THIS NOTICE DESCRIBES HOW DENTAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

Effective Date: February 16, 2026
 Last Updated: September 30, 2026

Before You Read

We wrote this in plain English because you deserve to understand how your personal health information is handled-not just receive a document that checks a legal box. If anything here is unclear, please ask us before or after your visit. We are happy to walk through it with you.

Who This Notice Applies To

Dental Care Acworth

  • 5552 Robin Road, Suite A, Acworth, GA 30102
  • 678-888-1554
  • staff@dentistinacworth.com
  • dentistinacworth.com

Privacy Officer: Dr. Arjan Hayer

This Notice applies to all dental and medical records our practice creates, receives, maintains, or transmits about you. It covers patients who receive care at our Acworth office.

1. Our Legal Responsibility

Federal law-the Health Insurance Portability and Accountability Act, known as HIPAA-requires us to protect your health information and tell you how we use it. We are legally obligated to:

  • Keep your health information private and secure
  • Follow the terms described in this Notice
  • Notify you as required by law if your health information is involved in a data breach
  • Provide you a copy of this Notice when required and whenever you request one

We will not sell your health information. We will not use your health information for purposes that require your written authorization without obtaining that authorization.

2. How We Use and Share Your Health Information

There are three standard situations where we can use or share your dental health information without asking for written permission first. These apply to dental practices under HIPAA.

For Your Dental Treatment

We use your records to examine your teeth, evaluate your oral health, make diagnoses, create treatment plans, and provide and coordinate your dental care.

Dental Care Acworth provides a range of dental services, including cleanings and exams, fillings and crowns, dental implants, cosmetic dentistry, and emergency dental care. Relevant health information may be shared with another health care professional when necessary to coordinate your treatment.

For Billing and Payment

We may use and share necessary information with your dental insurance company or other responsible parties to submit claims, process payments, and collect payment for dental services.

Dental Care Acworth accepts most major PPO insurance plans and offers flexible payment and financing options. Information necessary to process these payments may be shared with insurance companies, financing providers, or other parties involved in payment for your care.

For Running Our Practice

We may use your information internally for routine health care operations, including quality improvement, administrative activities, staff-related activities, and other activities necessary to operate our dental practice.

We may also contact you by phone, text, or other available communication methods regarding appointments, scheduling, billing, treatment, or other matters related to your care.

If you prefer a different reasonable method of communication, please let us know.

3. Other Situations Where We May Share Without Permission

Beyond treatment, payment, and health care operations, there are situations where the law permits or requires us to share your information without asking first. These may include:

  • Reporting to public health authorities when required or permitted by law
  • Responding to a court order, subpoena, or other lawful legal proceeding
  • Cooperating with law enforcement when legally authorized or required
  • Health oversight activities and government audits
  • Reporting suspected abuse, neglect, or domestic violence when required by law
  • Sharing information with a medical examiner or coroner when legally required
  • Supporting organ or tissue donation activities when applicable
  • Disclosures necessary to prevent or lessen a serious and imminent threat to health or safety
  • Other uses or disclosures permitted or required under applicable federal or state law

Unless you tell us otherwise, we may also share relevant information about your care with a family member or close friend who is involved in your care or helping with payment for your care, when permitted by law.

4. Substance Use Disorder Records

Certain substance use disorder records may receive additional protections under federal law.

Dental Care Acworth does not represent itself as a substance use disorder treatment provider. However, we may receive health information from another health care provider as part of coordinating your overall care.

When we receive information that is subject to additional federal protections, we will handle that information in accordance with applicable federal and state privacy requirements.

If you have questions about how information received from another health care provider is handled, please contact our Privacy Officer.

5. Everything Else Requires Your Written Permission

For uses or disclosures of your health information that are not described in this Notice and are not otherwise permitted or required by law, we will obtain your written authorization when required.

