South Mountain Family Dentistry

Effective Date: 02/04/2026

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

OUR COMMITMENT TO YOUR PRIVACY

At South Mountain Family Dentistry, we are committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (PHI) and to provide you with this Notice explaining our legal duties and privacy practices.

USES AND DISCLOSURES OF YOUR HEALTH INFORMATION

Treatment: To provide, coordinate, or manage your dental care.

Payment: To bill and collect payment from you or your insurance company.

Healthcare Operations: For practice operations such as quality assessment, training, and administrative purposes.

OTHER PERMITTED USES AND DISCLOSURES

We may also use or disclose your health information when required by law, including public health activities, legal proceedings, or law enforcement purposes, as permitted by applicable regulations.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the right to:
– Request access to or a copy of your health records
– Request corrections to your health information
– Request restrictions on certain uses or disclosures
– Request confidential communications
– Receive a paper copy of this Notice upon request

QUESTIONS OR COMPLAINTS

Privacy Officer: Crystal Fox
Phone: 828-522-9995
Address: 600 Malcolm Blvd

                  Connelly Springs, NC 28612

Email: southmountainfamiilydentistry@gmail.com