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.
Effective Date: June 30, 2026
My Tooth Docs (“we,” “us,” or “our”) is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of protected health information (“PHI”), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect.
How We May Use and Disclose Your Health Information
We may use and disclose your PHI for the following purposes without your written authorization:
- Treatment: To provide, coordinate, and manage your dental care — for example, sharing information with dentists, specialists, hygienists, or laboratories involved in your care.
- Payment: To bill and obtain payment for the services we provide — for example, sharing information with your dental or medical insurer, or with a patient-financing provider you choose to use.
- Health Care Operations: To support the business activities of our practice — for example, quality assessment, staff training, and administrative functions.
- Appointment Reminders & Communications: To contact you with appointment reminders, treatment alternatives, or other health-related information and services that may interest you.
- As Required by Law: When federal, state, or local law requires the use or disclosure, including for public health activities, reporting abuse or neglect, health oversight, law enforcement, and judicial or administrative proceedings.
Uses and Disclosures That Require Your Written Authorization
Other uses and disclosures — including most uses for marketing, any sale of PHI, and disclosure of psychotherapy notes (if any) — will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.
Your Health Information Rights
You have the following rights regarding the PHI we maintain about you:
- Right to Inspect and Copy: You may request to inspect and obtain a copy of your records.
- Right to Amend: You may request that we correct information you believe is incorrect or incomplete.
- Right to an Accounting of Disclosures: You may request a list of certain disclosures we have made of your PHI.
- Right to Request Restrictions: You may request limits on how we use or disclose your PHI; we are not required to agree except in limited circumstances permitted by law.
- Right to Confidential Communications: You may request that we communicate with you in a certain way or at a certain location.
- Right to a Paper Copy: You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
- Right to Be Notified of a Breach: You have the right to be notified following a breach of unsecured PHI.
Our Responsibilities
We are required to maintain the privacy of your PHI, provide you with this Notice, abide by its terms, notify you if we are unable to agree to a requested restriction, and accommodate reasonable requests for confidential communications.
Changes to This Notice
We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as any information we receive in the future. The current Notice will be posted on our Website and available at our offices, with its effective date.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.
- Our practice: Privacy Officer, My Tooth Docs — (630) 690-1406 or via our Contact page.
- Office for Civil Rights, U.S. Department of Health and Human Services: 200 Independence Avenue, S.W., Washington, D.C. 20201 — 1-877-696-6775 — hhs.gov/ocr/privacy/hipaa/complaints
Contact
To exercise any of your rights or for more information about this Notice, contact our Privacy Officer:
- Naperville: 11258 Illinois Route 59, Unit #1, Naperville, IL 60564 — (630) 690-1406
- South Holland: 16240 Louis Ave, South Holland, IL 60473 — (708) 333-2909