THIS NOTICE DESCRIBES HOW DENTAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
Effective Date: February 16, 2026
Last Updated: September 30, 2026
Before You Read
We wrote this notice in plain English because you deserve to understand how your personal health information is handled – not just receive a document that checks a legal box.
If anything here is unclear, please ask us before or after your visit. We are happy to help explain how your information is used, shared, and protected.
Who This Notice Applies To
Roswell Complete Dentistry
1875 Old Alabama Rd., Ste. 130
Roswell, GA 30076
Phone: 404-595-1840
Email: staff@roswellcompletedentistry.com
Website: roswellcompletedentistry.com
Privacy Officer: Dr. Dipesh
This Notice applies to all dental and medical records our practice creates, receives, maintains, or transmits about you. It applies to patients who receive care at our Roswell office.
1. Our Legal Responsibility
Federal law – the Health Insurance Portability and Accountability Act, known as HIPAA – requires us to protect your health information and explain how we use and disclose it.
We are legally obligated to:
- Keep your health information private and secure.
- Follow the terms described in this Notice.
- Notify you as required by law if your health information is involved in a data breach.
- Provide you with a copy of this Notice when required and whenever you request one.
We will not sell your health information. We will not use your health information for marketing purposes when your written authorization is required by law.
2. How We Use and Share Your Health Information
There are three standard situations where we may use or disclose your health information without asking for written permission first:
For Your Dental Treatment
We use your health information to examine your teeth and gums, diagnose dental conditions, develop treatment plans, provide dental services, prescribe medications when appropriate, and coordinate your care.
Our dental team may use your dental records, X-rays, digital images, examination findings, treatment notes, and other relevant information to provide appropriate care.
If we refer you to another dental or medical provider, such as an oral surgeon, specialist, or other healthcare professional, we may share relevant information needed to coordinate your care.
For Billing and Payment
We may use and disclose necessary health information to bill for dental services and collect payment.
For example, we may share information with your dental insurance company to submit claims, verify benefits, determine coverage, and obtain payment for covered services.
We may also share information that is necessary to process payments or financing arrangements when you choose to use a third-party financing provider.
For Running Our Practice
We may use your health information for routine healthcare operations.
These activities may include quality reviews, staff training, compliance activities, financial and administrative functions, auditing, and other activities necessary to operate our dental practice.
We may contact you by phone, text message, email, or other appropriate communication methods regarding appointments, reminders, treatment, follow-up care, or routine dental care.
If you prefer a different way for us to contact you, please let us know.
3. Other Situations Where We May Share Without Permission
Beyond treatment, payment, and healthcare operations, there are circumstances where federal or state law may permit or require us to use or disclose your health information without obtaining your written authorization first.
These situations may include:
- Reporting information to public health authorities when required by law.
- Responding to a court order, subpoena, or other legal proceeding when legally permitted or required.
- Cooperating with law enforcement when required or permitted by law.
- Complying with government oversight, audits, or regulatory requirements.
- Reporting suspected abuse, neglect, or domestic violence when required by law.
- Providing information to a medical examiner or coroner when legally required.
- Supporting organ donation or transplantation activities when applicable.
- Disclosing information when necessary to prevent a serious and imminent threat to health or safety.
Unless you tell us otherwise, we may also disclose relevant information about your care to a family member, close friend, or another person who is involved in your care or payment for your care, when permitted by law.
4. Substance Use Disorder Records – 2026 Federal Requirement
Federal requirements effective February 16, 2026 include specific provisions concerning the protection of certain substance use disorder records under 42 CFR Part 2.
What are substance use disorder records?
These are certain records relating to a patient’s identity, diagnosis, or treatment for a substance use disorder that originate from a federally assisted program covered by 42 CFR Part 2.
What this means for our patients
Roswell Complete Dentistry does not operate a substance use disorder treatment program and does not create substance use disorder treatment records as part of its dental services.
However, we may receive protected substance use disorder records from another healthcare provider as part of coordinating a patient’s care.
When applicable, these records may have additional federal protections beyond those that apply to ordinary health information.
Certain disclosures of Part 2 records may require the patient’s written consent or a court order, depending on the circumstances and applicable law.
If you have questions about how these records are handled, please contact our designated Privacy Officer using the contact information provided in this Notice.
5. Everything Else Requires Your Written Permission
For uses or disclosures of your health information that are not described in this Notice and are not otherwise permitted or required by law, we will generally ask you to provide written authorization before the information is used or disclosed.
Depending on applicable law, this may include:
- Certain marketing communications.
- Sharing information with your employer.
