Notice of Privacy Practices - Belle Meade Family Dentistry

This notice describes how medical and dental information about you may be used and disclosed, and how you can get access to this information. Please review it carefully. 

If you have any questions about this Notice please contact our Privacy Officer or any staff member in our office. 

Practice Privacy Officer: ___Rachel DeMicco______Contact Number:__615-298-2030________ 

HIPAA Privacy and Security Resource: David Wornica, CHPSE. Contact: 469-342-8300 ext. 628. 

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) under federal law, including the Health Insurance Portability and Accountability Act (HIPAA), and applicable Tennessee confidentiality laws. It explains your rights, our responsibilities, and how federal and Tennessee law work together to protect your privacy. 

We are required by law to maintain the privacy and security of your information, to provide you with this Notice, and to follow the terms of this Notice. We may change the terms of this Notice at any time. Any revised Notice will apply to all information we maintain and will be available upon request, in our office, or on our website. 

A. USES AND DISCLOSURES OF INFORMATION 

Uses and Disclosures Based on Your Implied Consent 

When you receive care in our office, you imply consent for us to use and disclose your information for the following purposes, as permitted by HIPAA and Tennessee law. 

1. Treatment 

We may use and disclose your information to provide, coordinate, or manage your care. Examples include: 

• Sharing records, X-rays, or chart notes with specialists 
• Sending treatment specifications to laboratories 
• Communicating with pharmacies regarding prescriptions 
• Coordinating follow-up care with other providers 
• Payment 

We may use and disclose your information to obtain payment for services, including: 

• Submitting claims to health or dental plans 
• Verifying coverage and eligibility 
• Obtaining prior authorizations 
• Responding to utilization review requests 
• Health Care Operations 

We may use and disclose your information for practice operations, such as: 

• Quality improvement activities 
• Staff training and evaluation 
• Licensing, accreditation, and compliance 
• Use of sign-in sheets or calling your name in the waiting area 

Example: Limited information may be disclosed to interns, students, or trainees involved in your care.

1. Business Associates 

We may disclose your information to third-party “Business Associates” (billing services, IT support, transcription services, and secure data storage providers). Business Associates are required by law to protect your information. 

1. Appointment Reminders and Communications 

We may contact you by phone, text, email, or mail regarding appointments, treatment, or health-related services. You may request alternative communication methods. 

Uses and Disclosures Requiring Your Written Authorization 

Certain uses and disclosures require your written authorization, including: 

• Marketing communications not conducted face-to-face 
• Sale of your information 
• Most disclosures of psychotherapy notes 
• Disclosures to employers or third parties not involved in your care 

You may revoke an authorization any time in writing, except to the extent we have already relied on it. 

Uses and Disclosures With Your Authorization or Opportunity to Object 

Family Members and Others Involved in Care 

Unless you object, we may share information with family members, friends, or others involved in your care or payment for your care. 

Disaster Relief 

We may disclose limited information to disaster relief organizations to assist with coordination of care. If you are unavailable or unable to object, we may use our professional judgment to determine what is in your best interest. 

Uses and Disclosures without Your Consent or Authorization 

We may use or disclose your information without your consent or authorization in the following situations: 

• Required by Law 
• Public Health Activities 
• Abuse, Neglect, or Domestic Violence Reporting 
• Health Oversight Activities 
• Judicial or Administrative Proceedings 
• Law Enforcement Purposes 
• Coroners and Medical Examiners 
• Organ and Tissue Donation 
• Workers’ Compensation Programs 
• National Security and Military Activities 

Special Protections for Substance Use Disorder Records 

If we receive or maintain records related to substance use disorder treatment that are protected under federal law (42 CFR Part 2), those records are subject to additional confidentiality protections. 

• These records may be used and disclosed for treatment, payment, and health care operations as permitted by law. 
• We will not use or disclose these records, or testimony about their contents, in civil, criminal, administrative, or legislative proceedings against you unless permitted by 

• Other uses and disclosures require your written authorization or must otherwise be permitted or required by law. 

Special Protections for Reproductive Health Information 

Information related to reproductive health care may be subject to additional privacy protections under federal law and our internal privacy practices. 

• We may use and disclose reproductive health information for treatment, payment, and health care operations as permitted by law. 
• We will not use or disclose reproductive health information for the purpose of investigating or imposing liability on an individual for seeking, obtaining, providing, or facilitating lawful reproductive health care. 
• Other uses and disclosures require your written authorization or must otherwise be permitted or required by law. 

YOUR RIGHTS 

You have the following rights regarding your protected health information: 

• Inspect and Copy – Review or obtain a copy of your records, subject to legal limits 
• Request Restrictions – Request limits on uses or disclosures (not always required to be honored) 
• Confidential Communications – Request alternative communication methods or locations 
• Amendment – Request corrections to your records 
• Accounting of Disclosures – Request a list of certain disclosures made in the past six years 
• Paper Copy – Request a paper copy of this Notice at any time 
• Breach Notification – Be notified if a breach occurs 

OUR RESPONSIBILITIES 

We are required by law to: 

• Maintain the privacy and security of your information 
• Notify you if a breach occurs 
• Use and disclose your information only as described in this Notice 
• Follow the more protective rule when federal and Tennessee laws differ 

COMPLAINTS 

If you believe your privacy rights have been violated, you may file a complaint with: 

• Our Office – Contact our Privacy Officer in writing 
• U.S. Department of Health and Human Services, Office for Civil Rights 

We will not retaliate against you for filing a complaint. 

This Notice was published and becomes effective on February 16, 2026.