NOTICE OF PRIVACY PRACTICES Lake Norman Dentistry

Last updated [February 16, 2026]

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOWYOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR MEDICALINFORMATION IS IMPORTANT TO US.
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CONTACT INFORMATION

For more information about our privacy practices, to discuss questions or concerns, or to get additional copies ofthis notice, please contact our Privacy Officer.
Office Telephone Number: 704-948-1300
215 Gilead Road Suite 300 Huntersville NC 28078

OUR LEGAL DUTY

We are required by law to protect the privacy of your protected health information (“medical information”). We are also required tosend 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 setforth at the top of this page and will remain in effect unless we replace it. We reserve the right at any time to change our privacypractices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right tomake any change in our privacy practices and the new terms of our notice are applicable to all medical information we maintain,including medical information we created or received before we made the change in practices.We may amend the terms of this notice at any time. If we make a material change to our policy practices, we will provide to youwith the revised notice. Any revised notice will be effective for all health information we maintain. The effective date of a revisednotice 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 copyof the current notice at any time. We collect and maintain oral, written and electronic information to administer our business and toprovide products, services and information of importance to our patients. We maintain physical, electronic and proceduralsafeguards in the handling and maintenance of our patients’ medical information, in accordance with applicable state and federalstandards, 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 fromyou. For example, your insurance plan may request and receive information on dates that you received services at our facility inorder 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 careoperations. 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, complaintresolutions and billing, de-identifying medical information, and creating limited data sets for health care operations, publichealth activities and research.

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

Your Authorization: You (or your legal personal representative) may give us written authorization to use your medical informationor to disclose it to anyone for any purpose. Once you give us authorization to release your medical information, we cannotguarantee 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 affectany use or disclosure permitted by your authorization while it was in effect. Unless you give us written authorization, we will not useor disclose your medical information for any purpose other than those described in this notice. We will obtain your authorizationprior to using your medical information for marketing, fundraising purposes or for commercial use. Once authorized, you may optout of these communications at any time.
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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 medicalinformation 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 tolocate and notify, a person responsible for your care in appropriate situations, such as a medical emergency or during disaster reliefefforts.
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We will provide you with an opportunity to object to these disclosures, unless you are not present or are incapacitated or it is anemergency or disaster relief situation. In those situations, we will use our professional judgment to determine whether disclosingyour 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-relatedproducts, 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 appointmentreminders via US Mail, email and telephone. By providing your email address to us, you agree that you may receive reminders andbreach notifications via email as a possible alternative to US Mail. It is the policy of our office to leave a message on any voicemail oranswering machine that may be attached to a number that you provide (home, cell or work). If you prefer that we do NOT leave amessage to confirm treatment or your appointments, please see our privacy officer.

Plan Sponsors: If your dental insurance coverage is through an employer’s sponsored group dental plan, we may share summaryhealth 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, adult abuse, neglect or domestic violence.
• to avert a serious an imminent threat to health or safety
• for health care oversight, such as activities of state insurance commissioners, licensing and peer review authorities andfraud prevention agencies.
• for research.
• in response to court and administrative orders and other lawful processes.
• to law enforcement officials regarding crime victims and criminal activities.
• to coroners, medical examiners, funeral directors and organ procurement organizations.
• to the military, to federal officials for lawful intelligence, counterintelligence, and national security activities, and tocorrectional institutions and law enforcement regarding persons in lawful custody; and
• as authorized by state worker’s compensation laws.

Special protections for SUD records: Substance Use Disorder (SUD) Treatment records have enhanced protection. They cannot beused in legal proceedings without your consent or 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.
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Business Associates: We may disclose your medical information to our business associates that perform functions on our behalf orprovide us with services if the information is necessary for such functions or services. Our business associates are required, undercontract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than asspecified 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 a 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 certainpurposes
• 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 certainpurposes, such as marketing. It is the policy of our office NOT to sell or disclose your information to any outside firms orbusiness partners. Your information may be used, only within our office, for the purposes of presenting to you certainproducts or services which our dentist(s) or staff feel may present a benefit for you, your oral health or happiness with yoursmile. If you would like to opt out of this level of service, please see our privacy officer.
• You have the right to receive your information in a confidential manner and restrict certain communication methods.
• You have a right to restrict who receives your information.
• You have a right to request amendment to be made to your health records by submitting the request in writing to ourprivacy officer. Your request does not guarantee the amendment but does guarantee that it will be reviewed andconsidered.
• If you believe your rights are being denied or your health information is not being protected, you can:
       a. File a complaint with your provider or health insurer
       b. 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 mayparticipate in, such as cancer walks, or other fundraising programs please see our privacy officer.

COMPLAINTS

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to yourmedical 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 maycontact our Privacy Officer to register either a verbal or written complaint. You may also submit a written complaint to the Office forCivil Rights of the United States Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F,Washington, DC, 20201. You may contact the Office for Civil Rights’ hotline at 1-800-368-1019. We support your right to privacy ofyour medical information. We will not retaliate in any way if you choose to file a complaint with us or with the US Department ofHealth and Human Services.

CONTACT US

If you have questions or comments about this Privacy Policy, please contact us at: