Privacy Policy
Last Updated: October 3, 2025
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.
1. Dental Practice Covered by this Notice
This Notice describes the privacy practices of Worthington Family Dental ("Dental Practice"). "We" and "our" means the Dental Practice. "You" and "your" means our patient.
2. How to Contact Us / Our Privacy Official
If you have any questions or would like further information about this Notice, you can contact Worthington Family Dental Privacy Official at:
admin@worthingtonfamilydental.com
3. Our Promise to You and Our Legal Obligations
The privacy of your health information is important to us. We understand that your health information is personal and we are committed to protecting it. This Notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.
Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
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 with respect to that information; and
- Abide by the terms of our Notice that is currently in effect.
4. How We May Use or Disclose Your Health Information
Common Uses and Disclosures
Treatment
We may use your health information to provide you with dental treatment or services, such as cleaning or examining your teeth or performing dental procedures. We may disclose health information about you to dental specialists, physicians, or other health care professionals involved in your care.
Payment
We may use and disclose your health information to obtain payment from health plans and insurers for the care that we provide to you.
Health Care Operations
We may use and disclose health information about you in connection with health care operations necessary to run our practice, including review of our treatment and services, training, evaluating the performance of our staff and health care professionals, quality assurance, and business planning.
Appointment Reminders
We may use or disclose your health information when contacting you to remind you of a dental appointment. We may contact you by using a postcard, letter, phone call, voice message, text or email.
Disclosure to Family Members and Friends
We may disclose your health information to a family member or friend who is involved with your care or payment for your care if you do not object or, if you are not present, we believe it is in your best interest to do so.
Disclosure to Business Associates
We may disclose your protected health information to our third-party service providers that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. All of our business associates are obligated, under contract with us, to protect the privacy of your information.
5. Your Rights with Respect to Your Health Information
You have the following rights with respect to your health information. To exercise any of these rights, you must submit a written request to our Privacy Official.
Right to Access and Review
You may request to access and review a copy of your health information. We may charge a reasonable fee to cover our cost to provide you with copies of your health information.
Right to Amend
If you believe that your health information is incorrect or incomplete, you may request that we amend it.
Right to Restrict Use and Disclosure
You may request that we restrict uses of your health information. If you pay out of pocket in full for a service and request that we not submit the claim to your health insurer, we must honor that request.
Right to an Accounting of Disclosures
You have a right to receive an accounting of disclosures of your health information for the six (6) years prior to the date that the accounting is requested.
Right to a Paper Copy of this Notice
You have the right to a paper copy of this Notice. You may ask us to give you a paper copy at any time.
Right to Receive Notification of a Security Breach
We are required by law to notify you if the privacy or security of your health information has been breached. The notification will occur by first class mail within sixty (60) days of the event.
6. Website Privacy
We do not use tracking cookies, analytics, or third-party advertising on our website. Any information you submit through contact forms on our website is sent directly to us and is not shared with third parties.
Information collected from our website may include your name, email address, phone number, and any message content you provide. This information is used solely to respond to your inquiries and provide requested services.
7. Our Right to Change Our Privacy Practices
We reserve the right to change the terms of this Notice at any time. Any change will apply to the health information we have about you or create or receive in the future. We will post the revised Notice on our website and in our office. The effective date of this Notice is October 3, 2025.
8. How to Make Privacy Complaints
If you have any complaints about your privacy rights or how your health information has been used or disclosed, you may file a complaint with us by contacting our Privacy Official at admin@worthingtonfamilydental.com.
You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you in any way if you choose to file a complaint.
Questions?
If you have questions about this Privacy Policy, please contact us:
Worthington Family Dental
6649 N. High Street, Suite 201
Worthington, OH 43085
Phone: 614-436-8336
Email: admin@worthingtonfamilydental.com