Substance Use Disorder Treatment Records

If we receive records from a federally assisted substance use disorder treatment program, those records carry protections that are stricter than HIPAA under federal law at 42 C.F.R. Part 2. Those records may not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you without your specific written consent or an appropriate court order. We will not use or disclose those records for fundraising. Once records are disclosed with your consent, they may be redisclosed by the recipient in ways that are no longer protected by Part 2.

Your Rights Regarding Your Health Information

Right to inspect and receive a copy of your records

You may ask to see and receive a copy of your dental records and billing records. Submit your request in writing to our office.

• If you request an electronic copy of records we maintain electronically, Texas law requires us to provide them no later than the 15th business day after we receive your written request, in electronic form unless you agree to a different format.
• For records we do not maintain electronically, we will respond within the time federal and Texas law allow, and in no event later than 30 days.
• We may charge a reasonable, cost-based fee for copies. We will not withhold your records because you have an unpaid balance for dental services, although we may require payment of copying costs before releasing copies.
• In limited circumstances we may deny a request. If we do, we will tell you in writing and explain how you may have the denial reviewed where the law provides that right.

Right to request an amendment

If you believe information in your record is incorrect or incomplete, you may ask us in writing to amend it and state the reason for your request. We may deny the request in certain circumstances, and if we do we will explain why in writing and tell you how to file a statement of disagreement.

Right to an accounting of disclosures

You may request a list of certain disclosures we made of your health information. The list does not include disclosures for treatment, payment, or health care operations, disclosures you authorized, or certain other disclosures the law excludes. Your first request in a 12-month period is free.

Right to request restrictions

You may ask us to limit how we use or disclose your health information for treatment, payment, or health care operations, or to limit what we share with a family member or friend involved in your care. We are not required to agree to every request. However, we must agree to your request to withhold information from your health plan when the disclosure is for payment or health care operations, the information relates solely to an item or service you paid for in full out of pocket, and the disclosure is not otherwise required by law.

Right to request confidential communications

You may ask us to contact you at a specific phone number, address, or by a specific method. For example, you may ask that we call only your mobile phone, or that we send mail to a work address. We will accommodate reasonable requests and will not ask you why.

Right to a paper copy of this notice

You may ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. A copy is also posted in our office and on our website at asbitaortho.com.

Right to be notified of a breach

We will notify you if a breach occurs that compromises the privacy or security of your unsecured health information, within the time frames federal and Texas law require.

Right to choose someone to act for you

If you have given someone a medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will verify that the person has authority before we act.

To exercise any of these rights, contact our Privacy Officer using the information at the end of this notice. Most requests must be in writing, and we will give you a form if you need one.

Parents, Guardians, and Patients Under 18

Most of our patients are minors. In general, a parent, managing conservator, or legal guardian is the personal representative of a minor patient and may exercise the rights described in this notice on the child’s behalf.

Under Texas law, a parent, guardian, or conservator is entitled to full and immediate access to a minor child’s complete electronic health record unless that access is restricted by a court order or otherwise limited by law. If a court order, divorce decree, or other legal document restricts a parent’s access to a child’s records, please provide our office with a copy so we can follow it.

In limited circumstances that Texas law defines, a minor may consent to their own care, and in those cases the minor controls the related information.

Use of Artificial Intelligence in Your Care

We may use artificial intelligence tools to assist in reviewing images, planning treatment, or preparing records. Texas law requires us to tell you when artificial intelligence is used in your diagnosis or treatment. Any output from these tools is reviewed by Dr. Asbita, who remains responsible for your diagnosis and treatment decisions. These tools support our clinical judgment; they do not replace it.

Where Your Electronic Records Are Stored

Texas law requires that electronic health records we create or maintain be stored within the United States or its territories. We require our software and hosting vendors to meet this requirement.

Our Responsibilities

• We are required by law to maintain the privacy and security of your 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 may in writing. If you tell us we may, you may change your mind at any time in writing.
• We train our workforce on federal and Texas privacy requirements, and we require new staff to complete that training within the time Texas law requires.
• We retain your dental records for at least the period Texas law requires. For patients who were minors when treated, we retain records until the patient reaches age 21 or for five years from the last date of treatment, whichever is longer.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us, and you may also file a complaint with the federal government or the State of Texas. We will not retaliate against you, and filing a complaint will not affect your care in any way.

With our practice:
Privacy Officer, Asbita Orthodontics
22610 Farm to Market 2920, Suite 600, Hockley, TX 77447
Phone: (281) 819-3332
Email: [email protected]

With the U.S. Department of Health and Human Services:
Office for Civil Rights, U.S. Department of Health and Human Services
200 Independence Avenue SW, Washington, DC 20201
Phone: 1-877-696-6775
Online: www.hhs.gov/ocr/privacy/hipaa/complaints/

With the State of Texas:
Office of the Attorney General of Texas, Consumer Protection Division
P.O. Box 12548, Austin, TX 78711-2548
Phone: 1-800-621-0508
Online: www.texasattorneygeneral.gov

Complaints regarding dental records may also be directed to the Texas State Board of Dental Examiners, 1801 Congress Avenue, Suite 8.600, Austin, TX 78701, phone (512) 463-6400.

Changes to This Notice

We reserve the right to change this notice and to make the revised notice effective for health information we already have as well as information we receive in the future. The current notice will always be posted in our office and on our website at asbitaortho.com, with its effective date shown. You may request a paper copy at any time.

Questions

If you have any questions about this notice or about how we handle your health information, please contact our Privacy Officer at (281) 819-3332 or [email protected]. You may also review our website Privacy Policy, which describes how we handle information collected through asbitaortho.com.