Notice of Privacy Practices

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. It applies to all Maintain Your Smile Dental offices, in Rockford, Rochelle, Roscoe.

Our responsibilities

We are required by law to:

• Protect the privacy of your protected health information (PHI).
• Give you this notice of our legal duties and privacy practices regarding your PHI.
• Notify you following a breach of your unsecured PHI.
• Follow the terms of the notice that is currently in effect.

How we may use and disclose your information

We may use and disclose your PHI for the following purposes:

• Treatment. To provide, coordinate, and manage your dental care and related services, including sharing information with other providers involved in your care.
• Payment. To bill and obtain payment for your care from you, an insurer, or another payer.
• Healthcare operations. For routine practice activities such as quality review, staff training, scheduling, and administration.

We may also use or disclose your PHI as otherwise permitted or required by law, such as for public health activities, or as authorized by you in writing. Certain uses and disclosures, including most marketing and any sale of PHI, require your written authorization, which you may revoke at any time.

Special protections for substance use disorder records (42 CFR Part 2)

Certain substance use disorder (SUD) treatment records receive protections under the federal regulation 42 CFR Part 2 that go beyond those provided to other PHI. Effective February 16, 2026, if we create, receive, or maintain any records that are covered by Part 2, the following apply:

• We will generally obtain your written consent before using or disclosing Part 2 records, including for treatment, payment, and healthcare operations, except where the regulation permits a disclosure without consent.
• Consistent with recent federal changes that align Part 2 more closely with HIPAA, you may give a single written consent covering future uses and disclosures of your Part 2 records for treatment, payment, and healthcare operations, and you may revoke that consent in writing at any time.
• A recipient of your Part 2 records may not re-disclose them without your written consent unless the regulation otherwise permits it.
• Your Part 2 records may not be used or disclosed in a civil, criminal, administrative, or legislative proceeding against you without your written consent or a court order that meets the requirements of Part 2.
• You may request an accounting of certain disclosures of your Part 2 records, and you may file a complaint if you believe these protections have been violated, without fear of retaliation.

Your rights

You have the right to:

• Receive a paper or electronic copy of this notice.
• Inspect and request a copy of your dental records.
• Request that we correct information you believe is inaccurate or incomplete.
• Request a restriction on certain uses or disclosures of your PHI.
• Request that we communicate with you in a specific way or at a specific location.
• Receive an accounting of certain disclosures of your PHI.
• File a complaint if you believe your privacy rights have been violated, without retaliation.

Changes to this notice

We may change this notice, and the changes will apply to all information we hold. The revised notice will be available on request and posted on this page, with an updated date above.

Contact information

To exercise your rights or ask questions about this notice, contact our Privacy Officer:

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.