Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Effective date: November 6, 2026. A printed copy is available at our front desk.

Your rights

When it comes to your health information, you have the right to:

• Get a copy of your dental and health records, electronic or paper. We provide a copy or summary, usually within 30 days, and may charge a reasonable, cost-based fee.
• Ask us to correct your records if you think they are incorrect or incomplete. We may say no, but we’ll tell you why in writing within 60 days.
• Request confidential communications, such as contacting you at a different phone number or address. We will say yes to all reasonable requests.
• Ask us to limit what we use or share. We are not required to agree, except that if you pay for a service in full out of pocket, you can ask us not to share it with your health insurer.
• Get a list of those with whom we’ve shared your information for the six years before your request, with certain exceptions.
• Get a copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you, such as a medical power of attorney or legal guardian.
• File a complaint if you feel your rights are violated (see below).

Your choices

You can tell us whether we may share information with family, close friends or others involved in your care, or in a disaster-relief situation. We never sell your information or use it for marketing without your written permission.

How we use and share your information

• To treat you, for example sharing X-⁠rays with a specialist we refer you to.
• To run our practice, for example appointment reminders and quality improvement.
• To bill for your services, for example sending claims to your dental insurance or Illinois Medicaid plan.
• As the law allows or requires, including public health and safety, health oversight, responding to lawsuits and legal actions, law enforcement, workers’ compensation, and to comply with federal and Illinois law.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time in writing.

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 on request, in our office and on our website.

Questions or complaints

Contact our Privacy Officer at (630) 549-⁠7916 or Bliss Dental Center, 1400 Lincoln Highway, Suite B, St. Charles, IL 60174. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue SW, Washington, DC 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

This website’s own data practices (analytics, forms and cookies) are described in our website privacy policy.