HIPAA Notice of Privacy Practices

Effective Date: November 3, 2026

Brown & Nawrocki Restorative & Cosmetic Dentistry

This Notice of Privacy Practices describes how medical and dental information about you may be used and disclosed, and how you can obtain access to this information. Please review it carefully.

Brown & Nawrocki Restorative & Cosmetic Dentistry is committed to protecting the privacy and security of your protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other applicable laws.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information, provide you with this Notice of Privacy Practices, and follow the terms of the notice currently in effect.

We are also required to:

• Protect your health information from unauthorized access, use, or disclosure.
• Notify you if a breach occurs that may have compromised the privacy or security of your unsecured protected health information.
• Explain our legal duties and privacy practices concerning your health information.
• Follow applicable federal and state privacy laws.

How We May Use and Disclose Your Health Information

We may use and disclose your protected health information without your written authorization for treatment, payment, and healthcare operations, as permitted by HIPAA.

Treatment

We may use and share your health information with dentists, dental specialists, physicians, laboratories, and other healthcare professionals involved in providing your care.

For example, we may share dental X-rays, treatment plans, or medical history with a specialist involved in your treatment.

Payment

We may use and disclose your health information to obtain payment for dental services, verify insurance coverage, submit claims, and process billing.

For example, we may provide your dental insurance company with information about procedures performed to determine coverage and payment eligibility.

Healthcare Operations

We may use and disclose your health information for activities necessary to operate our dental practice and improve the quality of patient care.

These activities may include:

• Quality assessment and improvement
• Staff training and professional development
• Practice administration and management
• Patient satisfaction and service evaluation
• Compliance with healthcare regulations

Other Permitted Uses and Disclosures

HIPAA permits or requires us to use or disclose your health information in certain additional circumstances, subject to applicable legal conditions and limitations.

These circumstances may include:

• Public health activities, including reporting certain diseases or health risks.
• Reporting suspected abuse, neglect, or domestic violence when authorized or required by law.
• Health oversight activities, such as audits, investigations, and inspections.
• Judicial or administrative proceedings when legally authorized.
• Law enforcement purposes under applicable legal requirements.
• Preventing or reducing a serious threat to health or safety.
• Workers’ compensation activities as authorized by law.
• Other disclosures required by federal or state law.

Appointment Reminders and Communications

We may use your contact information to communicate with you regarding appointment reminders, scheduling, treatment recommendations, and other healthcare-related matters.

Communications may occur by telephone, email, postal mail, or text message, as appropriate and permitted by law.

You may request reasonable restrictions or alternative methods of communication to help protect your privacy.

Uses and Disclosures Requiring Authorization

Certain uses and disclosures of your protected health information require your written authorization unless otherwise permitted or required by law.

These may include:

• Most uses and disclosures of psychotherapy notes, if applicable.
• Uses or disclosures of health information for marketing when authorization is required.
• Disclosures that constitute a sale of protected health information.
• Other uses and disclosures not otherwise permitted under HIPAA.

If you provide written authorization, you may revoke it at any time by submitting a written request, except to the extent we have already acted in reliance on that authorization.

Your Rights Regarding Your Health Information

Under HIPAA, you have important rights regarding your protected health information.

Right to Access Your Records

You have the right to inspect and obtain a copy of your dental and medical records and other protected health information maintained in a designated record set, subject to limited exceptions.

We generally must respond to your request within 30 days. A reasonable, cost-based fee may apply to certain copies.

Right to Request an Amendment

If you believe information in your records is incorrect or incomplete, you may request that we amend it.

We may deny your request under certain circumstances, but we will provide a written explanation of the denial and your applicable rights.

Right to Request Restrictions

You may request restrictions on how we use or disclose your health information for treatment, payment, or healthcare operations.

We are generally not required to agree to a requested restriction. However, when you pay out of pocket in full for a healthcare service, you may request that we not disclose information about that service to your health plan for payment or healthcare operations, unless disclosure is required by law.

Right to Confidential Communications

You may request that we contact you using a particular method or at an alternative location.

For example, you may request that appointment communications be sent to a specific telephone number or mailing address.

We will accommodate reasonable requests.

Right to an Accounting of Disclosures

You may request a list of certain disclosures of your protected health information made during the six years preceding your request, subject to applicable exceptions and limitations.

Right to a Paper Copy

You have the right to receive a paper copy of this Notice of Privacy Practices, even if you have previously agreed to receive it electronically.

Right to Choose a Personal Representative

If someone has legal authority to act on your behalf regarding healthcare decisions or health information, that person may exercise your rights as permitted by applicable law.

Special Protections for Certain Health Information

Certain categories of health information may be subject to additional protections under federal or state law.

When applicable, we will comply with any stricter privacy requirements, including special rules governing particular types of sensitive health information.

Fundraising and Marketing Communications

We may contact you about dental services, treatment alternatives, or health-related benefits and services when permitted by law.

Marketing communications requiring written authorization will not be sent using your protected health information without that authorization.

Where fundraising communications are permitted, you will have an opportunity to opt out of receiving them.

Security of Your Health Information

Brown & Nawrocki Restorative & Cosmetic Dentistry maintains reasonable administrative, physical, and technical safeguards designed to protect the confidentiality, integrity, and availability of protected health information.

Access to patient information is limited according to applicable privacy requirements and the responsibilities of authorized personnel.

Changes to This Notice

We reserve the right to change this Notice of Privacy Practices and make the revised notice effective for protected health information we already maintain, as well as information we receive in the future.

An updated notice will be made available at our office and through our website.

Questions or Complaints

If you believe your privacy rights have been violated, or if you have questions about this notice, you may contact our office.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.

You will not be retaliated against for filing a privacy complaint.

For information about filing a HIPAA complaint, visit: www.hhs.gov/hipaa/filing-a-complaint

Contact Information

For questions about this notice, requests concerning your health information, or privacy-related complaints, please contact:

Brown & Nawrocki Restorative & Cosmetic Dentistry

145 N Nova Rd
Ormond Beach, FL 32174
United States

Phone: (386) 310-0130

Email: drbc@tdn.care

Website:

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