This may include certain:

  • Marketing communications
  • Uses or disclosures of information for purposes not related to your dental treatment, payment, or health care operations
  • Other disclosures for which HIPAA or applicable law requires authorization

You may withdraw a written authorization at any time by notifying us in writing. We will honor that withdrawal going forward to the extent permitted by law. We cannot undo disclosures that were already made based on your earlier authorization.

6. Your Rights Over Your Health Information

HIPAA gives you specific rights regarding your personal health information. Here is what you can do and how to exercise each right.

See or Get a Copy of Your Records

You can ask to inspect or obtain a copy of your dental and billing records, subject to applicable legal requirements and permitted exceptions.

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

Ask Us to Correct Your Records

If you believe information in your records is incorrect or incomplete, you can ask us to correct it.

We may deny a request when permitted by law. If we deny your request, we will provide an explanation and information about your rights regarding the decision.

Request Restrictions on How We Use Your Information

You can ask us to limit certain uses or disclosures of your health information.

We are not always required by law to agree to a requested restriction. If we agree to a restriction, we will follow it as agreed, except when otherwise required by law or in an emergency.

Ask Us to Contact You Differently

You can ask us to contact you using a specific phone number, mailing address, or another reasonable communication method.

You do not have to provide a reason for requesting confidential communications.

Get a Record of Certain Disclosures

You can request an accounting of certain disclosures of your health information, subject to the limitations and exceptions provided by law.

The accounting generally does not include routine disclosures made for treatment, payment, or health care operations.

Get a Paper Copy of This Notice

Even if you received this Notice electronically, you can request a paper copy at any time.

You may request a copy from our office or contact us using the information provided below.

Be Notified of a Data Breach

If your protected health information is involved in a breach that requires notification under applicable law, we will notify you as required by law.

7. How to Exercise Your Rights

To make any of the requests described above, please contact Dental Care Acworth in writing. We are also happy to help explain the process by phone.

Dental Care Acworth – Privacy Officer: Dr. Arjan Hayer

  • 5552 Robin Road, Suite A, Acworth, GA 30102
  • 678-888-1554
  • staff@dentistinacworth.com
  • dentistinacworth.com

We will acknowledge and respond to your request within the timeframes required by applicable law.

8. How to File a Complaint

If you believe we have not properly protected your health information or respected your privacy rights, you have two options.

Contact Us Directly

You may contact Dental Care Acworth’s Privacy Officer using the contact information above.

We take privacy concerns seriously and will review complaints in accordance with applicable law.

We will not retaliate against you for raising a concern or filing a privacy complaint.

Contact the Federal Government

You may also file a complaint directly with the U.S. Department of Health and Human Services:

Office for Civil Rights
 U.S. Department of Health and Human Services
200 Independence Avenue SW, Washington, D.C. 20201
+1-800-368-1019 (toll-free)
www.hhs.gov/ocr/privacy/hipaa/complaints

You may submit a complaint through the HHS Office for Civil Rights complaint process.

Filing a complaint will not affect the quality of care you receive at Dental Care Acworth.

9. Changes to This Notice

We reserve the right to update this Notice of Privacy Practices as required or permitted by law.

If we make changes, the updated version will be:

  • Made available at our office
  • Available upon request
  • Published on our website at dentistinacworth.com

Any updated version will apply to health information we maintain, as permitted by applicable law.

The effective date at the top of this Notice identifies the current version.

10. Questions?

We want you to feel informed and comfortable about how your health information is handled.

If anything in this Notice is unclear, please ask us at your next appointment or contact our office.

Dental Care Acworth

  • 5552 Robin Road, Suite A, Acworth, GA 30102
  • 678-888-1554
  • staff@dentistinacworth.com
  • dentistinacworth.com

Office Hours:

Monday–Thursday: 8:00 AM–5:00 PM
Friday: 8:00 AM–2:00 PM

Dental Care Acworth provides dental care including cleanings and exams, fillings and crowns, dental implants, cosmetic dentistry, and emergency dental care for patients in Acworth, Kennesaw, Woodstock, Cobb County, and surrounding communities.