Endodontic Practice Privacy Policy

Introduction

At [Practice Name], we are committed to protecting your privacy and maintaining the confidentiality of your protected health information (PHI). This privacy policy outlines our practices for collecting, using, and safeguarding your personal and medical information in accordance with HIPAA regulations.

Information We Collect

• Patient demographics and contact information
• Medical and dental history
• Treatment records and radiographic images
• Insurance and payment information
• Referral documentation
• Clinical photographs and documentation

Use of Your Information

We use your personal and health information to:

• Provide endodontic treatment and care
• Coordinate with referring dentists
• Process insurance claims
• Send appointment reminders
• Maintain treatment records
• Comply with legal requirements

Information Sharing and Disclosure

We may share your information with:

• Other healthcare providers involved in your care
• Insurance companies for billing purposes
• Laboratory services
• Legal authorities when required by law

Security Measures

• Electronic health records are encrypted
• Staff training on privacy procedures
• Limited access to patient information
• Secure disposal of records
• Regular security assessments

Patient Rights

You have the right to:

• Access your health records
• Request amendments to your information
• Receive an accounting of disclosures
• Request restrictions on information sharing
• File a complaint regarding privacy violations

Contact Information

Privacy Officer: [Name] Phone: [Phone Number] Email: [Email Address]

Updates to Privacy Policy

This policy may be updated periodically. Patients will be notified of significant changes.

Effective Date

[Date]

Patient Signature

Date