WILLIAMS FAMILY DENTISTRY

Effective Date: September 3, 2026

This notice describes how medical and dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully. 

Williams Family Dentistry
1511 Emerald Plaza
College Station, TX 77845
(979) 695-8029

OUR RESPONSIBILITIES

Williams Family Dentistry is required by law to maintain the privacy and security of your protected health information (“PHI”), provide you with this Notice describing our legal duties and privacy practices, follow the Notice currently in effect, and notify you as required by law if a breach compromises the privacy or security of your unsecured PHI.

We may change our privacy practices and this Notice. If we make a material change, we will revise the Notice and make the revised Notice available as required by law.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use or disclose your PHI without your written authorization as permitted or required by law, including:

Treatment: To provide, coordinate, or manage your dental care, including sharing information with dentists, specialists, physicians, laboratories, or other health care providers involved in your care.

Payment: To obtain payment for services, determine eligibility or coverage, and submit claims or other information to dental or health plans and other payers.

Health Care Operations: To operate our practice and provide quality care, including quality assessment, employee review, training, credentialing, auditing, compliance, business planning, and other activities permitted by law.

Appointment Reminders & Health-Related Communications: We may contact you by telephone, text message, email, mail, patient portal, or other communication methods you provide for appointment reminders, treatment follow-up, billing, treatment options, and other health-related communications. We may leave messages or use other reasonable means to contact you as permitted by law.

Individuals Involved in Your Care or Payment: Unless you object, we may disclose relevant PHI to a family member, close friend, or other person you identify who is involved in your care or payment. We may also make such disclosures when, based on professional judgment and the circumstances, it is appropriate and permitted by law.

Business Associates: We may disclose PHI to third parties that perform services on our behalf, such as billing, electronic records, practice management, appointment reminders, communications, information technology, cloud storage, legal, accounting, and similar services. When required by law, these parties must safeguard your PHI through written agreements with us.

OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW

We may use or disclose PHI without your authorization when permitted or required by federal or Texas law, including for:

• Public health activities;
• Suspected abuse, neglect, or domestic violence;
• Health oversight activities, including audits, investigations, inspections, and licensing;
• Judicial or administrative proceedings and other lawful processes;
• Law enforcement when permitted or required by law;
• Workers’ compensation programs;
• Preventing or lessening a serious and imminent threat to health or safety;
• Military and national security activities;
• Coroners and medical examiners;
• Organ, eye, or tissue donation; and
• Research when permitted by law and appropriate safeguards are in place.

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION

Most uses and disclosures not described in this Notice require your written authorization. An authorization generally is required for most uses and disclosures of psychotherapy notes, when applicable; certain uses and disclosures for marketing; and the sale of PHI.

You may revoke an authorization in writing at any time, except to the extent we have already relied upon it.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

Right to Inspect and Obtain a Copy: You may inspect and obtain a copy of your PHI contained in designated record sets, subject to legal exceptions. We may require a written request as part of our reasonable procedures, and reasonable, cost-based fees may apply where permitted by law. You may request electronic records when required or reasonably available. Texas law also provides specific requirements concerning access to dental records.

Right to Request an Amendment: You may request that we amend PHI you believe is incorrect or incomplete. Your request should explain why. We may deny the request in circumstances permitted by law.

Right to Request Restrictions: You may request restrictions on our use or disclosure of your PHI for treatment, payment, or health care operations. We are not generally required to agree. However, if you pay for a service or item completely out-of-pocket and in full, you may request that we not disclose information concerning that service or item to your health plan for payment or health care operations, and we will honor the request when required by law.

Right to Confidential Communications: You may request that we communicate with you about your health information by alternative means or at alternative locations, such as a different telephone number, email address, or mailing address. We will accommodate reasonable requests as required by law.

Right to an Accounting of Certain Disclosures: You may request an accounting of certain disclosures of your PHI, subject to legal exceptions. This generally does not include disclosures for treatment, payment, health care operations, disclosures made directly to you, or other disclosures excluded by law.

Right to Receive a Paper Copy: You have the right to receive a paper copy of this Notice at any time and may request an electronic copy when available.

SPECIAL PROTECTIONS FOR CERTAIN INFORMATION

Certain information may receive additional protection under federal or Texas law, including HIV/AIDS, genetic, mental health, and alcohol or substance use disorder treatment information. We will comply with all applicable laws governing specially protected information.

Substance Use Disorder Treatment Information: If we receive or maintain information from a substance use disorder treatment program covered by 42 CFR Part 2 (“Part 2”), and a general consent permits use or disclosure for treatment, payment, or health care operations, we may use and disclose that information as described in this Notice and as permitted by law. If a specific consent limits use or disclosure, we will follow that consent.

Part 2 records have additional confidentiality protections and generally may not be used or disclosed against you in a civil, criminal, administrative, or legislative proceeding by a federal, state, or local authority unless permitted by your consent or a qualifying court order and otherwise authorized by law.

YOUR RIGHT TO FILE A COMPLAINT

If you believe your privacy rights have been violated, you may file a complaint with Williams Family Dentistry or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.

To file a complaint with our office:

Williams Family Dentistry
1511 Emerald Plaza
College Station, TX 77845
(979) 695-8029

ACKNOWLEDGMENT OF RECEIPT

We will make a good-faith effort to obtain your written acknowledgment that you received this Notice. Your signature acknowledges receipt of the Notice; it does not mean that you agree to any particular use or disclosure of your health information.

If you decline to sign, we will document our good-faith efforts to obtain your acknowledgment and, when applicable, the reason acknowledgment was not obtained.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice and make a revised Notice applicable to PHI we already maintain and information we receive in the future when permitted by law. A current copy of this Notice will be available upon request, posted in a prominent location in our office, and prominently available on our website.