McCollum Dental - Conyers, GA
HIPAA Notice of Privacy Practices
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.
Effective Date: 4/30/2026
Practice: McCollum Dental
Privacy Officer: Dr. Dave McCollum, DMD
Our Commitment
McCollum Dental is committed to maintaining the privacy of your protected health information (PHI). We are required by law to maintain the privacy of PHI, to provide you with notice of our legal duties and privacy practices with respect to PHI, and to notify you following a breach of unsecured PHI.
We are required to follow the terms of this Notice while it is in effect. We reserve the right to change the terms of this Notice and to make the new Notice effective for all PHI we maintain. If we revise this Notice, we will make the updated version available in our office and on our website at mccollumdental.com.
Section 1
How We May Use and Disclose Your Health Information
The following describes the ways we may use and disclose your PHI. Not every use or disclosure will be listed; however, all of the ways we are permitted to use and disclose information will fall within one of the following categories.
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your dental care and any related services. For example, we may share your information with a specialist, oral surgeon, or laboratory involved in your care.
Payment
We may use and disclose your PHI to obtain payment for services we provide. For example, we may contact your dental insurer to confirm coverage or to submit a claim for services rendered.
Health Care Operations
We may use and disclose your PHI to support the business activities of our practice. These activities include quality assessment, staff training, legal services, and other business management functions.
Appointment Reminders
We may use and disclose your PHI to contact you as a reminder that you have an appointment for treatment or medical care. This may include phone calls, text messages (if you have opted in), or email.
Treatment Alternatives and Health-Related Benefits
We may use and disclose your PHI to tell you about or recommend possible treatment options or alternatives, or health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care
Unless you object, we may disclose your PHI to a family member, friend, or other person identified by you who is involved in your care or who helps pay for your care.
Section 2
Uses and Disclosures Permitted by Law Without Your Authorization
As Required by Law
We will disclose your PHI when required to do so by federal, state, or local law.
Public Health Activities
We may disclose your PHI for public health activities, including reporting communicable diseases, reporting adverse events, or notifying persons at risk of disease.
Abuse, Neglect, or Domestic Violence
We may disclose your PHI to government authorities authorized to receive reports of abuse, neglect, or domestic violence as required or permitted by law.
Health Oversight Activities
We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.
Law Enforcement
We may disclose your PHI for law enforcement purposes as required by law or in response to a valid court order, warrant, or subpoena.
Serious Threats to Health or Safety
We may use or disclose your PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Workers’ Compensation
We may disclose your PHI to workers’ compensation programs as authorized by and to the extent necessary to comply with applicable law.
Coroners, Medical Examiners, and Funeral Directors
We may disclose PHI to a coroner, medical examiner, or funeral director as necessary to carry out their duties.
Substance Use Disorder Records
If your records include information relating to substance use disorder (SUD) treatment, those records are subject to additional protections under federal law (42 C.F.R. Part 2). Such records may generally only be disclosed with your written consent, except as otherwise permitted or required by law. McCollum Dental does not provide SUD treatment, but if any such information appears in your record, it will be treated with these heightened protections.
Section 3
Uses and Disclosures Permitted by Law Without Your Authorization
Other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization. You may revoke your authorization at any time by submitting a written request to our office. Your revocation will not apply to uses or disclosures we have already made in reliance on your authorization.
We will obtain your written authorization before using or disclosing your PHI for the following purposes:
- Most uses and disclosures of psychotherapy notes
- Uses and disclosures of PHI for marketing purposes
- Disclosures that constitute the sale of PHI
- Other uses and disclosures not otherwise permitted or required by law
Section 4
Your Rights Regarding Your Health Information
You have the following rights regarding the PHI we maintain about you. To exercise any of these rights, please submit a written request to our Privacy Officer (contact information below).
Right to Amend
You have the right to request an amendment of PHI about you if you believe the information is incorrect or incomplete. We may deny your request if the information was not created by us, is not part of the information you would be permitted to inspect and copy, or is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an accounting of certain disclosures we have made of your PHI in the six years prior to the date of your request. This does not include disclosures for treatment, payment, or health care operations.
Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to your request, except that we must agree to restrict disclosure of your PHI to a health plan if the disclosure is for payment or health care operations and you have paid for the service out of pocket in full.
Right to Confidential Communications
You have the right to request that we communicate with you about PHI by alternative means or at alternative locations (e.g., a different phone number or address). We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice at any time, even if you have agreed to receive it electronically. Contact our office to request a copy.
Right to Be Notified of a Breach
You have the right to be notified if your unsecured PHI is breached in a manner that compromises its privacy or security. We will notify you promptly in accordance with applicable law.
Section 5
How to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.
To file a complaint with HHS:
Visit www.hhs.gov/ocr/privacy/hipaa/complaints or call 1-800-368-1019.
Contact Us
McCollum Dental
1498 Klondike Rd SW #201, Conyers, GA 30094
Phone: (770) 922-7900
Email: office@mccollumdental.com