YOUR PRIVACY IS IMPORTANT TO US

This Notice explains how Griffin Orthodontics may use and disclose your health information and how you can access that information. We are required by law to protect the privacy of your health information and provide you with this Notice.

HOW WE MAY USE OR DISCLOSE YOUR INFORMATION

We may use or disclose your health information without your written authorization for purposes including:

• Treatment: To provide and coordinate your orthodontic care.
• Payment: To bill and obtain payment from you or your insurance company.
• Health Care Operations: To operate our practice, improve care, train staff, and perform other necessary business activities.
• Appointments and Communications: To contact you about appointments, treatment, billing, or other matters related to your care by phone, voicemail, text, email, or mail.
• Family or Caregivers: To share appropriate information with a parent, legal guardian, family member, or other person involved in your care or payment, when permitted by law.
• As Required by Law: When disclosure is required or permitted by federal or Wisconsin law, including certain public health, legal, regulatory, and law-enforcement purposes.

PHOTOGRAPHS AND IMAGES

Photographs, X-rays, scans, and other images may be taken and maintained as part of your orthodontic record and used for treatment, payment, and health care operations as permitted by law.

We will obtain written authorization when required before using identifiable patient photographs, testimonials, or other health information for marketing or promotional purposes.

SUBSTANCE USE DISORDER RECORDS

Certain substance use disorder (“SUD”) records receive additional federal protection under 42 U.S.C. § 290dd-2 and 42 CFR Part 2. If Griffin Orthodontics creates, maintains, or receives records subject to Part 2, we will comply with the additional confidentiality requirements applicable to those records.

Part 2 records may be used or disclosed as permitted by law, including pursuant to applicable patient consent. Such records generally may not be used or disclosed in a civil, criminal, administrative, or legislative proceeding against a patient unless permitted by Part 2, including with the patient’s written consent or pursuant to an applicable court order and subpoena.

We will comply with applicable federal and Wisconsin requirements governing the privacy and security of protected SUD records. The updated federal Part 2 requirements apply beginning February 16, 2026.

YOUR RIGHTS

You have the right to:

• Inspect and obtain a copy of your health information, subject to applicable law.
• Request correction of information you believe is incorrect or incomplete.
• Request restrictions on certain uses or disclosures.
• Request confidential communications by an alternative method or location.
• Request an accounting of certain disclosures.
• Receive a paper or electronic copy of this Notice.
• File a complaint with Griffin Orthodontics or the U.S. Department of Health and Human Services if you believe your privacy rights have been violated.

You will not be retaliated against for filing a complaint.

OUR RESPONSIBILITIES

Griffin Orthodontics is required to protect the privacy of your health information, provide you with this Notice, follow the Notice currently in effect, and notify you as required by law if a breach occurs involving your unsecured protected health information.

We may change this Notice from time to time. The current version will be available at our offices and at www.griffinortho.com.

QUESTIONS OR PRIVACY CONCERNS

If you have questions or concerns about your privacy, please contact:

Dr. David Griffin
Griffin Orthodontics
414-328-0704

You may also contact the U.S. Department of Health and Human Services, Office for Civil Rights to file a complaint.

We will not retaliate against you for filing a complaint.