Dentistry By Design

Notice of Privacy Practices

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.

1. Dental Practice Covered by this Notice

This Notice describesthe privacy practices of Dentistry by Design (“Dental Practice”). “We” and“our” means the Dental Practice. “You” and “your” means our patient.

2. How to Contact Us/Our Privacy Official

If you have anyquestions or would like further information about this Notice, you can contact Dentistryby Design’s Privacy Official at:

Dr. HoustonRash and Dr. Kayla White

1101 ClubVillage Drive, Suite 106.

Columbia, MO65203

573-874-8744 -573-499-4702

office@comodental.net

3. Our Promise to You and Our Legal Obligations

The privacy of yourhealth information is important to us. We understand that your healthinformation is personal and we are committed to protecting it. This Noticedescribes how we may use and disclose your protected health information tocarry out treatment, payment or health care operations and for other purposesthat are permitted or required by law. It also describes your rights to accessand control your protected health information. Protected health information isinformation about you, including demographic information, that may identify youand that relates to your past, present or future physical or mental health orcondition and related health care services.

We are required by lawto:

• Maintainthe privacy of your protected health information;
• Giveyou this Notice of our legal duties and privacy practices with respect to thatinformation; and
• Abideby the terms of our Notice that is currently in effect.

4. Last Revision Date

This Notice was lastrevised on July 21, 2025

5. How We May Use or Disclose Your HealthInformation

The following examplesdescribe different ways we may use or disclose your health information. Theseexamples are not meant to be exhaustive. We are permitted by law to use anddisclose your health information for the following purposes:

A.Common Uses and Disclosures

1.Treatment. Wemay use your health information to provide you with dental treatment orservices, such as cleaning or examining your teeth or performing dentalprocedures. We may disclose health information about you to dental specialists,physicians, or other health care professionals involved in your care.

2.Payment.We may use and disclose your health information to obtain payment from healthplans and insurers for the care that we provide to you.

3.Health Care Operations. We may use and disclose health informationabout you in connection with health care operations necessary to run ourpractice, including review of our treatment and services, training, evaluatingthe performance of our staff and health care professionals, quality assurance,financial or billing audits, legal matters, and business planning anddevelopment.

4.Appointment Reminders. We may use or disclose your health informationwhen contacting you to remind you of a dental appointment. We may contact youby using a postcard, letter, phone call, voice message, text or email.

5.Treatment Alternatives and Health-Related Benefits and Services. We may useand disclose your health information to tell you about treatment options oralternatives or health-related benefits and services that may be of interest toyou.

6. Disclosure to FamilyMembers and Friends. We may disclose your health information to afamily member or friend who is involved with your care or payment for your careif you do not object or, if you are not present, we believe it is in your bestinterest to do so.

7.Disclosure to Business Associates. We may disclose your protected healthinformation to our third-party service providers (called, “businessassociates”) that perform functions on our behalf or provide us with servicesif the information is necessary for such functions or services. For example, wemay use a business associate to assist us in maintaining our practicemanagement software. All of our business associates are obligated, undercontract with us, to protect the privacy of your information and are notallowed to use or disclose any information other than as specified in ourcontract.

B.Less Common Uses and Disclosures    

1.Disclosures Required by Law. We may use or disclose patient healthinformation to the extent we are required by law to do so. For example, we arerequired to disclose patient health information to the U.S. Department ofHealth and Human Services so that it can investigate complaints or determineour compliance with HIPAA.

2.Public Health Activities. We may disclose patient health information forpublic health activities and purposes, which include: preventing or controllingdisease, injury or disability; reporting births or deaths; reporting childabuse or neglect; reporting adverse reactions to medications or foods;reporting product defects; enabling product recalls; and notifying a person whomay have been exposed to a disease or may be at risk for contracting orspreading a disease or condition.

3.Victims of Abuse, Neglect or Domestic Violence. We may disclose healthinformation to the appropriate government authority about a patient whom webelieve is a victim of abuse, neglect or domestic violence.

4.Health Oversight Activities. We may disclose patient health information toa health oversight agency for activities necessary for the government toprovide appropriate oversight of the health care system, certain governmentbenefit programs, and compliance with certain civil rights laws.

5.Lawsuits and Legal Actions. We may disclose patient health information inresponse to (i) a court or administrative order or (ii) a subpoena, discoveryrequest, or other lawful process that is not ordered by a court if efforts havebeen made to notify the patient or to obtain an order protecting theinformation requested.

6.Law Enforcement Purposes. We may disclose your health information to alaw enforcement official for a law enforcement purposes, such as to identify orlocate a suspect, material witness or missing person or to alert lawenforcement of a crime.

7.Coroners, Medical Examiners and Funeral Directors. We may disclose yourhealth information to a coroner, medical examiner or funeral director to allowthem to carry out their duties.

8.Organ, Eye and Tissue Donation. We may use or disclose your healthinformation to organ procurement organizations or others that obtain, bank ortransplant cadaveric organs, eyes or tissue for donation and transplant.

9.Research Purposes. We may use or disclose your information forresearch purposes pursuant to patient authorization waiver approval by anInstitutional Review Board or Privacy Board.

10.Serious Threat to Health or Safety. We may use or discloseyour health information if we believe it is necessary to do so to prevent orlessen a serious threat to anyone’s health or safety.

