Notice of Privacy Practices
iDental LLC, doing business as iDental Orthodontics and Family Dentistry 1320 S Green Bay Rd, Racine, WI 53406 (262) 223-0280 | frontdesk@identalwi.com | identalwi.com
Effective Date: June 3, 2026
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.
Our Commitment to Your Privacy
iDental LLC ("we," "us," or "our") is committed to protecting the privacy of your health information. We are required by law to:
Maintain the privacy of your Protected Health Information ("PHI")
Provide you with this Notice describing our legal duties and privacy practices regarding your PHI
Notify you in the event of a breach affecting your unsecured PHI
Follow the terms of the Notice currently in effect
"Protected Health Information" means information that identifies you and relates to your past, present, or future physical or mental health, the dental care provided to you, or payment for that care.
How We May Use and Disclose Your Health Information
The following categories describe the ways we may use and disclose your PHI without requiring your written authorization. Not every permitted use or disclosure is listed, but every use or disclosure we make will fall within one of these categories or will be made with your written authorization.
1. For Treatment
We use and share your PHI to provide, coordinate, and manage your dental care. Examples include:
Sharing information with dentists, hygienists, dental assistants, and other staff involved in your care
Sending your X-rays, impressions, or treatment information to dental laboratories that fabricate crowns, bridges, dentures, retainers, aligners, or other appliances
Referring you to specialists (orthodontists, oral surgeons, endodontists, periodontists, etc.) and sharing relevant records with them
Coordinating with your physician or other healthcare providers when needed for your care
2. For Payment
We use and share your PHI to obtain payment for the services we provide. Examples include:
Submitting claims to your dental or medical insurance carrier
Verifying your insurance coverage and benefits
Obtaining pre-authorization for treatment
Communicating with billing services, collections agencies (when accounts are overdue), and financing companies you have chosen to use
3. For Health Care Operations
We use and share your PHI to operate our practice and ensure quality care. Examples include:
Reviewing the quality of care we provide
Training dental students, hygiene students, and other staff
Conducting business planning and management
Communicating with attorneys, accountants, consultants, and others bound by confidentiality
Reviewing the performance of staff and providers
4. Appointment Reminders, Treatment Alternatives, and Health-Related Benefits
We may contact you to:
Remind you of upcoming appointments by phone, mail, or other means
Inform you about treatment options or alternatives that may be of interest
Inform you about health-related products, services, or benefits we offer
If you prefer not to be contacted for these purposes, please tell us in writing.
5. Individuals Involved in Your Care
We may share PHI with a family member, friend, or other person involved in your dental care or payment, provided you do not object, or in an emergency when you are unable to express a preference.
6. Disclosures Required or Permitted by Law
We may use or disclose your PHI without your authorization in the following circumstances permitted by law:
Required by law: When federal, state, or local law requires disclosure
Public health activities: Reporting to public health authorities for disease prevention, control, or reporting (e.g., adverse events related to dental products)
Victims of abuse, neglect, or domestic violence: Reporting to appropriate authorities when we reasonably believe abuse has occurred
Health oversight: Disclosures to government agencies authorized to oversee healthcare (audits, investigations, inspections, licensure)
Judicial and administrative proceedings: In response to a court order, subpoena, or other lawful process
Law enforcement: For specific law enforcement purposes such as identifying or locating a suspect, fugitive, or missing person, or reporting crimes
Coroners, medical examiners, and funeral directors: As necessary to carry out their duties
Organ and tissue donation: To organizations involved in procurement, banking, or transplantation
Research: Only when an Institutional Review Board has waived the authorization requirement
Serious threat to health or safety: When necessary to prevent or lessen a serious threat to you or others
Military and veterans: As required by military command authorities
National security and intelligence: As authorized by law
Workers' compensation: As authorized by workers' compensation laws
Inmates: To correctional institutions when you are an inmate
Uses and Disclosures That Require Your Written Authorization
We will obtain your written authorization before using or disclosing your PHI for any purpose not described above. In particular, we will obtain your written authorization for:
Marketing communications that involve your PHI, except for face-to-face communications or promotional gifts of nominal value
Sale of your PHI (we do not sell PHI)
Use of your photograph, before-and-after images, or testimonials for marketing, advertising, or social media purposes
Most uses and disclosures of psychotherapy notes (if applicable)
You may revoke a written authorization at any time, in writing, except to the extent we have already acted in reliance on it.
Your Rights Regarding Your Health Information
You have the following rights with respect to your PHI:
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI in our records, including a copy in electronic form if we maintain it electronically. We may charge a reasonable fee for copies. In limited circumstances, we may deny your request; you may be entitled to have the denial reviewed.
To make a request: Submit a written request to our Privacy Official at the address above.
Right to Request Amendment
If you believe information in your record is incorrect or incomplete, you have the right to ask us to amend it. We may deny your request under certain circumstances, but you will have the right to submit a written statement of disagreement that we will include with your records.
To make a request: Submit a written request explaining the reason for the amendment to our Privacy Official.
Right to an Accounting of Disclosures
You have the right to receive a list of certain disclosures we have made of your PHI within the six years prior to your request. This does not include disclosures made for treatment, payment, healthcare operations, disclosures made with your authorization, or certain other disclosures.
To make a request: Submit a written request to our Privacy Official. The first accounting in any 12-month period is free; we may charge a reasonable fee for additional requests.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations, or to individuals involved in your care. We are not required to agree to most requested restrictions, except: if you pay for a service or item in full out of pocket and ask us not to share that information with your health plan for purposes of payment or healthcare operations, we must agree, unless required by law to disclose.
To make a request: Submit a written request to our Privacy Official specifying the information and the restriction you are requesting.
Right to Request Confidential Communications
You have the right to request that we communicate with you about your health information by a particular means or at a particular location. For example, you may request that we contact you only at a specific phone number or address. We will accommodate reasonable requests.
To make a request: Submit a written request to our Privacy Official.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
Right to Notification of a Breach
You have the right to be notified if there is a breach of your unsecured PHI.
Our Duties
We are required by law to:
Maintain the privacy of your PHI as required by HIPAA and applicable state law
Provide you with this Notice describing our legal duties and privacy practices
Follow the terms of the Notice currently in effect
Notify you if a breach occurs that may have compromised the privacy or security of your information
We reserve the right to change this Notice. The revised Notice will apply to all PHI we maintain, including information created or received before the change. Any revised Notice will be posted in our office and on our website at identalwi.com, with a new effective date. You may request a paper copy of the most recent version at any time.
Wisconsin State Law
Where Wisconsin state law provides greater privacy protections than HIPAA, we will follow state law. Wisconsin law provides additional protections for certain categories of information, including mental health records, HIV/AIDS-related information, and treatment for alcohol and drug abuse.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the federal government. We will not retaliate against you for filing a complaint.
To file a complaint with us:
Privacy Official iDental LLC 1320 S Green Bay Rd Racine, WI 53406 (262) 223-0280 frontdesk@identalwi.com
To file a complaint with the federal government:
U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 1-877-696-6775 www.hhs.gov/ocr/privacy/hipaa/complaints/
Contact for Questions
If you have any questions about this Notice or our privacy practices, please contact:
Privacy Official iDental LLC 1320 S Green Bay Rd, Racine, WI 53406 (262) 223-0280 frontdesk@identalwi.com