- Certain disclosures that are not related to your treatment, payment, or healthcare operations.
- Other uses or disclosures for which HIPAA requires written authorization.
If you provide a written authorization, you may generally revoke that authorization in writing at any time.
Revoking an authorization will not affect actions already taken based on the authorization before we received your revocation.
6. Your Rights Over Your Health Information
HIPAA gives you specific rights regarding your health information.
See or Get a Copy of Your Records
You may request to inspect or obtain a copy of your dental and billing records.
You may request the information in paper or electronic form when available.
We will respond to your request within the time period required by law.
If we deny your request for access for a legally permitted reason, we will provide an explanation and information about your rights to request a review when applicable.
Ask Us to Correct Your Records
If you believe information in your records is incorrect or incomplete, you may request that we amend the information.
Your request must generally be made in writing and explain why you believe the information should be changed.
We will respond within the time period required by law.
If we do not agree with your requested amendment, you may have the right to submit a written statement of disagreement for inclusion in your records.
Request Restrictions on How We Use Your Information
You may ask us to restrict certain uses or disclosures of your health information.
We are not required to agree to every requested restriction.
However, if we agree to a restriction, we will follow the restriction as required by law.
You may also request that we not disclose information to a health plan when you have paid for the healthcare service completely out of pocket, when applicable under HIPAA.
Ask Us to Contact You Differently
You may ask us to contact you using a specific phone number, mailing address, email address, or other communication method.
For example, you may request that we:
- Contact you at your cell phone instead of your home phone.
- Use a particular mailing address.
- Contact you by email when appropriate.
- Avoid leaving certain types of messages when legally and operationally feasible.
You do not generally need to explain why you are making the request.
We will consider reasonable requests as required by law.
Get a Record of Certain Disclosures
You may request an accounting of certain disclosures of your health information made by our practice.
The accounting generally covers disclosures made during the period required by HIPAA, up to six years before the date of your request.
Certain disclosures – including many routine disclosures for treatment, payment, and healthcare operations – are not required to be included.
You are entitled to receive an accounting as provided by law.
Get a Paper Copy of This Notice
Even if you received this Notice electronically or reviewed it online, you may request a paper copy at any time.
Please contact our office or ask a member of our team.
Be Notified of a Data Breach
If your unsecured protected health information is involved in a breach that requires notification under federal law, we will notify you as required by HIPAA.
7. How to Exercise Your Rights
To make a request concerning your health information or privacy rights, please contact us using the information below.
Roswell Complete Dentistry
Privacy Officer: Dr. Dipesh
1875 Old Alabama Rd., Ste. 130
Roswell, GA 30076
Phone: 404-595-1840
Email: staff@roswellcompletedentistry.com
Website: roswellcompletedentistry.com
You may also contact our office if you need help understanding how to make a request.
We will acknowledge and respond to your request within the timeframes required by applicable law.
8. How to File a Complaint
If you believe we have not properly protected your health information or respected your privacy rights, you have the right to file a complaint.
Contact Us Directly
Please contact Roswell Complete Dentistry or our designated Privacy Officer using the information above.
We take privacy concerns seriously and will review complaints according to our policies and applicable law.
We will not retaliate against you for filing a privacy complaint.
Contact the Federal Government
You may also file a complaint with the:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, D.C. 20201
Phone: 1-800-368-1019
You may also obtain information about filing a HIPAA complaint through the HHS Office for Civil Rights website:
www.hhs.gov/ocr/privacy/hipaa/complaints
Filing a complaint with the Office for Civil Rights will not affect the care you receive from Roswell Complete Dentistry.
9. Changes to This Notice
We reserve the right to change this Notice when required or permitted by law.
If we make changes, the updated Notice will be made available as required by applicable law and may be:
- Posted in our office.
- Available at the front desk upon request.
- Published on our website at roswellcompletedentistry.com.
The updated Notice will apply to the health information we maintain as permitted by law.
The effective date at the beginning of this Notice identifies the date the current version became effective.
10. Questions?
We want you to understand how your health information is collected, used, and protected.
If you have questions about this Notice or your privacy rights, please contact us.
Roswell Complete Dentistry
1875 Old Alabama Rd., Ste. 130
Roswell, GA 30076
Phone: 404-595-1840
Email: staff@roswellcompletedentistry.com
Website: roswellcompletedentistry.com
Office Hours:
Monday – Thursday: 8:00 AM – 5:00 PM
Friday: 8:00 AM – 2:00 PM
We are happy to help answer your questions about your privacy rights and how your health information is handled.
