Family Dental Care & Cosmetic Dentistry

Call (641)-324-1364 to schedule an appointment today!




 802 9th Avenue North

NORTHWOOD, IA 50459 641–324–1364









Each patient will receive accessible, respectful, skillful, and compassionate care without discrimination as to race, color, creed, gender, marital status, beliefs, national origin, age, disability, or diagnosis. Click here to view full Notice Of Nondiscrimination PDFlanguage assistance services PDF

Under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), all medical records and other individually identifiable health information of which we have knowledge must be kept confidential. All personal health information used by us or disclosed by us is covered by this Act regardless of whether this personal health information is in electronic, oral or paper form. Several new rights are granted to patients under this Act, allowing control over how your personal health information is used, how you can access it, and in some cases amend it.


We are required by law to maintain the privacy of your personal health information and to provide you with notice of our legal duties and privacy practices with respect to your personal health information. We may be assessed a penalty for any misuse or unauthorized disclosures of your personal health information as regulated by HIPAA. This Notice of Privacy Practices is effective on 4-4-03. We are bound to abide by the terms of this notice and reserve the right to make revisions to this policy. Should revisions be made, you will be notified in writing, and a copy of the revised policy will be made available at your request.


You will be asked to sign a consent form authorizing us to use and disclose your personal health information only for the following purposes, as defined under the Act:


Treatment means the provision, coordination, or management of health care and related services by one or more healthcare providers, including the coordination or management of health care by a healthcare provider with a third party; consultation between healthcare providers relating to a patient; or the referral of a patient for health care from one healthcare provider to another. An example of this would be a dentist referral to an orthodontist.


Payment means obtaining reimbursement for the provision of health care; determinations of eligibility or coverage; billing; claims management; collection activities; justification of charges; and disclosure to consumer reporting agencies; protected health information relating to the collection of reimbursements (only certain information may be disclosed). An example of this would be submitting your bill for health care services to your insurance company.


Health care operations are any activity related to covered functions in which we participate in the function of our offices, such as conducting quality assessment activities; protocol development; case management and care coordination; auditing functions; business management and general administrative activities, including implementation of this regulation; customer service evaluations; resolution of grievances; fundraising; and marketing for which an authorization is not required. An example of this would be evaluation customer services given to patients.

Persons involved in care: We may use or disclose dental and health information to a family member, your personal representative or another person identifies by you when they are involved in your care or in the payment of your care, of your location, your general condition, or death, i.e. a person has the authority by law to make health care decisions for you, we will treat your representative the same way we would treat you with respect to your health information and allowing a person to pick up periodontal, records, Xrays, or similar forms of dental and health information.

Disaster relief: We may use or disclose your dental and health information to assist in disaster relief efforts.

Marketing health-related services: We will not use your dental and health information for marketing communications.

Required by law: We may use or disclose your dental and health information when we are required to do so by law in response to a subpoena or court order.

Public health: We may use or disclose your personal health information to an oversight agency for activities including audits, investigations, inspections, and credentialing as necessary for licensure and for the government to monitor the healthcare system, programs and civil rights laws. Including disclosures to: prevent or control disease, injury or disability, report child abuse or neglect, report reactions to medications or problems with products or devices, notify a person of a recall, repair, or replacement of products or devices, notify a person who may have been exposed to a disease or condition or notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.

Judicial and administrative hearings: If you are involved in a law suit or dispute, we may disclose your personal health information in response to a court or administrative order or in response to subpoena, discovery request or other lawful process instituted by someone else involved a dispute but only if efforts have been made to contact you about the request or to obtain an order protecting the information requested.

Workers compensation: We may disclose your personal health information to the extent authorized by and to the extent necessary to comply with workers’ compensation or similar programs.

National security: We may disclose to military authorities the dental and health information of Armed Forces personnel under certain circumstances. We may disclose to authorize federal officials dental and health information required for lawful intelligence, counterintelligence, and other national Security activities. We may disclose to correctional institution or law enforcement official having lawful custody the protected health information of an inmate or patient under certain circumstances.

Coroners and medical examiners: We may release your personal health information to a coroner or medical examiner if necessary to identify a deceased person or determine cause of death.


Secretary of health and human services: We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA. We may, without prior consent, use or disclose your personal health information to carry out treatment, payment or health care operations.

Directly to you at your request; In an emergency treatment situation, if we attempt to obtain such consent as soon as reasonable practicable after the delivery of such treatment, if we are required by law to treat you and attempts to obtain consent are unsuccessful, or if we attempt to obtain consent but are unable, due to barriers of communication, but we determine in our professional opinion that treatment is clearly inferred from the circumstances;

Pursuant to and in compliance with an authorization signed by you; and Provided that you are informed in advance of the use and disclosure and have the opportunity to agree or prohibit or restrict the use or disclosure. This may be an oral agreement between us and may include a directory maintained at our facility containing specific information allowed by this Act.We may de-identify your personal health information by using codes or removing all individually identifiable health information.

All other uses and disclosures will be made only upon securing a written authorization form signed by you. You have the right to revoke this authorization, at any time, upon written notice and we will abide by that request. However, exception would be any actions already taken, relying on your authorizations, prior to revocation notice.

 We may contact you to provide appointment reminders or to inform you about treatment alternatives or other health related benefits or services that may be of interest to you.

Under HIPAA, you have the following rights with respect to your protected health information: You have the right to request restrictions on certain uses and disclosures of protected health information, including restrictions placed upon disclosure to family members, close personal friends, or any other person you identify. We are, however, not required to agree with a requested restriction.

You have the right to receive confidential communications of your protected health information, either directly from us or by alternative means or from alternative locations;

You have the right to inspect and copy your protected health information; You have the right to amend protected health information, however, this request may be denied under certain circumstances; You have the right to receive an accounting of disclosures of your protected health information made by us in the six years prior to the date of the accounting request; and You have the right to obtain a paper copy of this notice from us, even if you have already agreed to receive this notice electronically.

If you feel your privacy rights or the provisions of this notice of privacy policies has been violated, you have the right to file a formal written complaint.


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