Koneru Family Dentistry — Notice of Privacy Practices (HIPAA)

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

July 21, 2026

Your Information. Your Rights. Our Responsibilities.

Your Rights
When it comes to your health information, you have certain rights. You have the right to:

  • Get a copy of your paper or electronic dental record
  • Correct your paper or electronic dental record
  • Request confidential communications (how and where we contact you)
  • Ask us to limit the information we share
  • Get a list (accounting) of certain disclosures we’ve made
  • Get a copy of this privacy notice
  • Choose someone to act for you (power of attorney, legal guardian, etc.)
  • File a complaint if you believe your privacy rights have been violated

Your Choices
You have some choices in the way that we use and share information as we:

  • Communicate with family and friends involved in your care
  • Contact you with appointment reminders
  • Tell you about treatment options or services that may benefit you
  • Conduct fundraising communications (if applicable)
  • Use your information for marketing (we need your written permission in most cases)

Our Uses and Disclosures
We may use and share your health information as we:

  • Treat you
  • Run our practice
  • Bill for your services
  • Help with public health and safety issues
  • Comply with the law
  • Respond to lawsuits and legal actions
  • Address workers’ compensation, law enforcement, and certain government requests

Important SUD (Part 2) Notice:
To the extent that we have any substance use disorder (SUD) patient records that are protected
by 42 CFR Part 2, we will not use or disclose that information for civil, criminal, administrative,
or legislative investigations or proceedings against you without (1) your written consent or (2)
a court order and a subpoena, as required by law.

I. Who This Notice Applies To
This Notice describes the privacy practices of Koneru Family Dentistry (“we,” “us,” or “our”). It
applies to the dental services we provide and the records we maintain about you in our
practice.

II. How to Contact Us / Privacy Official
If you have questions about this Notice or want to exercise your rights, contact our Privacy
Official:

Ashly H.
Email: info@mouthhealer.com

Koneru Family Dentistry — Privacy Official
4703 Western Boulevard
Raleigh, NC 27606
(919) 851-9690

III. Our Responsibilities
We are required by law to:

  • Maintain the privacy and security of your protected health information
  • Provide you with this Notice of our legal duties and privacy practices
  • Follow the terms of the Notice currently in effect
  • Notify you promptly if a breach occurs that may have compromised the privacy or
    security of your information

We will not use or share your information other than as described in this Notice unless you tell
us we can in writing. If you tell us we can, you may change your mind at any time. Let us know
in writing if you change your mind.

IV. How We Typically Use or Share Your Health Information

1) Treat You
We can use your health information and share it with other professionals who are treating you.

Example: We share x-rays or clinical notes with a specialist you are referred to.

2) Run Our Practice
We can use and share your health information to run our practice, improve your care, and
contact you when necessary.

Examples: Quality improvement, training, care coordination, internal audits, legal compliance,
and business operations.

3) Bill for Your Services
We can use and share your health information to bill and get payment from health plans or
other entities.

Example: We submit information to your dental plan so it can pay for your treatment.

V. Appointment Reminders and Practice Communications

We may contact you to remind you about appointments or follow-up care. We may contact you
by phone, voicemail, text message, email, or mail unless you tell us you prefer another method.

VI. How Else We Can Use or Share Your Health Information
We are allowed or required to share your information in other ways—usually in ways that
contribute to the public good (for example, public health and safety). We must meet conditions
in the law before we can share your information for these purposes.

Public Health and Safety
We can share health information about you for certain situations such as:

  • Preventing disease
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

Comply With the Law
We will share information about you if state or federal laws require it, including with the U.S.
Department of Health and Human Services if it wants to see that we’re complying with federal
privacy law.

Law Enforcement and Government Requests
We may disclose health information as permitted by law for:

  • Law enforcement purposes
  • Health oversight activities
  • National security and protective services
  • Workers’ compensation claims

Lawsuits and Legal Actions
We can share health information about you in response to a court or administrative order, or in
response to a subpoena or lawful process as permitted by law.

VII. Uses and Disclosures That Require Your Written Authorization
We will obtain your written permission (authorization) before using or disclosing your
information for purposes not described in this Notice, unless otherwise permitted or required
by law.
In particular, we generally need your written authorization for:

  • Most marketing communications not otherwise permitted by HIPAA
  • Sale of protected health information (PHI)
  • Most sharing of psychotherapy notes (if applicable)

You may revoke your authorization at any time in writing, except to the extent we have already
acted in reliance on it.

