Norcross Dental Center
Effective Date: September 21, 2026 Last Updated: September 21, 2026
1. Introduction Norcross Dental Center (“we,” “our,” “us,” or “the Practice”), located at 5430 Jimmy Carter Blvd, Suite 125, Norcross, GA 30093, is committed to protecting the privacy and security of your protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), its implementing regulations, and other applicable federal and Georgia state laws. This Notice of Privacy Practices describes:
• How we may use and disclose your health information.
• Your rights regarding your health information.
• Our legal duties and privacy practices.
• How to exercise your rights or file a complaint. Please review this Notice carefully. We are required by law to maintain the privacy of PHI, provide you with this Notice of our legal duties and privacy practices, and notify you following a breach of unsecured PHI. We must abide by the terms of this Notice currently in effect. We reserve the right to change our privacy practices and the terms of this Notice at any time, provided the changes are permitted by law. Any revised Notice will be effective for all PHI we maintain. The current Notice will be available in our office and, if applicable, on our website. You may request a copy at any time.
PHI includes individually identifiable health information relating to your past, present, or future physical or mental health condition, the provision of healthcare to you, or payment for healthcare. This includes information in oral, written, or electronic form, such as:
• Demographic information (name, address, phone, email, date of birth, Social Security number)
• Medical and dental history, diagnoses, treatment plans, radiographs/X-rays, photographs, and clinical notes
• Insurance and billing information
• Appointment records and communications related to your care 3. How We May Use and Disclose Your Health Information We may use and disclose your PHI for the following purposes without your written authorization (unless otherwise required by law):
A. Treatment We may use and share your PHI to provide, coordinate, or manage your dental care. Examples include discussing your treatment with other providers involved in your care, referring you to specialists, or consulting with laboratories or pharmacies.
B. Payment We may use and disclose PHI to bill and collect payment for services. This includes submitting claims to your insurance company, determining eligibility or coverage, coordinating benefits, and collecting unpaid balances.
C. Healthcare Operations We may use and disclose PHI for our business activities, such as quality assessment, staff training, licensing, accreditation, auditing, legal services, business planning, and customer service. This may include reviewing records for quality improvement or using de-identified data for analysis.
D. Other Uses and Disclosures Permitted or Required by Law We may also use or disclose PHI:
• To public health authorities for disease reporting, product recalls, or other public health activities.
• To report abuse, neglect, or domestic violence as required by law.
• For health oversight activities (audits, investigations, inspections).
• In response to court orders, subpoenas, or other legal processes (with appropriate safeguards). • For law enforcement purposes under specific circumstances.
• To coroners, medical examiners, or funeral directors as needed.
• For organ or tissue donation purposes.
• For research under certain conditions (often with IRB approval or de-identification).
• To prevent or lessen a serious and imminent threat to health or safety.
• For specialized government functions (military, national security) when applicable.
• As required by workers’ compensation laws.
• To business associates (e.g., billing companies, IT vendors, labs) who perform functions on our behalf and have signed agreements requiring them to protect PHI.
• For appointment reminders, treatment alternatives, or health-related benefits and services (we will offer you the opportunity to opt out of certain communications where required). Uses an
D. Disclosures Requiring Your Written Authorization Most uses and disclosures of psychotherapy notes (if applicable), marketing communications, and the sale of PHI require your written authorization. We will not use or disclose your PHI for other purposes not described in this Notice without your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.
We do not sell your PHI or use it for marketing without authorization.
• Right to Inspect and Copy — You may request to inspect or obtain a copy of your PHI maintained in designated record sets. We may charge a reasonable, cost-based fee for copies. We will respond within the timeframes required by law (generally 30 days, with possible extension).
• Right to Request Amendment — You may request that we amend PHI you believe is incorrect or incomplete. We may deny the request in certain circumstances and will provide a written explanation.
• Right to an Accounting of Disclosures — You may request a list of certain disclosures of your PHI made by us (excluding those for treatment, payment, operations, and certain other exceptions) for up to six years prior to the request.
• Right to Request Restrictions — You may request restrictions on certain uses or disclosures of your PHI. We are not required to agree to all requests, but if we do, we will comply (except in emergencies). We must agree to restrict disclosures to a health plan if you paid out-of-pocket in full for the service and the disclosure is not otherwise rerequired by law.
• Right to Request Confidential Communications — You may request that we communicate with you about PHI in a certain way or at a certain location (e.g., only by mail or at a work address). We will accommodate reasonable requests.
• Right to a Paper Copy of This Notice — You may requestight to Request Confidential Communications — You may request te with you about PHI in a certain way or at a certain location (e.g., only by mail or at a work address). We will accommodate reasonable requests.
• Right to a Paper Copy of This Notice — You may requesta paper copy of this Notice at any time, even if you agreed to receive it electronically.
• Right to Be Notified of a Breach — You have the right to receive notification of a breach of your unsecured PHI as required by law.
• Right to Choose Someone to Act for You — If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
To exercise any of these rights, submit a written request to our Privacy Officer (contact information below). We will respond as required by law.
We are required to:
• Maintain the privacy and security of your PHI.
• Provide you with this Notice.
• Abide by the terms of the Notice currently in effect.
• Notify you promptly if a breach of unsecured PHI occurs that affects you.
• Not use or disclose your PHI except as described in this Notice or as authorized by you or permitted/required by law.
We implement administrative, physical, and technical safeguards to protect PHI, including access controls, encryption where appropriate, staff training, and business associate agreements.
If you believe your privacy rights have been violated, you may file a complaint with:
• Norcross Dental Center Privacy Officer
5430 Jimmy Carter Blvd, Suite 125
Norcross, GA 30093
Phone: (770) 441-7900 (or the current office number)
(You may also ask for the Privacy Officer by name when calling.)
• U.S. Department of Health and Human Services, Office for Civil Rights
You may file online at https://www.hhs.gov/hipaa/filing-a-complaint or by mail/phone as directed on the HHS website.
We will not retaliate against you for filing a complaint.
For questions about this Notice, to exercise your rights, or to obtain more information:
Privacy Officer
Norcross Dental Center
5430 Jimmy Carter Blvd, Suite 125
Norcross, GA 30093
Phone: (770) 441-7900
(Confirm current contact details with the practice, as phone numbers and staff may change.)
• This Notice applies to all patients of Norcross Dental Center.
• We may share information as needed for treatment continuity, insurance processing, and compliance with legal obligations.
• If you have questions about specific services (e.g., digital imaging, treatment planning, or third-party financing), ask our staff how those may involve PHI.
• Georgia law may provide additional protections in certain situations; this Notice is intended to meet both federal and state requirements where applicable.
Thank you for trusting Norcross Dental Center with your care. We are committed to protecting your privacy while delivering high-quality dental services.
