Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW DENTAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

Effective Date: February 16, 2026
Last Updated: September 30, 2026

Before You Read

We wrote this in plain, everyday English – because you deserve to actually understand how your personal health information is handled at our practice. Legal documents can be hard to get through, and we do not believe in hiding important information behind complicated language. If anything here is unclear, please ask us at your next visit. We are happy to explain it in person.

Who This Notice Applies To

Elegant Smiles

2882 N. Druid Hills Rd, Suite A, Atlanta, GA 30329
elegantsmiles@dentalatl.com
(404) 634-4224
dentalatl.com

1. Our Legal Responsibility

Federal law – the Health Insurance Portability and Accountability Act, commonly known as HIPAA – requires us to protect your health information and tell you clearly how we use it. We are legally obligated to:

Keep your health information private and secure at all times
Follow the terms described in this Notice
Notify you promptly if your health information is ever involved in a data breach
Provide you a copy of this Notice when you first become our patient, and any time you request one afterward

We will never sell your health information. We will never use it for advertising or marketing purposes without your specific written permission.

2. How We Use and Share Your Health Information

There are three standard situations where we can use or share your dental health information without asking for your written permission first. These are required under HIPAA and apply to every dental practice across the country.

For Your Dental Treatment
We use your records to examine your teeth, make diagnoses, build treatment plans, prescribe medications, and coordinate your care. We offer a full range of dental services – general, cosmetic, restorative, emergency, and pediatric dentistry – and accurate records are essential to delivering the right care at every visit. If we refer you to a specialist or another provider within our network, we may share relevant records like X-rays or treatment notes so they are fully prepared before your appointment.

For Billing and Payment
We share necessary information with your dental insurance company to submit claims and collect payment. This includes details about what treatment you received, when, and what it cost. We are in-network with most major PPO dental insurance plans – including Aetna, Delta Dental, Cigna, Humana, MetLife, Blue Cross Blue Shield, United Healthcare, and others. If you use third-party financing to cover treatment costs, we may also share what is needed to process those transactions.

For Running Our Practice
We use your information internally for routine activities – staff training, quality reviews, financial audits, and general administration. We may contact you by phone, text, or email to remind you about upcoming appointments or let you know it is time to schedule a routine checkup. If you prefer a different contact method, just tell us and we will use it going forward.

3. Other Situations Where We May Share Without Permission

Beyond treatment, payment, and operations, there are situations where the law either permits or requires us to share your information without asking you first. These do not come up often, but you should be aware they exist:

Reporting to public health authorities for disease control and community safety
Responding to a court order, subpoena, or other legal proceeding
Cooperating with law enforcement investigations when required by law
Complying with government oversight programs such as Medicare or Medicaid audits
Reporting suspected abuse, neglect, or domestic violence to appropriate authorities
Sharing information with a medical examiner, coroner, or funeral director when legally required
Supporting organ and tissue donation organizations when applicable
Disclosures necessary to prevent a serious and imminent threat to health or safety

Unless you tell us otherwise, we may also share relevant information about your care with a family member or close friend who is actively involved in helping you with your dental treatment.

4. Substance Use Disorder Records – 2026 Federal Requirement

As of February 16, 2026, federal law requires all dental practices to specifically address how they handle substance use disorder records in their Notice of Privacy Practices. This follows updated HIPAA regulations under 42 CFR Part 2.

What are substance use disorder records?
These are records related to a patient’s identity, diagnosis, or treatment for a substance use disorder that originate from a federally assisted treatment program – such as an addiction treatment or recovery facility.

What this means for our patients:
Elegant Smiles does not create substance use disorder records. However, we may occasionally receive them as part of coordinating your overall medical care with another provider.

When we do receive such records, here is how they are handled:

We can use them for treatment, payment, and standard healthcare operations – the same as other health records. However, these records carry stronger legal protections in specific situations. We cannot disclose them in legal proceedings against you without your written consent or a valid court order – even if we receive a subpoena. This is a higher level of protection than what standard health records typically receive.

