Texarkana, TX 75503
Endo (903) 792-3636 Ortho (903) 793-0055 Fax (903) 792-0062
Sandra Shambarger, DDS MS-Endodontist
James Shambarger, DDS MS-Orthodontist
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully. This information is made available upon request by a patient.
We understand that your dental health information is personal and we are committed to protecting any information about you. As our patient, we create dental records about your dental health, our care for you, and the services and/or items that we provide to you. By law, we are required to make sure that your Protected Health Information is kept private.
The following are ways in which we could use or disclose your information. All information is shared thru mail, phone or email.
· For dental treatment
· For appointment and patient recall reminders
· In response to requests arising from lawsuits or other disputes
· To avert a serious threat to health or safety
· In emergency situations
· Correspondence to your other dentist office in regards to insurance and/or payment information
· To run our practice more efficiently and ensure all patients receive quality care
If you believe that your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the Practice, contact the office manager. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
You have certain rights regarding the information that we maintain about you. These rights include:
· The right to inspect and copy
· The right to amend
· The right to request restrictions
· The right to a paper copy of this notice
· The right to request confidential communications