NOTICE OF PRIVACY PRACTICES
Effective Date: 01/01/2026
THIS NOTICE DESCRIBES HOW MEDICAL AND DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
OUR COMMITMENT TO YOUR PRIVACY
Aqua Dental is required by law to maintain the privacy of your protected health information (PHI), provide this Notice of our legal duties and privacy practices, and follow the terms of this Notice.
HOW WE MAY USE AND DISCLOSE YOUR INFORMATION
We may use and disclose your PHI without authorization for: Treatment (providing and coordinating dental care); Payment (billing and collection); and Healthcare Operations (quality assessment, training, licensing, and administrative activities).
SPECIAL CONFIDENTIALITY
Certain information, including some substance use disorder–related records if applicable, may be subject to additional federal confidentiality protections and will be used or disclosed only as permitted by law.
OTHER USES AND DISCLOSURES
Uses or disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except where we have already relied on it.
YOUR RIGHTS
You have the right to inspect and obtain a copy of your records, request amendments, request restrictions, request confidential communications, and receive an accounting of certain disclosures.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services. No retaliation will occur.
PRIVACY OFFICER & CONTACT INFORMATION
Privacy Officer: Dr. Hadi
Phone: 248-780-0220
Email: admin@aquadentalmi.com
Address: 7755 Highland Rd, Unit 2
White Lake, MI 48383
This Notice is available in our office and upon request