If you have specific questions about how your records are handled, please contact our Privacy Officer directly.

5. Everything Else Requires Your Written Permission

For any use or disclosure of your health information not described above, we will ask you to sign a written authorization form before sharing anything. This includes:

Marketing communications from third-party companies
Sharing your information with your employer
Any disclosures not directly related to your dental care

You can withdraw a written authorization at any time by notifying us in writing. We will honor that request going forward. We cannot undo disclosures already made based on your earlier permission.

6. Your Rights Over Your Health Information

HIPAA gives you real, specific rights over your personal health information. Here is exactly what you can do – and how to exercise each right.

See or Get a Copy of Your Records
You can ask to review your dental and billing records in person, or request a printed or electronic copy. We will respond within 30 days of your request. If we deny access for a legally permitted reason, we will explain why in writing and tell you how to appeal that decision.

Ask Us to Correct Your Records
If you believe something in your records is wrong or incomplete, you can ask us to correct it. We have up to 60 days to respond. If we agree, we will update the record and notify any relevant parties who received the incorrect version. If we do not agree, you have the right to add a written statement of disagreement directly to your file – and we will include it whenever those records are shared going forward.

Request Restrictions on How We Use Your Information
You can ask us to limit certain uses or disclosures of your health information – for example, asking us not to share details about a procedure you paid for entirely out of pocket with your insurance plan. We are not always required by law to agree, but if we do, we will honor that restriction without exception.

Ask Us to Contact You Differently
If you prefer we call your cell phone instead of your home number, mail things to a specific address, or reach you only by email – just tell us. We will make reasonable accommodations. You do not need to provide an explanation.

Get a Record of Disclosures
You can request a list of times we shared your health information outside our office over the past six years. This list will not include routine disclosures for treatment, payment, or operations – but will cover other disclosures we have made. You are entitled to one free list per year. Additional requests may carry a small administrative fee.

Get a Paper Copy of This Notice
Even if you received this Notice electronically or signed it digitally at intake, you can request a printed copy at any time – no explanation needed. Just ask at the front desk or contact us directly.

Be Notified of a Data Breach
If your health information is ever involved in a security breach, federal law requires us to notify you promptly. We will always follow this requirement without delay.

7. How to Exercise Your Rights

To make any of the requests described above, please contact us in writing. We are also happy to walk you through the process in person or over the phone if that is easier for you.

Elegant Smiles – Dr Dipesh

2882 N. Druid Hills Rd, Suite A, Atlanta, GA 30329
elegantsmiles@dentalatl.com
(404) 634-4224
dentalatl.com

We will confirm receipt of your request and respond within the timeframes required by law.

8. How to File a Complaint

If you believe we have not properly protected your health information or respected your privacy rights, you have two options – and you are fully protected either way.

Contact Us Directly
Reach out to our Privacy Officer using the contact information above. We take every concern seriously and will respond promptly. We will not retaliate against you – in any way – for raising a concern or filing a complaint. Your care will never be affected.

Contact the Federal Government
You may also file a complaint directly with the U.S. Department of Health and Human Services:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue SW, Washington, D.C. 20201
+1-800-368-1019 (toll-free)
www.hhs.gov/ocr/privacy/hipaa/complaints

Filing a complaint with either us or the federal government will never affect the quality of care you receive at Elegant Smiles or any of our partner locations.

9. Changes to This Notice

We reserve the right to update this Notice at any time as required or permitted by law. If we make material changes, the updated version will be:

Posted visibly in our office waiting area
Available at the front desk upon request
Published on our website at dentalatl.com

Any updated version applies to all health information we hold – both past records and anything created going forward. The effective date at the top of this Notice always reflects when the current version took effect.

10. Questions?

We want you to feel genuinely informed and comfortable about how your health information is handled. If anything in this Notice is unclear, please ask us before or after your next appointment – or call us anytime during office hours.

Elegant Smiles