Notice of Privacy Practices
Christina Brinda, DDS
7396 Wales Ave NW, North Canton, OH 44720
Phone: 330-498-0668 · Email: info@brindadental.com
Effective date: 03.11.2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information (PHI). We are also required to:
- give you this Notice of our legal duties and privacy practices with respect to your health information;
- follow the terms of the Notice currently in effect;
- notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
We will not use or share your information other than as described in this Notice unless you tell us we can in writing. If you give us written permission, you may change your mind at any time by letting us know in writing.
How We May Use and Disclose Your Health Information
Treatment. We may use and share your health information to provide, coordinate, or manage your dental care. Example: We may share information with a dental specialist, oral surgeon, or dental laboratory involved in your treatment, or with your physician.
Payment. We may use and share your health information to bill and receive payment from you, your dental insurance plan, or others. Example: We send information about your treatment to your dental insurance plan so it will pay for your services.
Health care operations. We may use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We may use your information to evaluate the quality of our services or to train our staff.
Appointment reminders and treatment information. We may contact you to remind you of appointments or to tell you about treatment options and health-related services we offer that may be of interest to you.
Business associates. We may share your information with companies that perform services for us, such as billing, IT, or software providers. These business associates are required by contract to protect your information.
Individuals involved in your care or payment. We may share relevant information with a family member, friend, or other person you identify who is involved in your care or in paying for it, unless you object. If you are not able to tell us your preference, for example in an emergency, we may share information if we believe it is in your best interest.
Other Uses and Disclosures Permitted or Required by Law
We may use or share your information without your authorization in the following situations, as permitted or required by law:
- As required by law: when federal, state, or local law requires it, including to the U.S. Department of Health and Human Services to show that we comply with federal privacy law.
- Public health and safety: to prevent disease, report adverse reactions to medications or products, report suspected abuse, neglect, or domestic violence, or prevent a serious threat to the health or safety of a person or the public.
- Health oversight activities: to agencies authorized by law to conduct audits, investigations, inspections, and licensure, such as the Ohio State Dental Board.
- Lawsuits and legal actions: in response to a court or administrative order, or a subpoena, as permitted by law.
- Law enforcement: for law enforcement purposes, as permitted by law.
- Coroners, medical examiners, and funeral directors: for example, to identify a deceased person.
- Organ and tissue donation: to organ procurement organizations.
- Research: for research approved under procedures required by law.
- Workers’ compensation: for workers’ compensation claims.
- Special government functions: for military, national security, and presidential protective services, and to correctional institutions or law enforcement officials having custody of an individual.
Uses and Disclosures That Require Your Written Authorization
We will not use or share your information in the following ways unless you give us written permission:
- marketing purposes;
- sale of your information;
- most sharing of psychotherapy notes;
- any other use or disclosure not described in this Notice.
You may revoke an authorization at any time in writing, except to the extent we have already acted on it.
Your Rights
When it comes to your health information, you have the following rights:
Get a copy of your dental record. You can ask to see or get an electronic or paper copy of your dental record and other health information we have about you. We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your record. You can ask us to correct health information that you believe is incorrect or incomplete. We may say “no” to your request, but we will tell you why in writing within 60 days.
Request confidential communications. You can ask us to contact you in a specific way (for example, by home or cell phone) or to send mail to a different address. We will agree to all reasonable requests.
Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information with your health insurer for payment or operations. We will say “yes” unless a law requires us to share it.
Get a list of those with whom we have shared information. You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why. The list will include all disclosures except those for treatment, payment, health care operations, and certain other disclosures, such as any you asked us to make. We will provide one accounting a year for free, but may charge a reasonable, cost-based fee if you ask for another within 12 months.
Get a copy of this Notice. You can ask for a paper copy of this Notice at any time, even if you have agreed to receive it electronically. We will provide you with a paper copy promptly.
Choose someone to act for you. If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority before we take any action.
Be notified of a breach. You have the right to be notified if a breach of your unsecured health information occurs.
File a complaint if you feel your rights are violated. You can complain if you feel we have violated your rights by contacting our Privacy Officer using the information below. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
To exercise any of these rights, please contact our Privacy Officer in writing at the address below.
State Law
If Ohio law provides greater privacy protection for your health information than federal law, we will follow the more protective law.
Changes to This Notice
We can change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website at www.brindadental.com.
Contact Information
Privacy Officer
Christina Brinda, DDS
7396 Wales Ave NW
North Canton, OH 44720
Phone: 330-498-0668
Email: info@brindadental.com