Notice of Privacy Practices

You have the right to:

• Obtain an electronic or paper copy of your medical and dental records.
• Request corrections to information you believe is inaccurate or incomplete.
• Ask us to contact you through a particular method or at a different address.
• Request restrictions on how we use or disclose your information.
• Request a list of certain disclosures made during the previous six years.
• Receive a paper copy of this notice at any time.
• Authorize another person to act as your personal representative.
• File a complaint without retaliation if you believe your privacy rights were violated.

We will generally respond to record requests within 30 days. We may charge a reasonable, cost-based fee when permitted by law.

If you pay for a service in full and out of pocket, you may ask us not to disclose information about that service to your health insurer for payment or health care operations. We will honor this request unless disclosure is required by law.

You may tell us whether we may:

• Share information with family members, friends, or others involved in your care or payment.
• Share information during a disaster-relief situation.
• Contact you regarding fundraising activities.

We will obtain your written authorization before using or disclosing your information for purposes that require authorization, including most marketing, the sale of health information, and most disclosures of psychotherapy notes. You may revoke an authorization in writing at any time, except where we have already acted in reliance upon it.

We may use or disclose your health information to:

• Provide, coordinate, and manage your dental treatment.
• Consult with other health care professionals involved in your care.
• Bill you, your insurer, or another responsible party.
• Operate and improve our practice.
• Contact you about appointments, treatment, follow-up care, or available services.
• Comply with public-health, safety, oversight, and reporting requirements.
• Report suspected abuse, neglect, or domestic violence when authorized or required.
• Respond to workers' compensation matters.
• Comply with lawful requests from courts, law enforcement, or government agencies.
• Work with coroners, medical examiners, funeral directors, or organ-procurement organizations.
• Conduct or support health research when legally permitted.
• Prevent or reduce a serious and imminent threat to health or safety.
• Comply with federal, state, and local law.

When Michigan or another applicable law provides greater privacy protection, we will follow the more protective requirement.

To the extent we maintain substance-use-disorder records protected under 42 CFR Part 2, those records will not be used or disclosed in legal proceedings against you unless you provide written consent or disclosure is authorized by a qualifying court order and subpoena.

Hammoud Family Dental is required to:

• Protect the privacy and security of your protected health information.
• Follow the privacy practices described in this notice.
• Provide you with a copy of this notice.
• Notify you promptly if a breach may have compromised your information.
• Refrain from using or disclosing your information except as described here or otherwise permitted by law.

We may revise this notice. Any revision may apply to information we already maintain. The current notice will be available at our office and on our website.

Please do not submit sensitive medical information through an unsecured website form or regular email. Website analytics, cookies, and advertising tools will be configured and used in accordance with applicable privacy requirements. Information submitted through appointment or contact forms will be handled according to our privacy and security procedures.

For questions, records requests, restrictions, or complaints, contact:

Privacy Officer: GHOZT MEDIA
Hammoud Family Dental
5777 W Maple Rd #160, West Bloomfield Township, MI 48322
Telephone: (248) 838-0883
Email: hello@ghozt.ai

You may also file a complaint with:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue SW, Washington, DC 20201
Telephone: 1-877-696-6775
hhs.gov/hipaa/filing-a-complaint

Hammoud Family Dental will not retaliate against you for making a complaint.