Schmidt and Berkers Family Dentistry

Effective Date: 1/1/2026

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.

Our Legal Duty

We are required by applicable federal (HIPAA) and Wisconsin state law (Wis. Stat. § 146.81-84) to maintain the privacy of your protected health information (PHI). We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your PHI.

Uses and Disclosures of Health Information

We use and disclose health information about you for treatment, payment, and healthcare operations. For example:

  • Treatment: We may disclose your PHI to a specialist, such as an orthodontist or oral surgeon, to whom we have referred you for care.
  • Payment: We may use and disclose your PHI to obtain payment for services we provide to you (e.g., submitting a claim to your dental insurance).
  • Healthcare Operations: We may use your PHI in connection with our healthcare operations, which include quality assessment and improvement activities and provider reviews.
  • Substance Use Disorder (SUD) Records: In accordance with the 2026 HIPAA Final Rule, any records regarding SUD treatment we receive or create are afforded special protection. We will obtain your written consent before disclosing these records for any purpose except as permitted by 42 CFR Part 2.

Your Rights Regarding Your PHI

  • Access: You have the right to look at or get copies of your health information, with limited exceptions. (Note: Under Wisconsin law, we may charge a reasonable, cost-based fee for copies).
  • Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your PHI for purposes other than treatment, payment, or healthcare operations.
  • Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your PHI.
  • Electronic Notice: If you receive this notice on our website or by email, you are entitled to receive this notice in written form upon request.

Questions and Complaints

If you want more information about our privacy practices or have questions/concerns, please contact us. If you are concerned that we may have violated your privacy rights, you may complain to us using the contact information below.

You also may submit a written complaint to the U.S. Department of Health and Human Services. We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint.

 

Privacy Officer: Abigail Scott
Telephone: (920)766-9521
Address: 1401 Arbor Way Kaukauna, WI 54130