HIPAA Notice of Privacy Practices
Cheyenne Mountain Dentistry and Wellness
Effective Date: October 15, 2026
Your Information. Your Rights. Our Responsibilities.
THIS NOTICE DESCRIBES HOW MEDICAL AND DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
At Cheyenne Mountain Dentistry and Wellness, protecting your personal health information is an important part of providing quality dental care. We are committed to maintaining the privacy and security of your protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other applicable federal and Colorado laws.
This Notice of Privacy Practices explains your rights, our legal responsibilities, and how we may use or disclose your health information.
1. Your Rights Regarding Your Health Information
You have certain rights concerning the dental and medical information we maintain about you.
Access Your Dental Records
You have the right to request an electronic or paper copy of your dental records and other health information maintained in our designated record set.
We will generally provide the requested information within 30 days, subject to any legally permitted extension.
A reasonable, cost-based fee may apply as permitted by law.
Request Corrections to Your Records
If you believe information in your dental or medical records is inaccurate or incomplete, you may request an amendment.
We may deny certain requests when permitted by law, but we will provide a written explanation, generally within 60 days.
Request Confidential Communications
You may request that we communicate with you in a particular way or at a specific location.
For example, you may ask us to contact you using your mobile phone rather than your home phone or to send correspondence to an alternative mailing address.
We will accommodate reasonable requests.
Request Restrictions on Information Sharing
You may ask us to limit certain uses or disclosures of your health information for treatment, payment, or healthcare operations.
Although we are not required to agree to every request, we will consider your preferences.
If you pay for a healthcare service entirely out of pocket, you may request that information about that service not be disclosed to your health insurance plan for payment or healthcare operations. We will honor that request unless disclosure is required by law.
Request an Accounting of Disclosures
You may request an accounting of certain disclosures of your protected health information made during the six years preceding your request.
Certain disclosures, including many made for treatment, payment, and healthcare operations, are excluded.
One accounting is available free of charge within a 12-month period. Additional requests may be subject to a reasonable, cost-based fee.
Obtain a Copy of This Notice
You may request a paper copy of this Notice of Privacy Practices at any time, even if you previously agreed to receive it electronically.
Designate a Personal Representative
If someone has legal authority to act on your behalf, such as a legal guardian or an individual holding an appropriate healthcare power of attorney, that person may exercise your privacy rights as permitted by law.
We will verify the individual’s authority before providing access to protected information.
File a Privacy Complaint
If you believe your privacy rights have been violated, you may file a complaint with our office or the U.S. Department of Health and Human Services.
We will not retaliate against you for filing a complaint or exercising your privacy rights.
2. How We Use and Disclose Your Health Information
HIPAA permits certain uses and disclosures of protected health information without your separate written authorization.
Treatment
We may use and share your health information to provide, coordinate, and manage your dental care.
Examples include:
- Reviewing your dental and medical history
- Planning dental procedures and treatment
- Consulting with dental specialists or other healthcare providers
- Coordinating referrals
- Communicating with laboratories involved in your care
- Managing follow-up treatment
For example, we may share relevant dental records with an oral surgeon to whom you have been referred.
Payment
We may use and disclose health information to obtain payment for services provided.
Examples include:
- Submitting dental insurance claims
- Verifying insurance eligibility and benefits
- Processing payments
- Coordinating billing and reimbursement
- Responding to insurance-related inquiries
For example, we may provide treatment information to your dental insurance company to process a claim.
Healthcare Operations
We may use and disclose health information to support the daily operations of our dental practice.
Examples include:
- Quality improvement activities
- Staff training and supervision
- Practice management
- Patient service coordination
- Compliance reviews and audits
- Business administration
- Evaluating and improving patient care
For example, we may review patient treatment records to evaluate and improve the quality of services we provide.
3. Appointment Reminders and Patient Communications
We may use your contact information to communicate with you about your dental care.
Communications may include:
- Appointment reminders and confirmations
- Scheduling changes
- Treatment follow-up instructions
- Preventive dental care reminders
- Billing and account information
- Other communications related to your care
These communications may be delivered by telephone, email, mail, or text message, consistent with applicable law and your communication preferences.
Standard email and SMS communications may not be fully secure. You may request an alternative communication method by contacting our office.
For additional information regarding optional text messaging, please review our website Privacy Policy.
4. Other Permitted or Required Uses and Disclosures
Under certain circumstances, we may use or disclose protected health information without separate authorization when permitted or required by law.
These circumstances may include:
Public Health and Safety: Reporting certain diseases, adverse events, suspected abuse or neglect, or preventing or reducing a serious threat to health or safety.
Legal Compliance: Responding to lawful requirements imposed by federal or state law.
Health Oversight: Cooperating with authorized audits, investigations, inspections, and licensing activities.
Law Enforcement: Responding to qualifying requests from law enforcement officials when legally permitted or required.
Judicial and Administrative Proceedings: Responding to lawful court orders, subpoenas, or other legal processes when applicable privacy requirements are satisfied.
