Notice of Privacy Practices

Effective/Last Revised: January 21, 2026

Introduction

This Notice of Privacy Practices (“Notice”) describes how Romney Pediatric Dentistry and its affiliates (“we,” “us,” “our,” or “Romney Pediatric Dentistry”) create, receive, maintain, and use your child’s health information, and what rights and protections you have regarding that information.  

Please read the Notice carefully. The Notice applies to health information created, received, or maintained by Romney Pediatric Dentistry in connection with the health care services we provide to your child. We are required by law to:

  • Maintain the privacy and security of your child’s health information
  • Provide you with the Notice describing our privacy practices
  • Notify you if a breach of your unencrypted health information occurs
  • Follow the privacy practices outlined in this Notice

Some of your child’s health information may be protected by additional federal law (42 C.F.R. Part 2) if it relates to diagnosis, treatment, or referral for treatment of substance use disorder. These records have extra privacy protections beyond, HIPAA, which are described in this Notice. 

Our Privacy Responsibilities 

We understand that your child’s health information is personal and sensitive, and we are committed to protecting it.  Romney Pediatric Dentistry is required by federal and state law to maintain privacy of health information that individually identifies you or your child.  This Notice describes the types of health information we maintain, how we may use and disclose that information, and the rights you have regarding your health information. 

Romney Pediatric Dentistry complies with:

  • The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its Privacy Rule
  • 42 C.F.R. Part 2 regulations governing substance use disorder records
  • Texas Health & Safety Code Chapter 181 (HB300) and other applicable Texas privacy laws

If we change the terms of this Notice, we will notify you of the changes and will provide an undated Notice.  We will post the revised Notice on our office and on our website (www.romneykidsdental.com), and any changes will apply to all health information we maintain.  

How We Collect and Maintain Your Health Information

Romney Pediatric Dentistry collects and maintains health information about you and your child in order to:

  • Provide your child with dental and health care services
  • Bill for services and process insurance claims
  • Obtain payment from your insurance company or other quality improvement, training, and business management
  • Comply with legal and regulatory requirements

Health information we collect includes your child’s medical and dental history, examination findings, clinical notes, laboratory results, x-rays, insurance information, payment information, and any other information you provide to us. 

How We May Use and Disclose Your Health Information

For Treatment

We use your child’s health information to diagnose their condition, provide treatment, arrange for specialized care, and coordinate care with other health care providers. For example, we may disclose information to a specialist your child is being referred to, or to another provider involved in your child’s care. 

For Payment

We use and disclose your child’s health information to obtain payment for dental services we provide to your child. This includes:

  • Submitting claims to your dental insurance plan or other health insurance plans
  • Billing you for services not covered by insurance
  • Collecting payment from you or your insurance company
  • Determining eligibility for benefits
  • Managing claims, appeals, and disputes with insurers

For Health Care Operations

We use and disclose your child’s health information to support our business operations, including:

  • Quality assessment and performance improvement 
  • Training dental students and staff
  • Accreditation and licensing
  • Peer review and credentialing
  • Compliance with legal and regulatory requirements
  • Facility planning and management
  • Cost management and business operations

Substance Use Disorder (SUD) Records

If your child’s health information includes records related to the diagnosis, treatment, or referral for treatment of substance use disorder, those records are protected by 42 C.F. R. Part 2 (federal regulation governing SUD information). Part 2 provides additional and more stringent privacy protections than HIPAA.

Use and Disclosure for Treatment, Payment, and Operations: Unlike other health information, Part 2 usually requires your written consent before Romney Pediatric Dentistry may use or disclose SUD records for treatment, payment, or health care operations, even though these uses and disclosers would normally be permissible under HIPAA without your consent. You may provider a single written consent that authorizes Romney Pediatric Dentistry to use and disclose your child’s SUD records for all treatment, payment, and health care operations purposes for a specified period of time.

Restrictions of Legal Proceedings: SUD records or testimony relaying the content of such records shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you, unless you provide written consent or a court order is obtained that meets the requirements of 42 C.F.R. Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure, and you must be provided notice and opportunity to be heard before disclosure occurs. 

