Our Privacy Policy

Our Privacy Policy

Our Privacy Policy

Cinco Meadows Dental



Privacy Officer: Susan Helm


Effective: January 1, 2024


Safeguarding your privacy and the security of your personal information is important to us. The dental records that belong to Cinco Meadows Dental practice are securely stored in electronic health records. As we continuously improve and expand services this policy may change. We are Required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties, and to notify affected individuals following a breach of unsecured protected health information.


This notice describes how we may use and disclose your medical and dental information. It also describes your rights and our legal obligations with respect to your Private Health Information (PHI). If you have any questions about this notice, please contact our Privacy officer as listed above.  


TREATMENT. We disclose medical and dental information to our employees and others health care providers involved in your care. We may also disclose medical or dental information to family members or others who help take care of you.


PAYMENT. We use and disclose medical and dental information about you to obtain payment for services we provide.


HEALTH CARE OPERATIONS. We may use and disclose medical and dental information about you to operate this dental practice. This includes certain administrative, financial, legal, and quality improvement activities necessary to support the core functions of treatment and payment.


APPOINTMENT REMINDERS. There are three ways we may remind patients of an appointment or recommended treatment. We may call, text, or email you limited information as a reminder. Unless you instruct us otherwise.


COMMUNICATION WITH FAMILY. We may share your health or dental information that is directly relevant to the involvement of a spouse, family member, or your personal representative in the form of instructions and decisions about your care. We may also disclose information to someone who helps pay for your care. If you are able and available, you will be given the opportunity to agree or object. If you are unable or unavailable to agree or object our healthcare professionals will use their best judgement in communication with your family.


MARKETING. We may contact you to give you information about products or services related to your treatment or that may interest you. We may similarly inform you of financial discount services provided by this practice and tell you which health plans this practice participates in. We may encourage you to maintain a healthy lifestyle and get recommended test. We will not otherwise use or disclose your medical and dental information for marketing purposes or accept any incentivized payment for these recommended products or services. We may request to use unidentifiable photos to promote recommended services. We will never use any personal identifiable information that would permit someone to identify you without prior written authorization. The authorization will disclose whether we receive any compensation, and you may withdraw the authorization in writing at any time.


REQUIRED BY LAW. We will disclose your health information to report abuse, neglect, domestic violence or to respond to judicial or administrative proceedings. We are sometimes required by law to disclose private health information to law enforcement to comply with a court order, warrant, subpoena, or summons issued by state or federal officials. We are sometimes required by law to disclose your health information to health oversight agencies during audits, investigations, inspections, or other proceedings. We are also required to release health information to coroners, to correctional institutions, to the military or for national security purposes, or to public health authorities to prevent or lessen imminent threat to health or safety of a particular person or for the general public.


BREACH NOTIFICATION. In case of a breach of unsecured protected health information, we will notify you as required by law.

This dental practice may not disclose your private health or dental information, or any personal identifiable information without your prior written authorization except to yourself or your designated representative. Personal identifiable information is any information that can be used to identify you. Such as, your name, date of birth, photo, address, phone number, email address or any information submitted to Cinco Meadows Dental by yourself or other healthcare providers.






1.       Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit. For example, if you tell us not to disclose information to your commercial health plan concerning specific services and choose to pay in full for these services, we will abide by your request, unless we must disclose this information for legal reasons. We reserve the right to accept or reject any other request and will notify you in writing of our decision.


2.       Right to request Confidential Communications. You have the right to receive your health information in a specific way or at a specific location. For example, you may ask that we do not text, but prefer to receive information via email.


3.       Right to Inspect and Copy. You have the right to inspect and copy your health information with limited exceptions. To access your medical and dental information, you must submit a written request detailing what information you want access to and whether you want to inspect it or get a copy of it and what format you prefer. We will provide copies in your requested format if it is readily producible or in an alternative form that is acceptable to you. We will also send a copy to any other person you designate in writing. We are allowed to charge a reasonable fee which covers our cost for labor, supplies, and postage. We may deny your request under limited circumstances. If we believe allowing access could possibly be harmful to the patient. You have a right to appeal.


4.       Right to Amend or Supplement. You have the right to request an amendment to your health record that you believe is incorrect or incomplete. You must make the request in writing and include the reasons you believe the information is inaccurate or incomplete. We may deny your request and are not required to change the record. You will be informed in writing why we disagree with your request. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.


5.       Right to Accounting of Disclosures. You have the right to receive an accounting of disclosures of your health record except for disclosures provided to you or your designated representative. We are not required to account for disclosures pursuant to treatment, payment, healthcare operations, communication to family or persons who care for you, or disclosures required by law. 


6.       Right to a Paper or Electronic Copy of this Notice of Privacy Practice.


COMPLAINTS. Please direct any complaints about how this practice handles your private health information to our Privacy officer Susan Helm at 713-347-1993 Ext. #3. If you are not satisfied with how this office handles a complaint, you may submit a formal complaint to:

U.S. Department of Health and Human Services Office for Civil Rights. The complaint form can be found at: www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf


You will not be penalized in any way for filing a complaint.