Workers’ Compensation: Disclosing information as authorized by workers’ compensation laws.
Medical Examiners and Funeral Directors: Providing information for legally authorized purposes.
Organ and Tissue Donation: Sharing information with authorized organ procurement organizations when applicable.
Research: Using or disclosing information for research when required HIPAA safeguards and conditions have been met.
Government Functions: Disclosures for certain military, national security, or other legally authorized government activities.
We will comply with applicable federal and Colorado privacy requirements, including any laws that provide greater protection for particular categories of health information.
5. Your Choices About Sharing Information
In certain circumstances, you may tell us your preferences about sharing your health information.
Family Members, Friends, and Caregivers
You may identify family members, friends, or other individuals who may receive information relevant to their involvement in your care or payment for your care.
If you cannot communicate your preferences, we may share limited information when permitted by law and when we determine it is in your best interest.
Disaster Relief
We may share limited information with authorized disaster relief organizations when appropriate and permitted by law.
Marketing Communications
Some communications about healthcare services may be permitted under HIPAA without separate authorization.
For marketing activities that require authorization under HIPAA, we will obtain your written authorization before using or disclosing your protected health information.
Consent to receive promotional SMS messages will be obtained separately when required.
Sale of Protected Health Information
We will not sell your protected health information without obtaining authorization when required by law.
Fundraising
If we conduct fundraising activities using protected health information, we will comply with applicable authorization and opt-out requirements.
6. Substance Use Disorder Treatment Records
Certain substance use disorder treatment records may receive additional protections under federal law, including 42 CFR Part 2.
To the extent Cheyenne Mountain Dentistry and Wellness receives or maintains records protected by Part 2, we will handle those records in accordance with applicable federal requirements.
Where permitted by a valid consent, certain Part 2 records may be used or disclosed for treatment, payment, and healthcare operations in accordance with applicable law.
However, Part 2 records generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against a patient without the patient’s written consent or a qualifying court order and subpoena or other legal mandate satisfying Part 2 requirements.
If Part 2 information is used for fundraising where permitted, patients will receive the required notice and opportunity to opt out.
7. Uses and Disclosures Requiring Written Authorization
Certain uses or disclosures of your protected health information require your written authorization.
These may include:
- Most uses and disclosures for marketing that require authorization under HIPAA
- The sale of protected health information
- Most uses and disclosures of psychotherapy notes, if maintained
- Other disclosures not otherwise permitted or required by law
You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on that authorization or where other legal exceptions apply.
8. Our Responsibilities to Protect Your Information
Cheyenne Mountain Dentistry and Wellness is required by law to maintain the privacy and security of your protected health information.
Our responsibilities include:
- Implementing appropriate administrative, physical, and technical safeguards
- Limiting access to protected health information as appropriate
- Using and disclosing information only as permitted or required by law
- Providing patients with this Notice of Privacy Practices
- Following the privacy practices described in the current notice
- Notifying affected individuals following a breach of unsecured protected health information when notification is required by law
- Complying with applicable federal and state privacy regulations
We will not use or disclose your information in ways not described in this notice unless permitted or required by law or authorized by you in writing.
9. Business Associates and Third-Party Service Providers
We may work with authorized third-party service providers that assist with operations such as:
- Patient scheduling and reminders
- Billing and insurance processing
- Electronic health record systems
- Information technology and data storage
- Secure patient communications
- Other administrative services
When these providers qualify as business associates under HIPAA, we require appropriate Business Associate Agreements and safeguards as required by law.
We do not authorize service providers to use protected health information for unrelated marketing or other unauthorized purposes.
10. Additional Protections Under Colorado Law
Certain categories of health information may be subject to additional confidentiality requirements under Colorado law.
These may include particular mental health, substance use disorder, and other specially protected records.
When applicable Colorado law provides greater privacy protections than HIPAA, we will follow the more protective requirements.
11. Changes to This Notice
Cheyenne Mountain Dentistry and Wellness reserves the right to revise this Notice of Privacy Practices as permitted by law.
Revisions may apply to protected health information we already maintain, as well as information received in the future.
Updated notices will be available:
- On our website
- At our dental office
- Upon request
The effective date will be updated whenever material revisions are made.
12. Questions, Requests, and Privacy Complaints
If you have questions about this notice, wish to exercise your privacy rights, or would like to submit a privacy complaint, please contact:
Cheyenne Mountain Dentistry and Wellness
Attention: Privacy Officer
3605 Star Ranch Rd.
Colorado Springs, CO 80906
Phone: (719) 576-3276
Email: info@cheyennemountaindental.com
Website: https://www.cheyennemountaindental.com/
You may also submit a complaint directly to:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201
Phone: 1-877-696-6775
Online: https://www.hhs.gov/hipaa/filing-a-complaint/
You will not be penalized or retaliated against for filing a privacy complaint.
Effective Date: October 15, 2026
Cheyenne Mountain Dentistry and Wellness is committed to respecting patient privacy, maintaining confidentiality, and protecting the trust patients place in our dental care team.