Notice of Privacy Practices (HIPAA)
Effective Date: 1/28/2026
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1) Who this Notice applies to
This Notice applies to the following MI Smiles Dental dental practices (the “Practice”):
- Grand Haven Smiles PLC (DBA: MI Smiles Dental Grand Haven)
- MI Smiles Dental Cascade PLC
- MI Smiles Dental Ionia PLC
- MI Smiles Dental Comstock Park PLC
Covered locations: See the current list of MI Smiles Dental locations at: https://www.mismilesdental.com/our-locations/.
Our website may also reference other dental practices or brands. Those practices have their own HIPAA Notice of Privacy Practices, which applies to care provided at those locations.
This Notice also applies to our workforce, including dentists, hygienists, assistants, and other team members who provide services for these practices.
Administrative and management support may be provided by CFD Management LLC; however, clinical services are provided by the participating dental practices listed above.
2) Our responsibilities
We are required by law to:
- Maintain the privacy and security of your protected health information (PHI).
- Provide you with this Notice of our legal duties and privacy practices regarding PHI.
- Follow the terms of this Notice that are currently in effect.
- Notify you if a breach occurs that may have compromised the privacy or security of your PHI.
3) Your rights
You have the right to:
Get a copy of this Notice
You may ask for a paper copy at any time, even if you agreed to receive it electronically.
Get an electronic or paper copy of your medical/dental record
You may ask to see or get a copy of your PHI. We will provide a copy or a summary, usually within 30 days. We may charge a reasonable, cost-based fee.
Ask us to correct your record
You may ask us to correct PHI you believe is incorrect or incomplete. We may deny your request in certain cases, but we will explain why in writing.
Request confidential communications
You may ask us to contact you in a specific way (for example, phone only) or at a specific location (for example, work address). We will accommodate reasonable requests.
Ask us to limit what we use or share
You may ask us not to use or share certain PHI for treatment, payment, or operations. We are not required to agree in most cases.
Important: If you pay for a service out-of-pocket in full, you can ask us not to share PHI about that service with your health plan for payment or operations. We must agree unless a law requires us to share it.
Get a list of certain disclosures
You may ask for an “accounting of disclosures” of your PHI for up to six years prior to the date you ask, excluding certain disclosures (such as those for treatment, payment, and operations).
Choose someone to act for you
If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your PHI.
File a complaint if you feel your rights are violated
You may complain if you believe we violated your privacy rights. We will not retaliate against you for filing a complaint.
See “Questions and Complaints” below for how to file.
4) How we may use and disclose your PHI
We may use and disclose your PHI for the following purposes:
Treatment
We may use and share your PHI to provide, coordinate, or manage your dental care.
Example: Sharing information with a specialist you are referred to.
Payment
We may use and share your PHI to bill and receive payment for services.
Example: Sending information to your dental plan to process a claim.
Health care operations
We may use and share your PHI to run our practice, improve care, and support business functions.
Examples: Quality improvement, training, licensing, and audits.
Business associates (vendors)
We may share PHI with vendors who help us operate our practice (called “business associates”), such as IT support or billing services. We require them to safeguard PHI as required by law.
People involved in your care
We may share PHI with family members, friends, or others involved in your care or payment for your care, consistent with your preferences and as allowed by law.
Appointment reminders and care-related communications
We may contact you with appointment reminders and care-related information. This may include phone calls, voicemails, text messages, emails, or mail.
Other permitted or required disclosures
We may also use or disclose PHI as permitted or required by law, such as:
- Public health and safety (for example, reporting abuse/neglect or preventing serious threats).
- Health oversight activities (audits, investigations, inspections).
- Legal proceedings (court orders, subpoenas, and other lawful processes).
- Law enforcement purposes, as permitted by law.
- Workers’ compensation claims, as authorized by law.
- Disaster relief efforts.
- Coroners, medical examiners, and funeral directors.
- Research, under required legal safeguards.
- Military/national security and specialized government functions (when applicable).
Secretary of Health and Human Services
We will disclose your PHI to the U.S. Department of Health and Human Services if required to investigate or determine our compliance with HIPAA.
Special protections
Some information may have additional protections under state or federal law. When a stricter law applies, we follow the stricter rule.
5) Uses and disclosures that require your written authorization
In most cases, we will not use or share your PHI for these purposes unless you give us written authorization:
- Marketing (as defined by HIPAA)
- Sale of PHI
You may revoke an authorization in writing at any time, except to the extent we have already acted based on it.
6) Changes to this Notice
We can change the terms of this Notice, and the changes will apply to all PHI we maintain. If we make material changes, we will update this Notice and make the updated version available.
7) Questions and complaints
If you have questions about this Notice, want to exercise your rights, or want to file a complaint, contact:
Privacy Contact Office: MI Smiles Dental Leadership Team
Contact Title: Office Administrator
Phone: (616) 426-6388
Email: [email protected]
Mailing Address: 3310 Central Blvd, Hudsonville, MI 49426
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.