HIPAA Omnibus Notice of Privacy Practices
Effective Date: June 16, 2025
Ascend Dental
577 E. State Street, Suite 100
Eagle, ID, 83616
(208) 939-3500
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND / OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The terms of this Notice of Privacy Practices (“Notice”) apply to Ascend Dental, its affiliates, and employees. Ascend Dental may share protected health information (PHI) as necessary for treatment, payment, and healthcare operations, as permitted by law.
We are legally required to:
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Maintain the privacy of your PHI;
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Provide this Notice explaining our legal duties and privacy practices;
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Notify you in the event of a breach of unsecured PHI;
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Abide by the terms of this Notice for as long as it remains in effect.
We reserve the right to change this Notice and make the revised Notice effective for all PHI we maintain. You may request a current copy at any time.
Uses and Disclosures of Your PHI
1. For Treatment, Payment, and Operations (TPO): With your written consent:
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Treatment: We may share your PHI with healthcare providers (doctors, specialists, pharmacists, labs, etc.) for your care.
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Payment: We may use/disclose your PHI to bill you or third parties and verify coverage.
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Healthcare Operations: We may use PHI for office management, quality improvement, appointment reminders, or treatment alternatives.
2. Required by Law: We must disclose PHI when required by federal, state, or local law.
3. Special Circumstances: PHI may be used/disclosed without consent in:
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Emergencies to prevent serious threats to safety
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Public health activities (e.g., disease prevention, child abuse reporting)
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Judicial/legal proceedings (court orders, subpoenas)
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Law enforcement (e.g., locating suspects, victims)
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Coroners/medical examiners for identifying deceased or determining cause of death
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Organ donation organizations (if applicable)
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Worker’s Compensation claims
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Military/national security functions
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Research approved by a review board
4. Business Associates: Third parties performing services for us must also protect your PHI under strict contracts.
5. Fundraising & Marketing: We may contact you for fundraising. You may opt-out. We won’t use PHI for paid marketing without written authorization.
6. Super-Confidential Info: PHI about HIV, substance use, or mental health is only disclosed with specific consent, unless legally required.
7. Sale of PHI: We will never sell your PHI without your explicit written authorization.
Your Rights Regarding PHI
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Inspect & Copy: You may review or obtain a copy of your PHI. Requests must be in writing. Fees may apply.
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Request Amendments: You may ask for corrections to your PHI if you believe it’s inaccurate. We may deny requests in limited cases.
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Accounting of Disclosures: You may request a list of disclosures of your PHI not related to TPO, once every 12 months at no cost.
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Request Restrictions: You can ask us not to share your PHI with certain individuals or insurers (especially if you pay out-of-pocket).
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Confidential Communications: You can request communication via specific methods or locations.
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Paper Copy of This Notice: You can request a paper copy of this Notice at any time.
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Notice of Breach: You will be notified if a breach compromises the privacy or security of your PHI.
Optional Privacy Practices
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Faxing & Emailing PHI: With your request and approval, we may fax or email your PHI using safeguards like encryption and cover sheets.
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Practice Transition: If Ascend Dental is sold or merged, patient records (including PHI) may be transferred to the new owner.
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Inactive Records: We will retain your PHI for at least 6 years (or longer per state law), then may securely destroy it.
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Collections: PHI may be disclosed for billing/collection in accordance with the law.
Complaints
If you believe your privacy rights have been violated, contact our Privacy Officer at:
Ascend Dental Privacy Officer
577 E. State Street, Suite 100
Eagle, ID 83616
(208) 939-3500
You may also contact:
Office for Civil Rights
Department of Health & Human Services
Jacob Javits Federal Building
26 Federal Plaza – Suite 3312
New York, NY 10278
Phone: (212) 264-3313
Fax: (212) 264-3039
For Further Information: If you have questions, need further assistance regarding or would like to submit a request pursuant to this Notice, you may contact the Ascend Dental Privacy Officer by phone at (208) 939-3500 or at the following address:
577 E. State Street, Suite 100
Eagle, ID, 83616
This Notice of Privacy Practices is also available on our Ascend Dental web page at https://www.eaglesmiles.com.