Notice of Privacy Practices

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.

Effective Date: September 18th, 2026

Who This Notice Applies To

This Notice describes the privacy practices of Espire Dental Management, LLC and the dental practices it supports, which operate together as a single affiliated covered entity for purposes of the federal Health Insurance Portability and Accountability Act (“HIPAA”). Throughout this Notice, “we,” “us,” and “our” refer to those practices and their workforce.

This Notice applies to all Espire Dental practice locations. A current list of our locations is available at www.espiredental.com/locations.

The practices covered by this Notice may share your protected health information with one another as needed for treatment, payment, and health care operations, as described below.

Our Commitment to Your Privacy

We understand that information about you and your health is personal. We are committed to protecting it. We create a record of the care and services you receive so we can provide quality care and meet legal requirements. This Notice explains how we may use and share that information, and it describes your rights regarding it.

We are required by law to:

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

“Protected health information” means information that identifies you and relates to your past, present, or future physical or dental health, the care you receive, or payment for that care. It includes information such as your name, address, phone number, email address, date of birth, insurance details, and your dental records.

How We May Use and Share Your Health Information

For Treatment

We may use your health information to provide, coordinate, and manage your dental care. We may share it with other providers involved in your care, such as an orthodontist, oral surgeon, endodontist, periodontist, laboratory, imaging provider, or your physician. For example, if you are referred to an oral surgeon, we may send that surgeon relevant records and imaging.

For Payment

We may use and share your health information to bill and collect payment for the care you receive. For example, we may share information with your dental or medical insurance plan to confirm coverage and benefits, obtain prior authorization, or submit a claim. We may also share information with a third party responsible for your bill, or with a billing or collection service acting on our behalf.

For Health Care Operations

We may use and share your health information to run our practices and improve the care we provide. For example, we may use it for quality review, staff training and evaluation, licensing and accreditation, business planning, and administrative activities. We may share information with certifying, licensing, and accrediting bodies such as state dental boards.

Within Our Practices

Members of our workforce who have a role in your treatment, billing, or the operation of our practices may access your information as needed to do their jobs.

To Business Associates

We may share your information with vendors who perform services for us, such as billing companies, practice management and electronic record systems, imaging services, and IT support. We require each of them by written contract to protect your information.

Appointment Reminders, Treatment Alternatives, and Health-Related Services

We may contact you to remind you of an appointment, to tell you about treatment alternatives, or to describe health-related benefits and services that may be of interest to you. We may do this by phone, text message, email, or mail, using the contact information you have given us.

To People Involved in Your Care

We may share information relevant to your care with a family member, friend, or other person you identify as involved in your treatment or payment. If you are present and able to make decisions, we will give you the opportunity to object first. If you are not present or are unable to agree, we will use our professional judgment to decide whether sharing is in your best interest.

Incidental Disclosures

Despite our safeguards, it is possible that other patients or visitors may overhear or see limited information in the course of normal operations, such as at a front desk or in a treatment area. We take reasonable steps to limit this.

Other Uses and Disclosures Permitted or Required by Law

We may use or share your health information without your authorization in the following circumstances:

As required by law, including under federal, state, or local law
Public health activities, such as reporting disease, injury, vital events, or product problems to public health authorities
Reporting abuse, neglect, or domestic violence to authorities authorized to receive it
Health oversight activities, such as audits, investigations, inspections, and licensure actions
Judicial and administrative proceedings, in response to a court or administrative order, or to a subpoena or discovery request where required assurances have been given
Law enforcement purposes, in the limited circumstances permitted by law
Coroners, medical examiners, and funeral directors, to carry out their duties
Organ and tissue donation, to organizations that handle procurement or transplantation
Research, where an institutional review board or privacy board has approved the use, or in other limited circumstances permitted by law
To avert a serious threat to the health or safety of you or others
Workers’ compensation, as authorized by and to the extent necessary to comply with workers’ compensation laws
Military, veterans, national security, and protective services, as required by law
Correctional institutions, if you are an inmate, as permitted by law
To you, and to the U.S. Department of Health and Human Services when it is investigating our compliance with privacy laws

Uses and Disclosures That Require Your Written Authorization

The following uses and disclosures will be made only with your written authorization:

Marketing. Most uses and disclosures of your health information for marketing purposes require your written authorization.
Sale of your information. We will not sell your protected health information without your written authorization.
Psychotherapy notes. Most uses and disclosures of psychotherapy notes, if any exist in your record, require your written authorization.

