Patient Privacy Notices

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. This notice is provided by Chena Dental Care LLC.

As a patient of Chena Dental Care, you have the right to: • Consent to uses and disclosures of your health information • Request limitations on how your information is shared • Obtain a copy of this notice • File a complaint if you believe your privacy has been violated • Request a list of those who have received your electronic health records • Access and obtain copies of your health records • Request corrections to your health information

We may use or share your health information without additional consent for the following purposes: • Treatment coordination between providers involved in your care • Payment processing with your insurance provider • Healthcare operations including quality improvement and staff training • Emergency response when necessary to prevent a serious threat to health or safety • Public health reporting as required by law • Research purposes (with appropriate safeguards) • Audits and compliance activities • Law enforcement purposes when required by law or court order

You have choices about how we use and share your information: • You may provide a single or limited consent for treatment, payment, and healthcare operations • You may request restrictions on how we share your information, though we may decline if it would affect your care • If you pay out-of-pocket in full for a service, you may request that we not share that information with your insurer

Under Alaska law, our staff are required to report suspected child abuse, neglect, sexual exploitation, and mental injury to the appropriate authorities.

Your health information requires your written consent or a court order for use in legal proceedings. We will not provide testimony without these protections in place.

Chena Dental Care is required to: • Obtain your consent before using your health information • Maintain the security of your protected health information • Notify you of any breaches affecting your information • Follow the privacy practices described in this notice • Provide you with a copy of this notice upon request

If you have questions about this notice or wish to file a complaint, please contact: Chena Dental Care LLC Attn: Privacy Administrator 2933 Horseshoe Way, North Pole, Alaska 99705 Phone: (907) 488-0861 Email: privacy@chenadentalcare.com