Last updated July 21, 2025

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.

This Notice of Privacy Practices applies to Face Forward Orthodontics and its affiliated healthcare professionals and staff. We are committed to protecting the privacy of your protected health information (PHI). This notice describes how we may use and disclose your PHI to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights regarding your PHI.

Understanding Your Protected Health Information (PHI)

PHI includes demographic information about you (such as your name, address, phone number), and information related to your past, present, or future physical or mental health or condition, and related healthcare services

How We May Use and Disclose Your Protected Health Information (PHI)

We may use and disclose your PHI for the following purposes:

1. For Treatment:

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes coordinating or managing your healthcare with a third party, such as another healthcare provider or specialist.

• Example: Information obtained by a nurse, orthodontist, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment. We may also disclose your PHI to other healthcare providers who are involved in your care to ensure that we have the necessary information to diagnose and treat your orthodontic condition.

2. For Payment:

Your PHI will be used, as needed, to obtain payment for the healthcare services we provide. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend, such as making a determination of eligibility or coverage for insurance benefits.

• Example: We may disclose your PHI to your dental insurance plan to obtain payment for your orthodontic treatment, or to verify your eligibility for benefits.

3. For Healthcare Operations:

We may use or disclose your PHI in order to support the business activities of our practice. These activities include, but are not limited to, quality assessment and improvement activities, training of medical students/residents/interns, licensing, and conducting or arranging for other business activities.

• Example: We may use your PHI to review the quality of care provided by our staff, for staff training, or for auditing purposes to ensure our billing is accurate.

4. Appointment Reminders:

We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at our practice. This may include phone calls, text messages, or postcards.

5. Treatment Alternatives and Health-Related Benefits and Services:

We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives, or health-related benefits or services that may be of interest to you.

6. Individuals Involved in Your Care or Payment for Your Care:

We may disclose PHI to a family member, relative, close friend, or any other person you identify, who is involved in your care or who helps pay for your care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.

7. Required By Law:

We may use or disclose your PHI when required to do so by federal, state, or local law.

8. Public Health Activities:

We may disclose your PHI for public health activities and purposes, including to a public health authority that is authorized by law to collect or receive the information. This includes reporting child abuse or neglect, preventing or controlling disease, injury, or disability.

9. Health Oversight Activities:

We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.

10. Lawsuits and Disputes:

If you are involved in a lawsuit or a dispute, we may disclose PHI in response to a court or administrative order. We may also disclose PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

11. Law Enforcement:

We may release PHI if asked to do so by a law enforcement official:

• In response to a court order, subpoena, warrant, summons, or similar process.

• To identify or locate a suspect, fugitive, material witness, or missing person.

• About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement.1

• About a death we believe may be the result of criminal conduct.2

• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or 3 location of the person who committed the crime.

12. Coroners, Medical Examiners, and Funeral Directors:

We may disclose PHI to a coroner or medical examiner. This may be necessary, for example, for identification purposes, or to determine cause of death. We may also disclose PHI to funeral directors as necessary to carry out their duties.

13. Organ and Tissue Donation:

We may disclose PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of facilitating organ or tissue donation and transplantation.

14. Research:

We may use and disclose your PHI for research purposes under certain limited circumstances, provided we meet specific conditions, such as obtaining your authorization or a waiver of authorization from an Institutional Review Board (IRB) or Privacy Board.

15. Serious Threat to Health or Safety:

Consistent with applicable federal and state laws, we may use and disclose PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

16. Military and Veterans:

If you are a member of the armed forces, we may release PHI as required by military command authorities.

17. National Security and Intelligence Activities:

We may release PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

18. Workers' Compensation:

We may release PHI for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

Your Rights Regarding Your Protected Health Information (PHI)

You have the following rights regarding the PHI we maintain about you:

1. Right to Inspect and Copy:

You have the right to inspect and obtain a copy of PHI that may be used to make decisions about your care, such as your medical and billing records. You must submit a written request to our privacy officer (office@faceforwardortho.com)] to inspect and/or copy your PHI. We may charge a reasonable, cost-based fee for the costs of copying, mailing, or other supplies associated with your request.

2. Right to Amend:

If you feel that PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the practice. To request an amendment, your request must be made in writing and submitted to our privacy officer. You must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may deny your request if you ask us to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.

• Is not part of the PHI kept by or for the practice.

• Is not information you are permitted to inspect and copy.

• Is accurate and complete.

3. Right to an Accounting of Disclosures:

You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of PHI about you for purposes other than treatment, payment, and healthcare operations (and certain other disclosures, such as those you authorized). To request an accounting of disclosures, you must submit your request in writing to our privacy officer. Your request must state a time period, which may not be longer than six years and may not include dates before July 21, 2025. The first accounting in any 12-month period will be provided free of charge; for additional requests, we may charge you a reasonable, cost-based fee.

4. Right to Request Restrictions:

You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.

• We are not required to agree to your request except for one specific instance: We must agree to a request to restrict disclosure of your PHI to a health plan if the disclosure is for purposes of carrying out payment or health care operations and is not otherwise required by law, and the PHI pertains solely to a healthcare item or service for which you, or someone on your behalf other than the health plan, has paid us in full.
  To request restrictions, you must make your request in writing to our privacy officer. 

5. Right to Request Confidential Communications:

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to our privacy officer. We will not ask you for a reason for your request. We will accommodate all reasonable requests.

6. Right to a Paper Copy of This Notice:

You have the right to obtain a paper copy of this notice, even if you have agreed to receive this notice electronically. You may ask us for a copy of this notice at any time. To obtain a paper copy of this notice, contact Face Forward Orthodontics at (425) 439-7022 or office@faceforwardortho.com. You can also view and print a copy from our website at www.faceforwardortho.com.

7. Right to Be Notified of a Breach:

You have the right to be notified following a breach of your unsecured PHI.

Changes to This Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for PHI we already have about you as well as any PHI we receive in the future. We will post a copy of the current notice on our website at www.faceforwardortho.com and in our office. The effective date of the notice will be clearly marked on the first page.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, please contact our privacy officer at 425-439-7022 or office@faceforwardortho.com. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Contact Information

If you have any questions about this Notice, please contact:

Face Forward Orthodontics
Attn: Privacy Officer
5701 NE Bothell Way #2 Kenmore, WA 98028

(425) 439-7022
office@faceforwardortho.com

www.faceforwardortho.com