Privacy Policy
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Notice of Privacy Practices
Last updated February 16, 2026
Notice of Privacy Practices
YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSABILITIES.
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.
Your Rights:
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsabilities to help you.
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information, usually within 30 days of your request, or in compliance with state law. We may charge a reasonable, cost-based fee.
- You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
- We may say “no” to your request, but we will tell you why in writing within 60 days.
- You can ask us to contact you in a specific way (for example, home or office phone) or send mail to a different address.
- We will say “yes” to all reasonable requests.
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive this notice electronically. We will provide you with a paper copy promptly.
- You can ask us NOT to use or share certain health information for treatment, payment, or our operations.
- We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
- We will say “yes” unless a law requires us to share that information.
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).
- We’ll provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
- You can complain if you feel we have violated your rights by contacting us.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
Your Choices
For certain health information you cant tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
- We can use your dental information and share it with other professionals who are treating you.
- We can use and share your health information to run our practice, improve your care, and contact you when necessary.
- We can use and share your health information to bill and get payment from dental plans or other entities.
How else can we use or share your health information? We are allowed or required to share your information in other ways—usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
- For workers’ compensation claims
- For law enforcement purposes
- With health oversight agencies
- For special government functions
- We can use or share your information for health research
- We will share information if required by state or federal law
- We can share health information with organ procurement organizations
- We can share information when an individual dies
- We can share information in response to a court or administrative order
- We may share PHI with students working in our Practice
- If you do not wish a student to observe, notify your provider
- The dental practice uses artificial intelligence to improve efficiency, accuracy and patient outcomes.
☐ AI in use
☐ AI not in use
- We may contact you as a reminder of your appointment
- Limited information may be left on voicemail or shared
- We may use automated reminder systems
- We may send letters or post cards
- You may provide preferred contact methods
- Reminders are part of treatment and do not require authorization
- Reasonable requests will be accommodated
Redisclosure: Protected health information disclosed to our practice pursuant to federal HIPAA requirements may be subject to further disclosure by the recipient and, if redisclosed, may no longer be afforded protection under applicable federal or state laws.
Privacy / Security Officer: Sylvia Salazar
Practice Name: Renew Dental
Practice Address: 1835 Madison St. Suite A, Clarksville, TN 37043
Practice Phone: 931-291-9373
Privacy / Security Officer Email: office@renewdentaltm.com
Our Responsibilities:
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information visit:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The amended notice will be available upon request, in our office, and when a website is available.
