Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices described in this Notice while it is in effect. This Notice takes effect February 16, 2026, and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make new Notice provisions effective for all protected health information that we maintain. When we make a significant change in our privacy practices, we will revise this Notice and post the new Notice clearly and prominently at our practice location. We will also provide copies of the new Notice upon request.

You may request a copy of this Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

How We May Use and Disclose Health Information About You

We may use and disclose your health information for different purposes, including treatment, payment, and health care operations. For each of these categories, we have provided a description and an example. Some information, such as HIV-related information, genetic information, alcohol and/or substance use disorder treatment records, and mental health records, may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they apply.

Treatment: We may use and disclose your health information for your treatment. For example, we may disclose your health information to a specialist providing treatment to you.

Payment: We may use and disclose your health information to obtain reimbursement for the treatment and services you receive from us or another entity involved in your care. Payment activities include billing, collections, claims management, and determinations of eligibility and coverage. For example, we may send claims to your dental health plan containing certain health information.

Health Care Operations: We may use and disclose your health information in connection with our health care operations. These activities include quality assessment and improvement, training programs, and licensing.

Individuals Involved in Your Care or Payment for Your Care: We may disclose your health information to family members, friends, or others identified by you who are involved in your care or payment for your care. If a person has legal authority to make health care decisions for you, we will treat that person as we would treat you with respect to your health information.

Disaster Relief: We may use or disclose your health information to assist in disaster relief efforts.

Required by Law: We may use or disclose your health information when required to do so by law.

Public Health Activities: We may disclose your health information for public health activities, including:

• Preventing or controlling disease, injury, or disability
• Reporting child abuse or neglect
• Reporting reactions to medications or problems with products or devices
• Notifying individuals of recalls, repairs, or replacements
• Notifying individuals who may have been exposed to a disease
• Notifying appropriate authorities of suspected abuse, neglect, or domestic violence

National Security: We may disclose health information to authorized officials for intelligence, national security activities, or to correctional institutions or law enforcement officials with lawful custody.

Secretary of HHS: We will disclose your health information to the U.S. Department of Health and Human Services when required to investigate compliance with HIPAA.

Workers’ Compensation: We may disclose your health information as authorized by laws relating to workers’ compensation.

Law Enforcement: We may disclose your health information for law enforcement purposes as permitted by law.

Health Oversight Activities: We may disclose your health information to oversight agencies for audits, investigations, inspections, and licensing.

Judicial and Administrative Proceedings: We may disclose your health information in response to court orders, subpoenas, or other lawful processes.

Research: We may disclose your health information to researchers when approved and safeguards are in place.

Coroners, Medical Examiners, and Funeral Directors: We may disclose health information as necessary for identification, determining cause of death, or performing duties.

Fundraising: We may contact you regarding fundraising activities. You may opt out at any time.

Substance Use Disorder (SUD) Information: We will handle SUD records in accordance with applicable laws (42 CFR Part 2) and your consent.

Other Uses and Disclosures: Your written authorization is required for:

• Psychotherapy notes
• Marketing
• Sale of health information
• Other uses not described in this Notice

You may revoke your authorization at any time in writing.

Your Health Information Rights

Access: You have the right to inspect and obtain copies of your health information. Requests must be made in writing. Fees may apply.

Accounting of Disclosures: You may request a list of disclosures of your health information.

Right to Request Restrictions: You may request limits on how your information is used or disclosed.

Alternative Communication: You may request communication by alternative means or locations.

Amendment: You may request corrections to your health information.

Breach Notification: You will be notified of any breaches of your unsecured health information.

Electronic Notice: You may request a paper copy even if you agreed to receive it electronically.

Questions and Complaints

If you have questions or believe your privacy rights have been violated, you may contact us or file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Privacy Official Contact Information:

Schroeder Cosmetic Dentistry and Sleep Better Indianapolis
Phone: 317-897-8028
Fax: 317-897-8025
Address: 8028 E. Tenth St., Indianapolis, IN 46218