Your Consent and Revocation Rights: You may provide a written consent authorizing Romney Pediatric Dentistry to use and disclose your child’s SUD records for treatment, payment, and health care operations.  This consent may be revoked at any time in writing, except that revocation will not affect uses or disclosures that occurred before we received your written revocation request. 

Additional SUD Protections: SUD information is more sensitive and restricted than other health information, Romney Pediatric Dentistry will not disclose your SUD records to law enforcement, attorneys, or other third parties for purposes of investigation, prosecution, or civil proceedings unless you have specifically authorized such disclosure in writing or a court has ordered disclosure consistent with Part 2. 

Other Uses and Disclosures

Redisclosure of Information

Information disclosed from your child’s health records may be subject to redisclosure by the recipient and may no longer be protected by HIPAA or 42 C.F.R. Part 2. For this reason, you should be cautious about requesting that we disclose your child’s health information to third parties. Once information is disclosed by Romney Pediatric Dentistry, we have no control over how the recipient uses or further discloses that information. 

When Authorization is Required

Except as described in this Notice, we will not use or disclose your child’s health information without your written authorization.  If we use or disclose your child’s information for a purpose other than those described above, we will obtain your specific written authorization first.

Uses and Disclosures with Your Authorization

You may authorize us to use and disclose your child’s health information for any purpose you specify. Any authorization you provide must be in writing. You may revoke your authorization at any time by submitting a written revocation request to our Privacy Officer (contact information below). 

Fundraising

If Romney Pediatric Dentistry intends to contact you for fundraising purposes, we will first provide you with a clear and conspicuous opportunity to elect not to receive such fundraising communications. Fundraising communications will not include your child’s health information; they may only include demographic information (such as your name and contact information) and information that reflects the type of health care we provide. 

Additional Permitted Uses and Disclosures (without your authorization)

We may use and disclose your health information without your authorization in the following circumstances:

  • Public Health Activities: To public health authorities for disease reporting, public health surveillance, or public health investigation
  • Health Oversight Activities: To health agencies for licensing, credentialing, audits, and investigations
  • Judicial and Administrative Proceedings: When required by law, court order, subpoena, or other legal process (consistent with Part 2 protections for SUD)
  • Law Enforcement: When required by law enforcement officials, consistent with Part 2 protections
  • Organ and Tissue Donation: To organizations engaged in procurement, banking, and transplantation of organs and tissues
  • Workers’ Compensation: As required by workers’ compensation laws
  • Communicable Disease Control: To prevent or control disease, injury, or disability
  • Abuse, Neglect, Domestic Violence, or Exploitation: To appropriate agencies when required or authorized by law
  • Serious Threats to Health or Safety: To prevent serious harm to you or others 
  • Military Personnel: When required by military command authority
  • National Security: When authorized by federal law
  • Incarcerated Individuals: To correctional institutions or law enforcement when you are an inmate

Reproductive Health Information

Romney Pediatric Dentistry will not use or disclose your child’s health information for the purpose of investigation or imposing liability on you for seeking, obtaining, providing, or facilitating lawful reproductive health care. When we receive requests for your child’s health information that may relate to reproductive health care, we may require additional assurances from the requestor (such as written certification that the information is not being sought for a prohibited investigation or proceeding) before using or disclosing that information.

Your Privacy Rights

You have the following rights with respect to your child’s health information:

Right to Access, Inspect, and Obtain Copies

You have the right to inspect and obtain a copy of your child’s health information, including SUD records, subject to certain legal limits. To request access to your child’s health information, contact our Privacy Officer at the address, telephone, or email address listed below. We will provide access to your child’s health information within 30 days of your request. If we deny access, we will provide you with a written explanation of the reason(s) for the denial and information about how you may appeal the denial.

Right to Request Amendments

You have the right to request that we amend or add to your child’s health information if you believe it is inaccurate or incomplete. To request an amendment, submit your request in writing to our Privacy Officer. We will respond to your amendment request within 60 days.  If we deny your request, we will provide written explanation of the reason(s) for the denial. 

