NOTICE OF PRIVACY PRACTICES

Backcountry Dental
6584 Creekside Ln, Suite 100
Park City, UT 84098
(435) 649-6332
office@backcountrydentalut.com
www.backcountrydentalut.com

Effective Date: August 1, 2026

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.

This Notice of Privacy Practices describes how Backcountry Dental may use and disclose your protected health information ("PHI"), your rights regarding your PHI, and our responsibilities regarding the privacy of your health information.

Please review this notice carefully.

YOUR RIGHTS

When it comes to your health information, you have certain rights.

Get a copy of your health information

You have the right to inspect and obtain a copy of your health information, including dental records, subject to applicable law.

You may request your records in paper or electronic form when available.

We will provide access to your health information within the time required by applicable law.

To request access to your records, contact:

Backcountry Dental 6584 Creekside Ln, Suite 100 Park City, UT 84098 (435) 649-6332 office@backcountrydentalut.com

Ask us to correct your health information

You may ask us to correct health information about you that you believe is incorrect or incomplete.

We may deny your request in certain circumstances. If we deny your request, we will explain why in writing and explain how you may submit a statement of disagreement.

Request confidential communications

You may ask us to contact you in a specific way or at a specific location.

For example, you may ask us to contact you by telephone rather than email or to contact you at a particular telephone number or mailing address.

We will accommodate reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or share certain health information for treatment, payment, or healthcare operations.

We are not required to agree to every request.

If you pay for a healthcare item or service completely out of pocket and request that we not disclose information about that item or service to your health plan for payment or healthcare operations, we will agree to your request unless disclosure is required by law.

Get a list of those with whom we have shared information

You may request an accounting of certain disclosures of your health information made by us during the six years before the date of your request.

The accounting will not include certain disclosures, such as disclosures made for treatment, payment, and healthcare operations, or disclosures you authorized.

We will provide one accounting in a 12-month period without charge. We may charge a reasonable, cost-based fee for additional requests within the same 12-month period.

Get a copy of this notice

You may request a paper copy of this Notice of Privacy Practices at any time.

You may also access this notice on our website:

www.backcountrydentalut.com/npp

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make decisions about your health information.

We will verify that the person has appropriate authority before taking action.

File a complaint

If you believe your privacy rights have been violated, you may file a complaint with Backcountry Dental or with the U.S. Department of Health and Human Services Office for Civil Rights.

You will not be retaliated against for filing a complaint.

YOUR CHOICES

For certain health information, you may tell us your preferences about what we share.

You have the right to ask us to:

Share information with a family member, close friend, or another person involved in your care or payment for your care.
Share information in a disaster-relief situation.

If you are unable to tell us your preference, we may share information when necessary to provide care or when we believe doing so is in your best interest.

We may also share information when necessary to lessen a serious and imminent threat to health or safety.

Marketing and use of your information for promotional purposes

We may communicate with you about our own dental services, treatment options, appointment-related matters, and other healthcare-related services as permitted by HIPAA.

When HIPAA requires your written authorization for a marketing use or disclosure of your PHI, we will obtain that authorization before using or disclosing your PHI for that purpose.

You may revoke an authorization in writing at any time, except to the extent we have already relied upon it.

We do not sell your PHI to third parties for their independent marketing purposes without the authorization required by law.

Patient testimonials, reviews, photographs, and other media

From time to time, Backcountry Dental may wish to use patient testimonials, photographs, videos, before-and-after images, or other patient-related content for educational, promotional, or marketing purposes.

We will obtain appropriate written authorization before using or disclosing PHI for these purposes when authorization is required by HIPAA.

Participation in any patient testimonial, photograph, video, before-and-after image, or other promotional activity is voluntary and will not affect the patient's treatment or eligibility for treatment.

A patient may decline to participate without affecting the quality of care they receive.

For minors, appropriate authorization will be obtained from a parent or legal guardian, as required by applicable law.

Our separate patient media release or authorization forms may provide additional details about how photographs, testimonials, videos, or other content may be used.

Online reviews

Patients may independently choose to post reviews about their experiences with Backcountry Dental on Google or other public websites.

Backcountry Dental does not disclose private patient information in response to public reviews.

We will not confirm that a reviewer is or was a patient of Backcountry Dental or disclose protected health information about that person in response to a public review.

If Backcountry Dental wishes to identify a person as a patient or republish an identifiable patient testimonial or review in our own marketing materials, we will obtain appropriate authorization when required by law.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use and disclose your health information without your written authorization for purposes permitted or required by HIPAA and applicable law.

