Capital City Dentistry

Notice of Privacy Practices & Communication Privacy Policy

Effective Date: February 16, 2026

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

I. Dental Practice Covered by this Notice

This Notice describes the privacy practices of Capital City Dentistry (“Dental Practice,” “we,” “us,” or “our”).

“You” and “your” refers to our patients.

II. How to Contact Us / Privacy Official

If you have questions about this Notice or about our privacy practices, please contact:

Privacy Official
Capital City Dentistry
Email: gteubner@capitalcitydentistryjc.com

III. Our Commitment to Protecting Your Information

The privacy of your health information is important to us. We understand that health information is personal, and we are committed to protecting it.

This Notice describes how we may use and disclose your Protected Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws.

Protected health information includes information that:

• Identifies you
• Relates to your past, present, or future health condition
• Relates to the health care services you receive

We are required by law to:

• Maintain the privacy of your protected health information
• Provide you with this Notice describing our legal duties and privacy practices
• Follow the terms of the Notice currently in effect

IV. Text Messaging & Electronic Communications

Capital City Dentistry may communicate with patients through SMS text messaging, phone calls, email, or other electronic methods for purposes such as:

• Appointment reminders
• Post-treatment instructions
• Account notifications
• Office updates
• Two-way patient communication

Message frequency may vary depending on your interactions with our office.

Message and data rates may apply depending on your mobile carrier.

You may opt out of receiving SMS messages at any time by replying:

STOP, QUIT, END, REVOKE, OPT OUT, CANCEL, or UNSUBSCRIBE

You may reply HELP for assistance or contact our office directly.

V. Information We Collect for Messaging

If you opt in to receive SMS messages from our office, we may collect:

• Your mobile phone number
• Your consent to receive SMS communications
• Your messaging preferences

This information is used solely to communicate with you regarding your dental care and related services.

VI. Mobile Information Privacy Statement

Mobile information will not be shared with third parties or affiliates for marketing or promotional purposes.

All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.

VII. How We May Use or Disclose Your Health Information

The following examples describe different ways we may use or disclose your health information. These examples are not exhaustive.

A. Common Uses and Disclosures

1. Treatment

We may use your health information to provide dental treatment or services. We may disclose your health information to specialists, physicians, or other healthcare professionals involved in your care.

2. Payment

We may use and disclose your health information to obtain payment from insurance providers or health plans.

3. Health Care Operations

We may use and disclose your health information for activities necessary to operate our practice, including:

• Quality improvement
• Staff training
• Business planning
• Financial audits
• Legal compliance

4. Appointment Reminders

We may contact you regarding appointments using:

• Phone calls
• Voice messages
• Emails
• Text messages
• Written reminders

5. Treatment Alternatives & Health-Related Services

We may inform you about treatment options or other services that may benefit your oral health.

6. Family & Friends Involved in Your Care

We may disclose health information to family members or others involved in your care or payment for care unless you object.

7. Business Associates

We may disclose protected health information to service providers who assist us in operating our practice (such as billing providers, software vendors, or communication platforms). These partners are contractually obligated to safeguard your information.

VIII. Less Common Uses and Disclosures

We may also disclose your health information for the following purposes when permitted or required by law:

• Public health reporting
• Abuse or neglect reporting
• Government oversight activities
• Legal proceedings or subpoenas
• Law enforcement purposes
• Coroners or medical examiners
• Organ donation
• Research approved by a review board
• Preventing serious threats to health or safety
• Military or national security purposes
• Workers’ compensation claims

IX. Special Protections for Substance Use Disorder (SUD) Records

Certain records relating to Substance Use Disorder diagnosis, treatment, or referral for treatment may be protected under 42 CFR Part 2.

These records may not be disclosed without your written consent unless otherwise permitted by law.

X. Your Written Authorization

Uses or disclosures not described in this Notice will only be made with your written authorization, including:

• Marketing uses of protected health information
• Sale of protected health information
• Release of psychotherapy notes

You may revoke authorization at any time in writing.

XI. Your Rights Regarding Your Health Information

You have the following rights.

Right to Access

You may request copies of your health records.

Right to Amend

You may request corrections to your health information.

Right to Restrict Use or Disclosure

You may request limitations on certain uses of your information.

Right to Confidential Communication

You may request communications through alternative methods or locations.

Right to Accounting of Disclosures

You may request a list of disclosures made during the past six years.

Right to a Paper Copy

You may request a printed copy of this Notice at any time.

Right to Notification of a Security Breach

You will be notified if your information is compromised in a data breach.

XII. Additional Privacy Protections

Certain types of health information may have additional protections under federal or state law, including:

• HIV-related information
• Mental health records
• Alcohol or substance use records
• Genetic information

When these laws apply, we will comply with the stricter requirements.

XIII. Changes to This Privacy Notice

We reserve the right to change this Notice at any time. Any revisions will apply to all protected health information we maintain.

The updated Notice will be posted in our office and on our website (if applicable).

XIV. How to File a Privacy Complaint

If you believe your privacy rights have been violated, you may file a complaint with:

Capital City Dentistry Privacy Official
Email: gteubner@capitalcitydentistryjc.com

You may also file a complaint with the:

U.S. Department of Health and Human Services
Office for Civil Rights

We will not retaliate against you for filing a complaint.