Right to Request Restrictions

You have the right to request restrictions on the use and disclosure of your child’s health information, including SUD records. However, we are not required to agree to a restriction unless it is required by law. To request a restriction, submit your request in writing to our Privacy Officer, specifying what information should be restricted and how it should be restricted.  If we agree to your restriction request, we will honor that restriction unless it involves and emergency situation. 

Right to Request Confidential Communications

You have the right to request that we communicate with you about your child’s health information by alternative means or at alternative locations. For example, you may request that we send bills and other communication to a different address or phone number. To request confidential communication, submit your request in writing to our Privacy Officer.

Right to Receive Notice of Breaches

You have the right to be notified if there is a breach of security or privacy of your unencrypted health information.  We will notify you of any breach without unreasonable delay and no later than 60 calendar days after the breach.

Right to an Accounting of Disclosures

You have the right to request an accounting (list)of disclosures of your health information made by Romney Pediatric Dentistry, including disclosures of SUD records that require accounting under Part 2. The accounting will not include certain routine disclosures such as those made for treatment, payment, and health care operations (unless required by law), or disclosures made with your authorization. To request an accounting of disclosure, submit your request in writing to our Privacy Officer.  We will provide the accounting within 30 days of your request. 

Right to a Paper or Electronic Copy

You have the right to request and obtain a paper or electronic copy of your child’s health information.  We may charge a reasonable fee for copying, mailing, and other labor costs associated with your request. 

Right to Revoke Authorization

You may revoke any authorization you may have given Romney Pediatric Dentistry, including authorizations for SUD records, at any time by submitting a written revocation request to our Privacy Officer.  Your revocation will not be effective for uses or disclosures that occurred before we received your revocation request.

Our Privacy Safeguards

Romney Pediatric Dentistry is committed to protecting your health information through reasonable administrative, physical, and technical safeguards. These safeguards include:

  • Restricted access to health information based on job duties
  • Secure storage of physical records
  • Encryption of electronic health information
  • Secure authentication and access controls for computer systems
  • Regular training of staff on privacy and security
  • Policies and procedures to prevent unauthorized use and disclosure
  • Incident response procedures for potential security breaches

Complaints

If you believe Romney Pediatric Dentistry has violated your child’s privacy rights, you have the right to file a complaint. You may file a complaint with:

  • Romney Pediatric Dentistry 

Contact our Privacy Officer:

  • Name: Beth Darden, Office Manager
  • Address: 3600 FM 407 Ste. 160 Bartonville, TX 76226
  • Telephone: (940) 455-7339
  • Email: bdarden@romneykidsdental.com

We will not retaliate you for filing a complaint.  All complaints will be handled promptly and confidentially. 

  • U.S. Department of Health and Human Services (HHS)

 

Office for Civil Rights (OCR)

Individuals may file a complaint with the HHS Office for Civil Rights if they believe a covered entity has violated their HIPAA privacy rights. Complaints must be filed in writing and may be submitted electronically or by mails:

  • Website: 
  • Mail: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201
  • Texas Attorney General

Because Romney Pediatric Dentistry is located in Texas and complies with Texas Health & Safety Code Chapter 181 (HB 300), you may also file a complaint with the Texas Attorney General regarding violations of Texas privacy law:

  • Website:
  • Telephone: (512) 463-2100

 

Additional Information

Your Rights Are Not Affected

The privacy protections described in this Notice do not limit any other rights you may have under federal or state law. For example, you may have additional rights under Texas state privacy law.

If you have questions about this Notice or Romney Pediatric Dentistry’s privacy practices, please contact our Privacy Officer at:

  • Name: Beth Darden, Office Manager
  • Address: 3600 FM 407 Ste. 160 Bartonville, TX 76226
  • Telephone: (940) 455-7339
  • Email: bdarden@romneykidsdental.com

Effective Date

This Notice is effective 1/21/2026, and applies to all health information created, received, maintained, or used by Romney Pediatric Dentistry on or after this date.

 

This Notice has been prepared in compliance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 C.F.R. Part 164), 42 C.F.R. Part 2 (Confidentiality of Substance Use Disorder Patient Records), and Texas Health & Safety Code Chapter 181 (HB 300).

Last Updated: January 2026