Privacy Policy/Notice of Privacy Practices

Newark Dental Associates Effective Date: February 16, 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.

CONTACT INFORMATION

If you have questions about this Notice of Privacy Practices, would like additional copies, or wish to exercise your privacy rights, please contact our Privacy Officer:

  • Practice: Newark Dental Associates
  • Telephone: 740-344-4000
  • Address: 1478 W Main St, Newark, Ohio 43055

OUR LEGAL DUTY

Newark Dental Associates is required by federal law, including the Health Insurance Portability and Accountability Act (HIPAA), and applicable Ohio state laws to protect the privacy of your protected health information (PHI). We are required to provide you with this Notice describing our legal duties and privacy practices.

We must follow the privacy practices described in this Notice while it is in effect. We reserve the right to change our privacy practices as permitted by law. Any changes will apply to all PHI we maintain and will be reflected in a revised Notice.

USES AND DISCLOSURES OF YOUR HEALTH INFORMATION

  • Treatment: We may use or disclose your PHI to dentists, specialists, hygienists, assistants, and other healthcare providers involved in your dental care.
  • Payment: We may use and disclose your PHI to obtain payment for services provided, including billing insurance carriers or you directly.
  • Healthcare Operations: We may use or disclose your PHI for practice operations such as quality assessment, provider review, audits, compliance activities, training, and administrative functions.

YOUR AUTHORIZATION

Uses and disclosures of your PHI not described in this Notice will be made only with your written authorization. You may revoke your authorization in writing at any time, except where we have already relied on it.

APPOINTMENT REMINDERS AND COMMUNICATIONS

We may contact you via mail, phone, voicemail, text message, or email to remind you of appointments or provide information related to your care. By providing your contact information, you consent to these communications. You may request alternative or confidential communication methods at any time.

SPECIAL PROTECTIONS AND OHIO LAW

Certain health information is subject to additional protections under federal and Ohio law, including:

  • Mental health records
  • HIV/AIDS information
  • Substance use disorder treatment records
  • Genetic testing information
  • Reproductive health information
  • Records involving abuse or neglect

When applicable, we will comply with the most restrictive law.

YOUR RIGHTS

You have the right to:

  • Inspect and obtain a copy of your health records
  • Request amendments to your records
  • Receive an accounting of certain disclosures
  • Request confidential communications
  • Request restrictions on certain uses or disclosures
  • Receive a copy of this Notice
  • File a complaint without fear of retaliation

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services, Office for Civil Rights:

Office for Civil Rights 200 Independence Avenue, SW, Room 509F

Washington, DC 20201

Phone: 1-800-368-1019

I acknowledge I have read and or received this NPP form

Patient's Signature: __________________________________________________________________________

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