11.Specialized Government Functions. We may disclose your health informationto the military (domestic or foreign) about its members or veterans, fornational security and protective services for the President or other heads ofstate, to the government for security clearance reviews, and to a jail orprison about its inmates.

12.Workers' Compensation. Wemay disclose your health information to comply with workers' compensation lawsor similar programs that provide benefits for work-related injuries or illness.

6. YourWritten Authorization for Any Other Use or Disclosure of Your HealthInformation

Uses and disclosures ofyour protected health information that involve the release of psychotherapynotes (if any), marketing, sale of your protected health information, or otheruses or disclosures not described in this notice will be made only with yourwritten authorization, unless otherwise permitted or required by law. You mayrevoke this authorization at any time, in writing, except to the extent thatthis office has taken an action in reliance on the use of disclosure indicatedin the authorization. If a use or disclosure of protected health informationdescribed above in this notice is prohibited or materially limited by otherlaws that apply to use, we intend to meet the requirements of the morestringent law.

7. Your Rights with Respect to Your HealthInformation

You have the followingrights with respect to certain health information that we have about you(information in a Designated Record Set as defined by HIPAA). To exercise anyof these rights, you must submit a written request to our Privacy Officiallisted on the first page of this Notice.

A.Right to Access and Review    

You may request toaccess and review a copy of your health information. We may deny your requestunder certain circumstances. You will receive written notice of a denial andcan appeal it. We will provide a copy of your health information in a formatyou request if it is readily producible. If not readily producible, we willprovide it in a hard copy format or other format that is mutually agreeable. Ifyour health information is included in an Electronic Health Record, you havethe right to obtain a copy of it in an electronic format and to direct us tosend it to the person or entity you designate in an electronic format. We maycharge a reasonable fee to cover our cost to provide you with copies of yourhealth information.

B.Right to Amend

If you believe that yourhealth information is incorrect or incomplete, you may request that we amendit. We may deny your request under certain circumstances. You will receivewritten notice of a denial and can file a statement of disagreement that willbe included with your health information that you believe is incorrect orincomplete.

C.Right to Restrict Use and Disclosure

You may request that werestrict uses of your health information to carry out treatment, payment, orhealth care operations or to your family member or friend involved in your careor the payment for your care. We may not (and are not required to) agree toyour requested restrictions, with one exception: If you pay out of your pocketin full for a service you receive from us and you request that we not submitthe claim for this service to your health insurer or health plan forreimbursement, we must honor that request.

D.Right to Confidential Communications, Alternative Means and Locations

You may request toreceive communications of health information by alternative means or at analternative location. We will accommodate a request if it is reasonable and youindicate that communication by regular means could endanger you. When yousubmit a written request to the Privacy Official listed on the first page ofthis Notice, you need to provide an alternative method of contact oralternative address and indicate how payment for services will be handled.

E.Right to an Accounting of Disclosures

You have a right toreceive an accounting of disclosures of your health information for the six (6)years prior to the date that the accounting is requested except for disclosuresto carry out treatment, payment, health care operations (and certain otherexceptions as provided by HIPAA). The first accounting we provide in any12-month period will be without charge to you. We may charge a reasonable feeto cover the cost for each subsequent request for an accounting within the same12-month period. We will notify you in advance of this fee and you may chooseto modify or withdraw your request at that time.

F.Right to a Paper Copy of this Notice

You have the right to apaper copy of this Notice. You may ask us to give you a paper copy of theNotice at any time (even if you have agreed to receive the Noticeelectronically). To obtain a paper copy, ask the Privacy Official.

G.Right to Receive Notification of a Security Breach

We are required by lawto notify you if the privacy or security of your health information has beenbreached. The notification will occur by first class mail within sixty (60)days of the event. A breach occurs when there has been an unauthorized use or disclosureunder HIPAA that compromises the privacy or security of your healthinformation.

The breach notificationwill contain the following information: (1) a brief description of whathappened, including the date of the breach and the date of the discovery of thebreach; (2) the steps you should take to protect yourself from potential harm resultingfrom the breach; and (3) a brief description of what we are doing toinvestigate the breach, mitigate losses, and to protect against furtherbreaches.

VIII.Special Protections for HIV, Alcohol and Substance Abuse, Mental Health andGenetic Information

Certain federal andstate laws may require special privacy protections that restrict the use anddisclosure of certain health information, including HIV-related information,alcohol and substance abuse information, mental health information, and geneticinformation. For example, a health plan is not permitted to use or disclosegenetic information for underwriting purposes. Some parts of this HIPAA Noticeof Privacy Practices may not apply to these types of information. If yourtreatment involves this information, you may contact our office for moreinformation about these protections.

IX.Our Right to Change Our Privacy Practices and This Notice

We reserve the right tochange the terms of this Notice at any time. Any change will apply to the health information we have about you orcreate or receive in the future. We will promptly revise the Notice when thereis a material change to the uses or disclosures, individual’s rights, our legalduties, or other privacy practices discussed in this Notice. We will post therevised Notice on our website (if applicable) and in our office and willprovide a copy of it to you on request. The effective date of this Notice is August31, 2016.

X.How to Make Privacy Complaints

If you have anycomplaints about your privacy rights or how your health information has beenused or disclosed, you may file a complaint with us by contacting our PrivacyOfficial listed on the first page of this Notice.

You may also file a written complaint with theSecretary of the U.S. Department of Health and Human Services, Office for CivilRights. We will not retaliate against you in any way if you choose to file acomplaint.