Notice of Privacy Practices
EFFECTIVE DATE: February 16, 2026
THIS NOTICE DESCRIBES HOW MEDICAL/DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
WHO WE ARE
This Notice of Privacy Practices applies to Teravista Dentistry of Round Rock and our workforce, including Dr. Omar Karim, DMD (Privacy Officer), and all staff members. We are committed to protecting the privacy of your health information and complying with all applicable federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA).
OUR LEGAL DUTY
We are required by law to:
- Maintain the privacy and security of your protected health information (PHI)
- Provide you with this Notice of our legal duties and privacy practices
- Follow the terms of the Notice currently in effect
- Notify you if a breach occurs that may have compromised the privacy of your information
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Treatment
We may use your health information to provide, coordinate, or manage your dental care and related services. For example, we may share information with other health care providers involved in your care, such as oral surgeons, specialists, or laboratories.
Payment
We may use and disclose your health information to obtain payment for services we provide. For example, we may send your information to your dental insurance company to process a claim. We may also share information with a third-party billing service to facilitate payment for your care.
Health Care Operations
We may use and disclose your health information for health care operations, which are activities necessary to run our practice. Examples include quality improvement activities, training staff, reviewing the competence of our health care professionals, and conducting general administrative activities such as scheduling through our online appointment booking system.
Appointment Reminders
We may contact you as a reminder that you have an appointment for treatment or medical care by phone, text message, email, or other means.
Treatment Alternatives and Health-Related Benefits
We may use and disclose your health information to tell you about possible treatment options or alternatives, and about health-related benefits or services that may be of interest to you.
Business Associates
Some services are provided through contracts with third-party vendors known as “business associates.” We require all business associates (such as our billing service, EHR provider, and online scheduling platform) to protect your health information and comply with HIPAA.
Required by Law
We will disclose your health information when required to do so by federal, state, or local law.
Public Health Activities
We may disclose your health information for public health activities authorized by law.
Health Oversight Activities
We may disclose your health information to a health oversight agency for activities such as audits, investigations, and inspections.
Law Enforcement
We may disclose your health information to law enforcement officials as required or permitted by law.
Judicial and Administrative Proceedings
We may disclose your health information in response to a court or administrative order, subpoena, or other lawful process.
Serious Threats to Health or Safety
We may use or disclose your health information when necessary to prevent or lessen a serious and imminent threat to health or safety.
Workers’ Compensation
We may disclose your health information to comply with workers’ compensation or similar laws.
SPECIAL PROTECTIONS FOR CERTAIN INFORMATION
Some information is entitled to special confidentiality protections under applicable federal and/or state law. We will abide by these special protections as they apply to your records. Types of information that may receive heightened protection include: HIV-related information, genetic information, mental health records, alcohol and/or substance use disorder treatment records, and other sensitive health information protected by applicable Texas state law.
SUBSTANCE USE DISORDER (SUD) TREATMENT RECORDS — SPECIAL FEDERAL NOTICE (42 CFR Part 2)
Federal law (42 U.S.C. 290dd-2 and 42 CFR Part 2) provides special confidentiality protections for records relating to the identity, diagnosis, prognosis, or treatment of any patient maintained in connection with the performance of a federally assisted substance use disorder treatment program. If your records contain substance use disorder (SUD) information protected under Part 2:
- We generally may not use or disclose your SUD treatment records without your specific written consent, except in limited circumstances permitted by law (such as medical emergencies, certain audit or oversight activities, or as required by court order).
- Your SUD treatment records may not be used in civil, criminal, administrative, or legislative proceedings against you without your written consent or a specific court order that meets Part 2 requirements.
- You have the right to receive a list of disclosures we have made of your SUD treatment records.
- Violations of Part 2 are a federal crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurs.
If you believe your Part 2 rights have been violated, contact:
Substance Abuse and Mental Health Services Administration (SAMHSA)
1-800-662-4357 | www.samhsa.gov
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your health information, including your dental and billing records. Submit a written request to our Privacy Officer. We will respond within 30 days.
Right to Amend
If you believe information in your record is incorrect or incomplete, you may request an amendment in writing to our Privacy Officer.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your health information, other than for treatment, payment, or health care operations.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your health information. You also have the right to restrict disclosures to a health plan for services you paid for in full out-of-pocket.
Right to Request Confidential Communications
You have the right to request that we communicate with you in a specific way or at a specific location.
Right to a Paper Copy of This Notice
You may request a paper copy of this Notice at any time at our front desk or by contacting our Privacy Officer.
Right to Receive Notification of a Breach
You have the right to be notified if a breach of your unsecured protected health information occurs.
OUR DUTIES
We are required to maintain the privacy of your health information, provide you with notice of our privacy practices, and follow the terms of this Notice. We reserve the right to change our privacy practices. Any material changes will be reflected in a revised Notice provided to you.
USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
The following require your written authorization: psychotherapy notes, uses for marketing purposes, sale of your health information, and any use or disclosure not described in this Notice. You may revoke your authorization in writing at any time.
PRIVACY OFFICER AND CONTACT INFORMATION
Privacy Officer: Dr. Omar Karim, DMD
Teravista Dentistry of Round Rock
4010 Sandy Brook Drive, Suite 104
Round Rock, TX 78665
Phone: (512) 593-6343
Email: doctor@teravistadental.com
HOW TO FILE A COMPLAINT
If you believe your privacy rights have been violated, you may file a complaint with us or with:
Office for Civil Rights, U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints
We will not retaliate against you for filing a complaint.
CHANGES TO THIS NOTICE
We reserve the right to revise this Notice. Any revised Notice will be posted in our office and on our website at www.dentistroundrocktx.com. You may request a current copy at any time.
Teravista Dentistry of Round Rock | Notice of Privacy Practices | Effective February 16, 2026 | Dr. Omar Karim, DMD — Privacy Officer
