HIPAA Privacy Policy

Your Information. Your Rights. Our Responsibilities.

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

Golden Kids Dental & Orthodontics is committed to protecting the privacy and security of your protected health information (“PHI”). This Notice of Privacy Practices explains how we may use and disclose your health information, your rights regarding your information, and our legal responsibilities under the Health Insurance Portability and Accountability Act (HIPAA). This policy was tailored from the provided HIPAA template.

Protected health information includes information about your past, present, or future physical or mental health condition, dental treatment, payment information, and other identifying information maintained by our office.

Uses & Disclosures of Protected Health Information

Golden Kids Dental & Orthodontics may use and disclose your protected health information for purposes related to treatment, payment, healthcare operations, and other situations permitted or required by law.

Treatment

We may use and disclose your protected health information to provide, coordinate, or manage your dental and orthodontic care.

Examples include:

• Coordinating treatment with specialists or physicians
• Referring patients for additional healthcare services
• Sharing information necessary for diagnosis or treatment planning
• Discussing care with healthcare providers involved in your treatment

Payment

We may use and disclose your information as necessary to obtain payment for services provided.

Examples include:

• Submitting insurance claims
• Verifying insurance benefits
• Collecting payment for services
• Obtaining prior authorizations when necessary

Healthcare Operations

We may use or disclose your protected health information to support the daily operations of Golden Kids Dental & Orthodontics.

Examples include:

• Quality assessment and improvement
• Staff training and education
• Licensing and accreditation activities
• Appointment reminders
• Patient communications
• Administrative and business operations

We may contact you regarding:

• Appointment reminders
• Treatment follow up
• Treatment alternatives
• Health related services that may benefit you

Other Permitted Uses & Disclosures

We may use or disclose your protected health information without your authorization when required or permitted by law, including:

• Public health reporting
• Abuse or neglect reporting
• Health oversight activities
• Legal proceedings
• Law enforcement requests
• Coroner or funeral director requests
• Organ donation
• Research permitted by law
• National security activities
• Workers’ compensation claims
• Compliance investigations by the Department of Health & Human Services

Any other uses or disclosures not described in this notice will only occur with your written authorization unless otherwise permitted by law.

You may revoke an authorization in writing at any time except to the extent action has already been taken in reliance on the authorization.

Your Rights Regarding Your Health Information

You have certain rights regarding your protected health information.

Right to Inspect & Copy Records

You have the right to inspect and request copies of your health information maintained by our office. Fees may apply for copies as permitted by law.

Certain records may be restricted from access under federal or state law.

Right to Request Restrictions

You may request restrictions on how we use or disclose your protected health information.

You may also request that information not be shared with certain individuals involved in your care.

We are required to comply with requests restricting disclosure to health plans if:

• The information pertains solely to services paid out of pocket in full
• The disclosure is not otherwise required by law

Right to Confidential Communications

You may request that we communicate with you in a specific way or at a specific location.

Examples include:

• Contacting you only by phone
• Sending mail to a different address
• Using alternative communication methods

Right to Request Amendments

You may request corrections or amendments to your health information if you believe information is inaccurate or incomplete.

If we deny your request, you may submit a written statement of disagreement.

Right to an Accounting of Disclosures

You have the right to request an accounting of certain disclosures of your protected health information made by our office.

This accounting does not include disclosures related to:

• Treatment
• Payment
• Healthcare operations
• Authorized disclosures
• Certain legally permitted disclosures

Right to a Paper Copy of This Notice

You may request a paper copy of this HIPAA Notice at any time, even if you agreed to receive it electronically.

Right to Choose Someone to Act for You

If you have designated a medical power of attorney or legal guardian, that individual may exercise your privacy rights and make decisions regarding your protected health information as permitted by law.

Our Responsibilities

Golden Kids Dental & Orthodontics is required by law to:

• Maintain the privacy and security of your protected health information
• Provide you with this Notice of Privacy Practices
• Follow the terms currently in effect
• Notify you following a breach of unsecured protected health information when required by law

We reserve the right to update or revise this Notice of Privacy Practices at any time. Updated notices will be posted in our office and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with Golden Kids Dental & Orthodontics or with the U.S. Department of Health & Human Services.

You may contact our office directly regarding privacy concerns. We will not retaliate against you for filing a complaint.

Contact Information

Golden Kids Dental & Orthodontics
2421 Ford St, Golden, CO 80401
Phone: 303.216.1108
Website: https://goldenkidsdentalandorthodontics.com

If you have questions regarding this Notice of Privacy Practices, please contact our office and ask to speak with our HIPAA Compliance Officer.

Effective Date:  05/14/2026