NOTICE OF PRIVACY PRACTICES
Peninsula Endodontics
302 Bulifants Blvd, Suite 102
Williamsburg, VA 23188
Phone: 757-903-2577
Email: [email protected]
Effective Date: January 2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Peninsula Endodontics ("we," "our," or "us") is required by law to maintain the privacy and security of your protected health information ("PHI"), to provide you with this Notice of our legal duties and privacy practices, and to abide by the terms of the Notice currently in effect.
Protected health information includes information that identifies you and relates to your past, present, or future physical or mental health condition, treatment, or payment for healthcare services.
HOW WE MAY USE AND DISCLOSE YOUR INFORMATION
Treatment: We may use and disclose your PHI to provide, coordinate, or manage your endodontic and dental treatment. This includes communication with referring dentists, general dentists, specialists, dental laboratories, physicians, pharmacies, or other healthcare providers involved in your care.
Payment: We may use and disclose your PHI to obtain payment for services provided. This includes submitting insurance claims, verifying benefits, obtaining prior authorizations, billing you or a responsible party, and collection activities as permitted by law.
Healthcare Operations: We may use your PHI for healthcare operations, including quality assessment and improvement activities, staff training and credentialing, licensing and accreditation, compliance reviews and audits, risk management, business planning, and administrative functions.
OTHER PERMITTED AND REQUIRED DISCLOSURES
We may disclose your PHI without your written authorization when required or permitted by law, including public health activities, health oversight agencies, judicial or administrative proceedings, law enforcement purposes (subject to HIPAA limitations), to prevent a serious threat to health or safety, workers' compensation claims, military and national security activities, or as otherwise required by federal, state, or local law.
SPECIAL PROTECTIONS FOR REPRODUCTIVE HEALTH INFORMATION (2024 Federal Update)
Peninsula Endodontics will not use or disclose protected health information for the purpose of conducting criminal, civil, or administrative investigations or imposing liability related to lawful reproductive healthcare, unless required by federal law and accompanied by appropriate legal attestation as required under 45 CFR Part 164.
USES AND DISCLOSURES REQUIRING WRITTEN AUTHORIZATION
We will obtain your written authorization for marketing communications not permitted by law, the sale of protected health information, most uses and disclosures of psychotherapy notes (if applicable), and any other uses not described in this Notice. You may revoke your authorization at any time in writing, except to the extent that we have already acted in reliance upon it.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the right to request restrictions, request confidential communications, inspect and obtain a copy of your health records, request amendments, request an accounting of disclosures, and receive a paper copy of this Notice upon request.
OUR RESPONSIBILITIES
Peninsula Endodontics is required to maintain the privacy and security of your PHI, provide you with this Notice, notify you if a breach occurs that may have compromised your information, and follow the terms of this Notice.