Notice of Privacy Practices | House Dental

House Dental
Notice of Privacy Practices — Client Rights and HIPAA Authorizations
Effective Date: January 14, 2026

The following specifies your rights under the Health Insurance Portability and Accountability Act of 1996, as amended from time to time ("HIPAA").

Tell your provider if you do not understand this authorization, and they will explain it to you.
You have the right to revoke or cancel this authorization at any time, except: (a) to the extent information has already been shared based on this authorization; or (b) this authorization was obtained as a condition of obtaining insurance coverage. To revoke or cancel this authorization, you must submit your request in writing to the provider at the following address:

House Dental
3133 E. Camelback Road
Suite #190
Phoenix, AZ 85016

Our Legal Duty

We are required by law to protect the privacy of your protected health information ("medical information"). We are also required to send you this notice about our privacy practices, our legal duties, and your rights concerning your medical information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect on the date set forth at the top of this page and will remain in effect unless 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. We reserve the right to make any change in our privacy practices and the updated terms of our notice applicable to all medical information we maintain, including medical information we created or received before we made the change.

We may amend the terms of this notice at any time. If we change our privacy practices, we will give you the revised notice. Any revised notice will be effective for all health information we maintain. The effective date of a revised notice will be noted. A copy of the current notice in effect will be available in our facility and on our website. You may request a copy of the current notice at any time. We collect and maintain oral, written, and electronic information to administer our business and to provide products, services, and information of importance to our patients. We maintain physical, electronic, and procedural safeguards in the handling and maintenance of our patients' medical information, in accordance with applicable state and federal standards, to protect against risks such as loss, destruction, and misuse.

Uses and Disclosures of Your Medical Information

Treatment

We may disclose your medical information, without your prior approval, to another dentist or healthcare provider working in our facility or otherwise providing you treatment for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, your health information may be disclosed to an oral surgeon to determine whether surgical intervention is needed.

Payment

We provide dental services. Your medical information may be used to seek payment from your insurance plan or from you. For example, your insurance plan may request and receive information on dates that you received services at our facility to allow your employer to verify and process your insurance claim.

Health Care Operations

We may use and disclose your medical information, without your prior approval, for health care operations. Health care operations include:

healthcare quality assessment and improvement activities;
reviewing and evaluating dental care provider performance, qualifications and competence, health care training programs, provider accreditation, certification, licensing, and credentialing activities;
conducting or arranging for medical reviews, audits, and legal services, including fraud and abuse detection and prevention; and
business planning, development, management, and general administration including customer service, complaint resolution, and billing, de-identifying medical information, and creating limited data sets for health care operations, public health activities, and research.

We may disclose your medical information to another dental or medical provider or to your health plan subject to federal privacy protection laws, as long as the provider or plan has had a relationship with you and the medical information is for that provider's or health plan's care quality assessment and improvement activities, competence and qualification evaluation and review activities, or fraud and abuse detection and prevention.

Your Authorization

You (or your legal personal representative) may give us written authorization to use your medical information or to disclose it to anyone for any purpose. Once you give us authorization to release your medical information, we cannot guarantee that the person to whom the information is provided will not disclose that information. You may take back or "revoke" your written authorization at any time, except if we have already acted based on your authorization. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect. Unless you give us written authorization, we will not use or disclose your medical information for any purpose other than those described in this notice. We will obtain your authorization prior to using your medical information for marketing, fundraising purposes, or for commercial use. Once authorized, you may opt out of these communications at any time.

Family, Friends, and Others Involved in Your Care or Payment for Care

We may disclose your medical information to a family member, friend, or any other person you involve in your care or payment for your health care. We will disclose the medical information that is relevant to the person's involvement. We may use or disclose your name, location, and general condition to notify, or to assist an appropriate public or private agency to locate and notify, a person responsible for your care in appropriate situations, such as a medical emergency or during disaster relief efforts.

We will provide you with an opportunity to object to these disclosures, unless you are not present or are incapacitated, or it is an emergency or disaster relief situation. In those situations, we will use our professional judgment to determine whether disclosing your medical information is in your best interest under the circumstances.

Health-Related Products and Services

We may use your medical information to communicate with you about health-related products, benefits, services, payment for those products and services, and treatment alternatives.

