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Effective Date: November 26, 2025
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.
AFFINITY FAMILY DENTAL is committed to protecting your health information. We are required by law to:
- Maintain the privacy of your protected health information (PHI)
- Provide you with this notice of our legal duties and privacy practices
- Follow the terms of the notice currently in effect
- Notify you following a breach of unsecured PHI
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
For Treatment: We may use your health information to provide you with dental treatment or services, such as cleaning and examining your teeth. We may disclose health information about you to dental specialists, physicians, or other health care professionals involved in your care.
For Payment: We may use and disclose your health information to bill and collect payment for the treatment and services provided to you. For example, we may contact your health insurance company to verify coverage and benefits.
For Health Care Operations: We may use and disclose your health information for our health care operations, including quality assessment and improvement activities, reviewing competence or qualifications of health care professionals, and conducting training programs.
YOUR RIGHTS
You have the following rights regarding your health information:
- Right to inspect and copy your health information
- Right to request amendment of your health information
- Right to an accounting of disclosures
- Right to request restrictions on uses and disclosures
- Right to request confidential communications
- Right to a paper copy of this notice
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Affinity Family Dental or with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint.
CONTACT INFORMATION
Affinity Family Dental
200 E McGalliard Rd, Muncie, IN 47303
Phone: +1 765-254-1706
Email: contact@Affinityfamilydental.com