Notice of Privacy Practices and Office Privacy Policy

Effective Date: October 12, 2025

Provider: Preventive Dental
Dr. Shad Lewis, DMD

Purpose of This Notice

This notice describes how your health information may be used and disclosed, and how you can access that information. Please review it carefully.

Our Commitment to Your Privacy

We protect your personal and health information. Your dental record contains information about your health history, diagnosis, and treatment. Federal and state laws require us to keep this information private.

Use and Disclosure of Health Information

Your health information may be used or shared for the following purposes:

• Treatment: To provide, coordinate, or manage your dental care. This may include sharing information with other healthcare providers involved in your care.
• Payment: To bill and collect payment from you, your insurance company, or a third party.
• Healthcare Operations: For office management, quality improvement, and staff training.

We may also disclose your information:

• When required by law.
• To public health authorities to prevent or control disease.
• To comply with court orders or law enforcement requests.
• To dental boards or other regulatory agencies as required.

Other Uses Require Your Authorization

Other disclosures of your information will only be made with your written consent. You can revoke your authorization at any time in writing.

Your Rights Regarding Health Information

• Request a copy of your dental record.
• Request corrections to your record if you believe it is inaccurate.
• Request limits on how we use or share your information.
• Receive an accounting of certain disclosures we make.
• Request confidential communication (for example, to send bills to a different address).

Our Legal Duties

• Maintain the privacy of your health information.
• Provide you with this notice of our privacy practices.
• Notify you if there is a breach of unsecured information that affects you.

Office Policy on Confidentiality

We will not share your information with friends, family members, or others without your permission, except when required by law or necessary for your care. Conversations about your treatment may be overheard only as part of the normal course of providing care in an open clinical environment, but staff are trained to minimize this as much as possible.

Changes to This Notice

We reserve the right to change this policy and will post the current version in our office and on our website.

Questions or Complaints

If you have any questions about this notice or believe your privacy rights have been violated, contact:

Privacy Officer
Preventive Dental
Shad Lewis
2211 Quarry Dr, Suite E-67
Reading, PA 19609

You may also contact:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201