Any other use or disclosure not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time by submitting your revocation in writing to the contact listed at the end of this Notice. A revocation will not apply to information we have already used or shared in reliance on your authorization.

State Law and More Protective Rules

In addition to HIPAA, state and other federal laws may provide additional privacy protections or give you additional rights concerning your health information. When a law that applies to your health information provides greater privacy protection or additional rights than HIPAA, we will follow that law.

These additional protections may vary depending on the state in which you receive care and the type of health information involved. For example, additional protections may apply to certain information relating to mental health, substance use disorder treatment, HIV or other communicable diseases, genetic information, reproductive health care, and health care provided to minors.

Additional information regarding state-specific privacy rights and protections applicable to the Espire Dental practice where you receive care is provided in the State-Specific Privacy Addendum to this Notice.

Your Rights Regarding Your Health Information

You have the following rights regarding the health information we maintain about you.

Right to Request Restrictions

You may ask us to limit how we use or share your health information for treatment, payment, or health care operations, or to limit what we share with someone involved in your care. We are not required to agree to every request. However, we are required to agree to one type of request: if you pay in full, out of pocket, for a service, you may ask us not to share information about that service with your health plan, and we will honor that request unless the law requires us to share it.

Right to Request Confidential Communications

You may ask us to communicate with you about your health in a specific way or at a specific location. For example, you may ask that we contact you only by mail, or only at a particular phone number. We will accommodate reasonable requests, and we will not ask you why you are making the request.

Right to Inspect and Get a Copy

You have the right to inspect and get a copy of your dental records and billing records. If we maintain your records electronically, you may request an electronic copy. You may also ask us to send a copy to a person or organization you designate. We will respond within 30 days, and we may charge a reasonable, cost-based fee. In limited circumstances we may deny a request, and you may ask that the denial be reviewed.

Right to Request an Amendment

If you believe information in your record is incorrect or incomplete, you may ask us to amend it. Your request must be in writing and must explain why the change should be made. We may deny your request in certain circumstances, and if we do, you have the right to submit a written statement of disagreement that we will include with your record.

Right to an Accounting of Disclosures

You may request a list of certain disclosures we have made of your health information. This list does not include disclosures made for treatment, payment, or health care operations, disclosures made to you or with your authorization, and certain other disclosures. You may request an accounting covering up to six years. The first request in any 12-month period is free, and we may charge a reasonable fee for additional requests.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this Notice at any time, even if you agreed to receive it electronically. Ask any staff member and we will provide one.

Right to Be Notified of a Breach

You have the right to be notified if a breach occurs that may have compromised the privacy or security of your health information.

How to Exercise These Rights

To exercise any of these rights, contact us using the information at the end of this Notice. Most requests must be made in writing.

Changes to This Notice

We reserve the right to change this Notice and to make the revised Notice effective for health information we already have as well as information we receive in the future. The current Notice will always be posted on this page and displayed in our offices, with its effective date. You may request a copy of the current Notice at any time.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you in any way for filing a complaint.

To File a Complaint With Us

Troy Stone, CHRO
Espire Dental
7995 E Prentice Ave, Ste 211
Greenwood Village, CO 80111
Phone: 503.501.9508
Email: tstone@espiredental.com

To File a Complaint With the Federal Government

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue SW, Room 509F
HHH Building, Washington, D.C. 20201
Phone: 1-800-368-1019 (TDD: 1-800-537-7697)
Online: ocrportal.hhs.gov

A complaint to the Office for Civil Rights must generally be filed within 180 days of when you knew or should have known that the violation occurred.

Questions

If you have any questions about this Notice or about how we handle your health information, please contact Troy Stone at tstone@espiredental.com.