VIII. Your Rights in Detail

Get a Copy of Your Medical/Dental Record
You can ask to see or get an electronic or paper copy of your dental record and other health
information we have about you. Ask us how to do this.
We will provide a copy or a summary, usually within 30 days. We may charge a reasonable, costbased
fee.

Ask Us to Correct Your Record
You can ask us to correct health information about you that you think is incorrect or incomplete.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request Confidential Communications
You can ask us to contact you in a specific way (for example, only by cell phone) or to send mail
to a different address.
We will say “yes” to all reasonable requests.

Ask Us to Limit What We Use or Share
You can ask us not to use or share certain health information for treatment, payment, or
operations. We are not required to agree, and we may say “no” if it could affect your care.
If you pay out-of-pocket in full for a service, you can ask us not to share that information with
your health insurer for payment or our operations. We will say “yes” unless a law requires us to
share it.

Get a List of Those With Whom We’ve Shared Information
You can ask for a list (accounting) of certain disclosures of your health information for six years
prior to the date you ask, who we shared it with, and why.
We will provide one accounting per 12 months for free; we may charge a reasonable, cost-based
fee for additional requests.

Get a Copy of This Notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive it
electronically. We will provide you a copy promptly.

Choose Someone to Act for You
If someone has legal authority to act for you (legal guardian, medical power of attorney), that
person can exercise your rights and make choices about your health information. We will verify
authority before taking action.

IX. Special Protections for Certain Types of Information
Certain federal and state laws may provide additional protections for sensitive health
information (for example, certain mental health information, genetic information, or substance
use disorder records). If additional protections apply, we will follow the more stringent
requirements.

X. File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with us using the
contact information above.
You may also file a complaint with the U.S. Department of Health and Human Services, Office
for Civil Rights (OCR). We will not retaliate against you for filing a complaint.

XI. 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 updated Notice will be available upon request, in our office, and on our website.

Koneru Family Dentistry

Online Privacy Policy

Last revised: March 7, 2025

Thank you for visiting our website. Koneru Family Dentistry is committed to respecting your online privacy. The following privacy policy sets forth how we use personal information collected at this site. Please read the entire privacy policy before using the site or submitting any of your personal information. When you use the site, you are accepting the practices described in this policy. The privacy practices may be changed in the future. Any changes will be posted and changes will only apply to activities and information in the future, not retroactively. Please review the privacy policy every time you visit our site to understand how personal information you provide will be used.

Collected Information
We collect personal information such as names, phone numbers, email addresses, etc., only when voluntarily submitted by our visitors. The information you provide is only used to fulfill your particular request unless you give us permission to use it in another manner.

Terms & Conditions
By providing your phone number by phone or online, you consent to receive SMS text messages from Koneru Family Dentistry. Message and data rates may apply. You may reply STOP to opt out of messages.

Shared Information
We may share information with government agencies or any other companies assisting us in fraud prevention or investigation. We may do so when permitted or required by law or when investigating fraud that has already taken place. We also may use other businesses to perform certain services for us, such as maintaining our site and our email services and processing inquiries. We may provide personal information to those businesses when that information is necessary for them to complete a requested transaction or otherwise perform their duties. We will not sell or share your personal information with any unaffiliated third parties for marketing purposes.

Collective Data
Occasionally, we may collect statistical and non-personal information about the use of the site. This information may include how many visitors visit a specific page on the site, how long they stay there, and which hyperlinks they visit. We collect this information to determine which areas of the site are most popular and where to enhance the site for our visitors. This collective data may be used to describe the use of our site to third parties or in response to a government request. However, this data will not personally identify you or any other of our website visitors.

Links to Other Sites
While visiting our site, it is possible that you could be directed (via hyperlink or other means) to other sites that are outside of our control. These other websites may send their own cookies to visitors, collect data, or solicit your personal information. It is important that you read the privacy policies of these other sites before using them. We are not responsible for the privacy practices of other websites and cannot guarantee the security of any personal information that is collected on those other sites.

Contact Us
We reserve the right to make changes to our privacy policy. Any changes to this privacy policy will be posted here. If you have any questions or concerns about our Privacy Policy, please contact us at:

Koneru Family Dentistry

4703 Western Blvd.
Raleigh, NC 27606

919-851-9690