HIPAA Notice of Privacy Practices

Harris Orthodontics: https://harrisorthodonticsatl.com/

Effective Date: October 15, 2026 | Publication Date: October 15, 2026

THIS NOTICE DESCRIBES HOW MEDICAL AND DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Protected Health Information (PHI) about you is maintained as a written and/or electronic record of your contacts, consultations, and visits for orthodontic and healthcare services with Harris Orthodontics. Specifically, PHI includes information about you—including demographic details (e.g., name, address, telephone number, email, date of birth)—that may identify you and relates to your past, present, or future physical or dental health condition, orthodontic care, and related healthcare services.

Our practice is required by law to maintain the privacy and confidentiality of your PHI, to follow the terms of this Notice of Privacy Practices, and to provide you with this notice of our legal duties and privacy practices. This Notice describes how we may use and disclose your PHI to carry out treatment, obtain payment for services rendered, conduct healthcare operations, and for other purposes permitted or required by law. It also outlines your rights to access and control your PHI.

You have specific rights under the federal Privacy Rule regarding your Protected Health Information:

You have the right to obtain a copy of our Notice of Privacy Practices at any time. We reserve the right to revise or amend the terms of this notice. Any revision will apply to all PHI we maintain. You may obtain an updated copy by contacting our office, requesting one at your next appointment, or accessing it directly on our website.

We must obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice. For example, we require your written authorization for marketing communications, paid promotions, or any sale of your PHI. You may revoke any written authorization at any time in writing, except to the extent that Harris Orthodontics has already taken action in reliance upon it.

You have the right to request that we communicate with you about your orthodontic treatment or billing matters through an alternative method (e.g., specific email address, phone number) or at an alternative location (e.g., cell phone, office address, PO Box). We will accommodate all reasonable written requests.

You have the right to inspect and receive a paper or electronic copy of your complete dental and orthodontic records, including diagnosis notes, radiographs (CBCT / X-rays), and billing records. As permitted by federal and Georgia state regulations, we may charge a reasonable, cost-based fee for copies, postage, or electronic media preparation.

You have the right to ask us in writing not to use or disclose specific parts of your PHI for treatment, payment, or healthcare operations. While we will consider all requests, we are not legally required to agree to every restriction, especially if it affects your emergency care.

Exception: If you pay for an orthodontic service or item entirely out-of-pocket and request that we not disclose PHI related to that service to your dental or health insurer, we are required by law to honor that restriction.

If you believe that the PHI we have about you is incorrect or incomplete, you may request an amendment in writing for as long as the information is maintained by our practice. We may decline your request under certain circumstances (for example, if the record was not created by our office or if the record is accurate and complete), but we will provide you with a written explanation within 60 days.

You have the right to request a list (an “accounting”) of certain disclosures of your PHI made by Harris Orthodontics to outside persons or entities, excluding disclosures made for treatment, payment, healthcare operations, or authorized directly by you.

You have the right to receive timely written notification in the event of an unauthorized acquisition, access, use, or disclosure of your unsecured PHI that compromises the security or privacy of your information.

We will use and disclose your PHI to provide, coordinate, and manage your orthodontic care and related dental services. This includes coordinating with referring general dentists, pediatric dentists, oral surgeons, dental laboratories (for custom appliances, aligners, and retainers), and pharmacies. For example, Dr. Peyton Harris may share your dental records or 3D scans with a specialist to collaborate on your treatment plan.

We may use and disclose your PHI to bill and collect payment from you, your dental insurance company, or third-party payers. This includes determining insurance eligibility, pre-authorizing orthodontic benefits, and submitting insurance claims.

We may use and disclose your PHI to support the everyday business and clinical management of Harris Orthodontics. These activities include quality assessment and improvement, staff training, clinical evaluations, financial audits, licensing, compliance reviews, and legal services.

We may contact you via phone call, text message, voicemail, email, or mail to remind you of scheduled orthodontic appointments, communicate treatment status, discuss appliance maintenance, or share information regarding alternative treatments or clinical updates relevant to your care. You have the right to manage your communication preferences or opt out of non-essential communications.

Our practice may participate in secure Health Information Exchanges or digital healthcare networks to securely share patient health information electronically with other authorized healthcare providers involved in your treatment.

Unless you object, we may share relevant PHI with a family member, parent, legal guardian, or personal representative who is involved in your orthodontic care or payment for care. In emergency situations or if you are incapacitated, our providers will exercise their professional medical judgment to determine whether disclosure is directly relevant and in your best interest.

We may disclose your PHI when required by federal, state, or local laws; for public health oversight activities (such as disease prevention or medical device tracking with the FDA); in response to court orders or administrative subpoenas; for worker’s compensation cases; to report suspected abuse, neglect, or domestic violence; or to avert a serious and imminent threat to health and safety.

In the event that our practice receives or maintains records protected under federal regulations governing substance use disorder patient records (42 CFR Part 2), such records will not be used or disclosed without your express written consent, except as specifically authorized by federal law.

If you believe your privacy rights have been violated, or if you have questions or concerns regarding our privacy policies, you may file a complaint with our Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services (HHS) Office for Civil Rights. We will not retaliate or penalize you in any way for filing a complaint.

To contact our office regarding your privacy:

• Practice Name: Harris Orthodontics
• Attn: Privacy Officer / Compliance Office
• Address: 800 Marietta St NW, Suite C, Atlanta, GA 30318
• Phone: (404) 902-6912
• Email: info@harrisorthodonticsatl.com
• Website: https://harrisorthodonticsatl.com/
• Office Hours: Monday – Friday: 8:00 AM – 5:00 PM | Saturday – Sunday: Closed