HIPAA Notice of Privacy Practices
Jacksonville Emergency & Family Dental Care
Effective Date: November 3, 2026
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.
Jacksonville Emergency & Family Dental Care is committed to protecting the privacy and security of your health information. This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI), your rights regarding that information, and our responsibilities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other applicable laws.
1. 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 explaining our legal duties and privacy practices.
- Follow the terms of the Notice currently in effect.
- Notify affected individuals following a breach of unsecured Protected Health Information when required by law.
- Comply with applicable federal and state privacy laws.
We reserve the right to change our privacy practices and the terms of this Notice. Any revised Notice may apply to all Protected Health Information we maintain. An updated copy will be available at our offices and through our website.
2. How We May Use and Disclose Your Health Information
We may use and disclose your Protected Health Information for treatment, payment, and healthcare operations without obtaining your written authorization, as permitted by law.
Treatment
We may use and share your health information to provide, coordinate, or manage your dental care and related services.
For example, we may share information with another dentist, physician, specialist, dental laboratory, or healthcare provider involved in your treatment.
Payment
We may use and disclose your health information to obtain payment for dental services provided to you.
This may include submitting claims to dental insurance companies, verifying insurance coverage, determining benefits, and collecting payment for services.
Healthcare Operations
We may use and disclose your information for activities necessary to operate our dental practice.
Examples include:
- Quality assessment and improvement activities.
- Staff training and professional development.
- Administrative and business management activities.
- Compliance reviews and audits.
- Patient service coordination.
- Evaluation of the quality of care provided.
3. 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 requirements.
Required by Law
We may disclose your health information when required to do so by federal, state, or local law.
Public Health Activities
We may disclose information to authorized public health authorities for activities such as preventing or controlling disease, reporting certain conditions, or responding to public health concerns.
Health Oversight Activities
We may disclose information to authorized agencies conducting audits, investigations, inspections, licensing activities, and other legally permitted oversight functions.
Judicial and Administrative Proceedings
We may disclose health information in response to a court order, subpoena, or other lawful legal process, when applicable requirements are satisfied.
Law Enforcement
We may disclose information to law enforcement officials when permitted or required by law.
Serious Threats to Health or Safety
We may disclose health information when necessary to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public, as permitted by law.
Workers’ Compensation
We may disclose information as authorized by laws relating to workers’ compensation or similar programs.
Special Government Functions
We may disclose information for certain specialized government functions, including military, national security, and other activities authorized by law.
Coroners, Medical Examiners, and Funeral Directors
We may disclose information to coroners, medical examiners, and funeral directors when permitted by applicable law.
4. Appointment Reminders and Treatment Alternatives
We may use your contact information to remind you about scheduled appointments or to communicate with you regarding your dental care.
We may also contact you about treatment options, dental services, or other health-related benefits that may be relevant to your care, as permitted by law.
You may request that we communicate with you through alternative methods or at alternative locations.
5. Uses and Disclosures Requiring Authorization
In circumstances where HIPAA requires your written authorization, we will obtain it before using or disclosing your Protected Health Information.
Examples generally include:
- Most uses and disclosures of psychotherapy notes, if applicable.
- Uses and disclosures of PHI for marketing purposes that require authorization.
- Disclosures that constitute a sale of PHI.
- Other uses and disclosures not otherwise permitted or required by law.
If you provide written authorization, you may revoke it in writing at any time. Revocation will not affect actions already taken in reliance on your authorization.
Additional protections may apply to certain categories of sensitive health information under federal or state law.
6. Your Rights Regarding Your Health Information
You have certain rights concerning your Protected Health Information. These rights include the following:
Right to Inspect and Obtain a Copy
You have the right to inspect and obtain a copy of your dental and billing records and other Protected Health Information maintained in a designated record set, subject to limited exceptions.
You may request an electronic or paper copy of your records. We may charge a reasonable, cost-based fee as permitted by law.
Right to Request an Amendment
If you believe information in your dental records is incorrect or incomplete, you may request that we amend it.
We may deny your request under certain circumstances, but we will provide an explanation in writing when required by law.
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 requested restrictions, except when you request that we not disclose information about a service to your health plan when you have paid for that service in full out of pocket and the disclosure is not otherwise required by law.
Right to Request Confidential Communications
You may request that we contact you in a specific way or at a specific location, such as using a particular telephone number or mailing address.
We will accommodate reasonable requests as required by law.
Right to an Accounting of Disclosures
You may request a list of certain disclosures of your Protected Health Information made during the six years before your request, subject to applicable exclusions and legal requirements.
Right to Receive a Paper Copy
You have the right to receive a paper copy of this Notice at any time, even if you 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, such as a legal guardian or an individual holding an applicable healthcare power of attorney, that person may exercise certain rights on your behalf, subject to applicable law.
7. Family Members and Others Involved in Your Care
We may share relevant health information with family members, friends, or other individuals involved in your care or payment for your care, when permitted by HIPAA.
When appropriate, we will provide you with an opportunity to agree or object to such disclosures.
If you are unable to communicate your preferences, we may use professional judgment to determine whether a disclosure is in your best interest, consistent with applicable law.
8. Business Associates
We may work with third-party service providers that perform functions or services on our behalf and may require access to Protected Health Information.
These providers may include billing companies, technology vendors, practice management providers, and other administrative service providers.
When required by HIPAA, we enter into appropriate Business Associate Agreements requiring these providers to safeguard Protected Health Information.
9. Breach Notification
We take reasonable steps to protect your Protected Health Information against unauthorized access, use, or disclosure.
If a breach of unsecured Protected Health Information occurs, we will notify affected individuals and appropriate authorities as required by applicable law.
10. Complaints and Privacy Concerns
If you believe your privacy rights have been violated, you may submit a complaint directly to Jacksonville Emergency & Family Dental Care.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).
For more information about filing a complaint, visit:
https://www.hhs.gov/ocr/complaints/index.html
We will not retaliate against you for filing a complaint or exercising your privacy rights.
11. Contact Information
If you have questions about this Notice, wish to exercise your HIPAA rights, or would like to submit a privacy-related concern, please contact our practice.
Jacksonville Emergency & Family Dental Care
University Location
1716 University Blvd S
Jacksonville, FL 32216
Phone: (904) 224-0046
Dunn Location
1840 Dunn Ave, Suite #3
Jacksonville, FL 32218
Phone: (904) 224-0047
Wells Location
1700 Wells Rd, Suite 19
Orange Park, FL 32073
Phone: (904) 586-1234
Website: www.jaxemergencydental.com
For privacy-related requests, please contact the appropriate office and ask to speak with the individual responsible for privacy matters.
12. Changes to This Notice
Jacksonville Emergency & Family Dental Care reserves the right to revise this Notice of Privacy Practices at any time.
Any revised Notice may apply to all Protected Health Information maintained by our practice, including information created or received before the revision.
The most current version of this Notice will be available upon request at our offices and may be posted on our website.
Effective Date: November 3, 2026