Treatment

We may use your health information and share it with other healthcare professionals involved in your care.

For example, we may share relevant dental information with another dentist, dental specialist, dental laboratory, physician, or other healthcare professional involved in your treatment.

Payment

We may use and disclose your health information to bill and receive payment for dental services.

For example, we may provide information to your dental insurance plan when submitting a claim for treatment.

Healthcare operations

We may use and disclose your health information for healthcare operations, including activities necessary to operate our dental practice, improve the quality of our services, coordinate care, conduct quality assessment activities, and manage our business.

Appointment reminders and communications

We may use your health information to contact you about appointments, appointment reminders, appointment confirmations, appointment changes, treatment, billing, appointment reviews or other matters related to your care.

We may contact you by telephone, voicemail, text message, email, mail, or other communication methods permitted by law.

You may request reasonable restrictions or confidential communications as described in this notice.

Business associates

We may share PHI with third-party service providers that perform services for or on behalf of Backcountry Dental.

These may include providers of:

Practice management services
Billing services
Information technology
Electronic communications
Appointment reminders
Patient messaging
Appointment scheduling
Payment processing
Data storage
Other administrative or professional services

When required by HIPAA, we require our business associates to appropriately safeguard PHI through a Business Associate Agreement or other legally required arrangement.

Required by law

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

Public health

We may disclose health information for certain public health activities permitted by law, including activities related to preventing or controlling disease, reporting certain conditions, or addressing public health threats.

Serious threats to health or safety

We may use or disclose health information when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, consistent with applicable law.

Workers' compensation

We may disclose health information as authorized by and to the extent necessary to comply with workers' compensation laws and other similar programs.

Law enforcement

We may disclose health information for certain law-enforcement purposes when permitted or required by law.

Health oversight

We may disclose health information to government agencies authorized to conduct oversight activities, including audits, investigations, inspections, licensing activities, and other oversight permitted by law.

Legal proceedings

We may disclose health information in response to a court or administrative order, subpoena, discovery request, or other lawful process when permitted or required by law.

Coroners and medical examiners

We may disclose health information to a coroner or medical examiner when permitted by law.

Organ and tissue donation

We may disclose health information for organ, eye, or tissue donation and transplantation purposes when permitted by law.

Disaster relief

We may disclose health information to organizations assisting with disaster-relief efforts when permitted by law.

SUBSTANCE USE DISORDER RECORDS

Federal law provides additional protections for certain records relating to substance use disorder treatment that are subject to 42 CFR Part 2.

If Backcountry Dental receives or maintains records that are subject to Part 2, we will comply with the applicable Part 2 requirements governing the use and disclosure of those records.

Part 2 records may be subject to additional consent and confidentiality requirements beyond those that generally apply to PHI under HIPAA.

Backcountry Dental is not a substance use disorder treatment program.

OTHER USES AND DISCLOSURES

Other uses and disclosures of your health information not described in this notice will be made only with your written authorization when required by law.

If you provide written authorization, you may revoke that authorization in writing at any time, except to the extent we have already relied upon the authorization.

OUR RESPONSIBILITIES

Backcountry Dental is required by law to:

Maintain the privacy and security of your protected health information.
Provide you with this notice describing our legal duties and privacy practices.
Follow the privacy practices described in the notice currently in effect.
Notify affected individuals as required by law if a breach occurs that compromises the privacy or security of unsecured protected health information.
Provide you with a copy of this notice upon request.

We reserve the right to change our privacy practices and this notice.

If we make a material change to our privacy practices, we will update this notice and make the revised notice available upon request and on our website.

The revised notice will apply to all protected health information we maintain, except where otherwise required by law.

QUESTIONS OR COMPLAINTS

If you have questions about this notice or believe that your privacy rights have been violated, please contact:

Backcountry Dental 6584 Creekside Ln, Suite 100 Park City, UT 84098
Phone: (435) 649-6332
Email: office@backcountrydentalut.com

You may also file a complaint with the:

U.S. Department of Health and Human Services Office for Civil Rights

You may file a health information privacy complaint online through the HHS Office for Civil Rights Complaint Portal:

HHS Office for Civil Rights Complaint Portal

Additional information about filing a HIPAA privacy complaint is available from HHS:

HHS: Filing a Health Information Privacy Complaint

You may also contact the Office for Civil Rights at:

U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201

Phone: 1-800-368-1019 TDD: 1-800-537-7697