HIPAA notice
How we protect your health information.
This notice explains how we may use and share your health information, the rights you have, and how to reach us with questions. Effective October 5, 2026.
About this notice
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
In this notice, "health information" means the records we keep about your dental and medical care and about paying for it. "We" and "our" mean Chesterfield Family Dental.
Your rights
You have the following rights over your health information. To use any of them, call or write to our office.
- Get a copy of your records. You can ask to see your dental and health records or to get a paper or electronic copy. We will respond within 30 days of your request. We may charge a reasonable fee based on our cost.
- Ask us to correct your records. If you think something in your records is wrong or missing, you can ask us to fix it. We may say no, and if we do, we will tell you why in writing.
- Ask us to contact you in a certain way. For example, you can ask us to call a different phone number or send mail to a different address. We will say yes to reasonable requests.
- Ask us to limit what we use or share. You can ask us not to use or share certain information for your treatment, for payment, or for running our office. We do not have to agree. But if you pay for a service or item in full out of pocket, you can ask us not to share information about it with your health plan, and we will agree unless a law requires us to share it.
- Get a list of certain disclosures. You can ask for a list of times we shared your health information in the six years before your request, who we shared it with, and why. The list leaves out sharing for treatment, payment, and running our office, and sharing you asked us to do.
- Get a paper copy of this notice. You can ask for a paper copy at any time, even if you agreed to get it electronically.
- Have someone act for you. If someone is your legal guardian or holds your medical power of attorney, that person can use your rights and make choices about your health information. We will make sure the person has this authority before we act.
- File a complaint. If you believe we have not respected your rights, you can file a complaint with us or with the federal government. See Questions and complaints below.
Your choices
For some kinds of sharing, you get to decide. Tell us what you want, and we will follow your wishes.
- Family and friends. You can tell us whether we may share information with family members, close friends, or others who are involved in your care or help pay for it.
- Disaster relief. You can tell us whether we may share information with a disaster relief group, for example so your family can learn where you are.
- If you are not able to tell us your choice, such as when you are unconscious, we may share information if we believe it is in your best interest. We may also share it when needed to lessen a serious and imminent threat to health or safety.
- We never sell your health information.
- We never use your health information for marketing unless you give us written permission.
- If we ever raise funds, we will not contact you for fundraising without giving you a say, and you can tell us not to contact you again.
How we use and share your information
We usually use or share your health information in these ways.
- To treat you. We use your health information to care for you, and we share it with other professionals who are treating you. For example, we may send your X-rays to a specialist we refer you to.
- To bill for your care. We use and share your information to bill and get paid by health plans or others. For example, we give your dental insurance plan information about your treatment so it can pay for it.
- To run our practice. We use and share your information to run our office, improve your care, and contact you when needed. This is called health care operations.
- Appointment reminders. We may use your information to remind you about upcoming visits.
- Business associates. Some work is done for us by outside companies. We may share your information with them so they can do that work. Each one must agree in a written contract to protect your information.
Other uses the law allows or requires
We may also share your information in other ways, usually to help the public. We can only do so when we meet the conditions in the law.
- Public health and safety. For example, to help prevent disease, to report suspected abuse or neglect, or to prevent a serious threat to someone's health or safety.
- Research. We may use or share information for health research that meets privacy rules.
- Following the law. We will share information when federal, state, or local law requires it, including with the U.S. Department of Health and Human Services if it asks to check that we follow federal privacy law.
- Organ and tissue donation. We may share information with groups that handle organ and tissue donation.
- Coroners, medical examiners, and funeral directors. We may share information with them when a person dies.
- Workers' compensation. We may share information for workers' compensation claims.
- Law enforcement. We may share information with a law enforcement official for purposes the law allows.
- Health oversight. We may share information with agencies that oversee health care, such as for audits and inspections.
- Special government functions. We may share information for military, national security, and presidential protective services.
- Correctional institutions. We may share information about an inmate with a correctional institution or law enforcement official who has custody of that person.
- Lawsuits and legal actions. We may share information in response to a court or administrative order, or in response to a subpoena.
Missouri law
In some cases, Missouri law may give your health information more protection than federal law. When it does, we follow the stricter rule.
Our responsibilities
- We are required by law to protect the privacy and security of your health information.
- We will tell you promptly if a breach happens that may have compromised the privacy or security of your information.
- We must follow the practices in this notice and give you a copy of it.
- We will not use or share your information in any way not described here unless you give us permission in writing. You can take back that permission at any time by telling us in writing.
Changes to this notice
We may change this notice. Any change will apply to all the information we have about you, including information we had before the change.
Updated copies will be available at our office and on our website.
Questions and complaints
If you have questions about this notice, or want to use any of your rights, contact our Privacy Officer. Call our office at (417) 883-1415, or write to the Privacy Officer at 1334 E. Kingsley, Suite D, Springfield, MO 65804.
If you believe your privacy rights have been violated, you can file a complaint with us using the contact details above. You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201. You can call them at 1-877-696-6775 or visit www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you in any way for filing a complaint.
Effective date
This notice takes effect on October 5, 2026.
This notice applies to Chesterfield Family Dental, its dentists, and its staff at our Springfield office.
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New patients are welcome. Call us or send a request, and we will help you take the next comfortable step.
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