Reminders

We may use or disclose medical information to send you reminders about your dental care, such as appointment reminders via US Mail, email, or telephone. By providing your email address to us, you agree that you may receive reminders and breach notifications via email as a practical alternative to US Mail. It is the policy of our office to leave a message on any voicemail or answering machine that may be attached to a number that you provide (home, cell, or work). If you prefer that we NOT leave a message to confirm treatment or your appointments, please let the office know.

Plan Sponsors

If your dental insurance coverage is through an employer-sponsored group dental plan, we may share summary health information with the plan sponsor.

Public Health and Benefit Activities

We may use and disclose your medical information, without your permission, when required by law and when authorized by law for the following kinds of public health and public benefit activities:

for public health, including to report disease and vital statistics, child abuse, neglect, or domestic violence;
to avert a serious and imminent threat to health and safety;
for health care oversight, such as activities of state insurance commissioners, licensing and peer review authorities, and fraud prevention agencies;
for research;
in response to court and administrative orders and other lawful process;
to law enforcement officials with regard to crime victims and criminal activities;
to coroners, medical examiners, funeral directors, and organ procurement organizations;
to the military, and to federal officials for law enforcement regarding persons in lawful custody; and
as authorized by state workers' compensation laws.

Special Protections for SUD Records

Substance Use Disorder (SUD) treatment records have enhanced protections. They cannot be used in legal proceedings without your consent or a court order.

If a use or disclosure of health information described above in this notice is prohibited or materially limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law.

Business Associates

We may disclose your medical information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. Our business associates are required, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

Data Breach Notification Purposes

We may use your contact information to provide legally required notices of unauthorized acquisition, access, or disclosure of your health information.

Additional Restrictions on Use and Disclosure

Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you. "Highly Confidential Information" may include confidential information under federal laws governing reproductive rights, alcohol and drug abuse information, and genetic information, as well as state laws that often protect the following types of information:

HIV/AIDS;
Mental health;
Genetic tests (in accordance with GINA 2009);
Alcohol and drug abuse;
Sexually transmitted diseases and reproductive health information; and
Child or adult abuse or neglect, including sexual assault.

Your Rights

You have the right to see and get a copy of your health records.
You have a right to amend your health information.
You have a right to ask to get an Accounting of Disclosures of when and why your health information was shared for certain purposes.
You are entitled to receive a Notice of Privacy Practices that tells you how your health information may be used and shared.
You may decide if you want to give your Authorization before your health information may be used or shared for certain purposes, such as marketing. It is the policy of our office NOT to sell or disclose your information to any outside firms, products, or services which our dentist(s) or staff feel may present a benefit for you, your oral health, or happiness with your smile. If you would like to opt out of this level of service, you may do so by letting our office know.
You have the right to receive your information in a confidential manner and restrict certain communication methods.
You have the right to restrict who receives your information.
You have the right to request amendments to be made to your health records by submitting the request in writing to our Privacy Officer. Your request does not guarantee the amendment but does guarantee that it will be reviewed and considered.
If you believe your rights are being violated or your health information is not being protected, you can:
- File a complaint with your provider or health insurer; or
- File a complaint with the U.S. Government.
Right to opt out of fundraising activities. If you would like to opt out of any fundraising programs that our office may participate in, such as cancer walks or other fundraising programs, you may do so by letting our office know.

Complaints

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your medical information, about amending your medical information, about restricting our use or disclosure of your medical information, or about how we communicate with you about your medical information (including a breach notice communication), you may contact our Privacy Officer to register either a verbal or written complaint.

You may also submit a written complaint to the Office for Civil Rights of the United States Department of Health and Human Services. We support your right to the privacy of your medical information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Room 509F
Washington, D.C. 20201

Office for Civil Rights hotline: 1-800-368-1019
www.hhs.gov/ocr/privacy/hipaa/complaints

Contact Information

If you have questions about this notice or would like to exercise any of your rights, contact our Privacy Officer.

Privacy Officer
House Dental
3133 E Camelback Rd, Ste 190
Phoenix, AZ 85016

(602) 954-1217

Provider Dr. Allison House, DMD
Practice House Dental
Address 3133 E Camelback Rd, Ste 190, Phoenix, AZ 85016
Phone (602) 954-1217
Effective Date January 14, 2026