HIPAA Notice of Privacy Practices

Lucas Elite Dental Studio, PLLC

Effective Date: May 30, 2026

This notice describes how dental and health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Lucas Elite Dental Studio, PLLC is required by law to protect the privacy and security of your protected health information (“PHI”). PHI includes information that identifies you and relates to your dental or health condition, care, or payment for care.

Contact

Lucas Elite Dental Studio, PLLC
Attn: Privacy Officer
2730 Country Club Road, STE C
Lucas, TX 75002
Phone: (972) 905-0786
Email: office@lucaselitedental.com

Our Responsibilities

We are required to:

• Protect the privacy and security of your PHI
• Follow the duties and privacy practices described in this Notice
• Give you a copy of this Notice
• Notify you if a breach occurs that may have compromised your PHI
• Use or disclose PHI only as allowed by law, this Notice, or your written authorization

Your Rights

You have the right to:

Get a copy of your dental record. You may ask to see or receive an electronic or paper copy of your dental and billing records. We may charge a reasonable, cost-based fee as permitted by law.

Ask us to correct your record. You may ask us to correct information you believe is incorrect or incomplete. We may deny the request in some cases, but we will explain why in writing.

Request confidential communications. You may ask us to contact you in a specific way or at a specific address. We will agree to reasonable requests.

Ask us to limit certain uses or disclosures. You may ask us not to use or share certain PHI for treatment, payment, or health care operations. We are not required to agree to every request. If you pay for a service in full out of pocket, you may ask us not to share that information with your health plan for payment or health care operations unless a law requires us to do so.

Get a list of certain disclosures. You may ask for an accounting of certain disclosures of your PHI, generally for up to six years before your request.

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

Choose someone to act for you. If someone has legal authority to act for you, we will verify that authority before taking action.

File a complaint. You may complain to us or to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Your Choices

You may tell us your preferences about sharing PHI with family, friends, caregivers, or others involved in your care or payment for your care.

If you cannot tell us your preference, we may share information when we believe it is in your best interest or needed for disaster relief.

We do not sell PHI. We do not use or disclose PHI for marketing when HIPAA requires written authorization unless you give us that authorization. You may revoke an authorization in writing at any time, except to the extent we already relied on it.

How We May Use and Disclose PHI

We may use and disclose PHI for:

Treatment. We may share PHI with dentists, specialists, laboratories, imaging providers, pharmacies, or other health care providers involved in your care.

Payment. We may use and share PHI to bill and collect payment from you, your dental plan, health plan, or another responsible party.

Health care operations. We may use and share PHI to run our practice, improve care, train staff, conduct quality reviews, manage compliance, and perform business operations.

Business associates. We may share PHI with vendors that perform services for us, such as billing, scheduling, electronic health records, IT, secure communications, legal, accounting, or consulting services. When required, we have written agreements requiring those vendors to protect PHI.

Appointment reminders and care communications. We may contact you about appointments, follow-up care, treatment options, prescriptions, test results, dental instructions, or health-related services.

Family, caregivers, and disaster relief. Unless you object, we may share relevant information with people involved in your care or payment for your care, or with disaster relief organizations.

Legal and public purposes.We may use or disclose PHI when allowed or required by law, including for public health, abuse or neglect reporting, health oversight, audits, investigations, licensing matters, legal proceedings, law enforcement, workers’ compensation, coroners or medical examiners, government functions, and HHS compliance reviews.

Uses Requiring Written Authorization

We will obtain your written authorization when required by law, including for most uses of psychotherapy notes if we ever maintain them, marketing that requires authorization, sale of PHI, or other uses not permitted without authorization.

You may revoke an authorization in writing at any time, except to the extent we already acted in reliance on it.

Website, Online Forms, and Tracking

Information submitted through our website, appointment tools, or electronic communications may be PHI if it relates to dental care, treatment, payment, insurance, or scheduling.

We do not use PHI for targeted advertising. We do not disclose PHI to Google, social media platforms, or advertising networks for advertising, analytics, conversion tracking, or audience-building.

We do not use Google Ads Enhanced Conversions, advertising pixels, session replay, keystroke logging, or similar tracking technologies on contact, booking, intake, payment, patient portal, or other pages where PHI may be submitted.

Texas Electronic PHI Notice

Your PHI may be subject to electronic disclosure. We may use or disclose PHI electronically for treatment, payment, health care operations, insurance-related functions, and other purposes allowed or required by HIPAA, HITECH, Texas law, or your written authorization.

When a separate authorization is required by law, we will obtain it.

Texas Patient Records and Complaint Information

Texas law gives patients the right to request access to health care records and requires information about records requests, licensing authorities, and complaints.

Records Requests

To request dental or billing records, contact:

Lucas Elite Dental Studio, PLLC
Attn: Privacy Officer
2730 Country Club Road, STE C
Lucas, TX 75002
Phone: (972) 905-0786
Email: office@lucaselitedental.com

Please include the patient’s full name, date of birth, contact information, records requested, dates of service if known, where the records should be sent, and proof of legal authority if requesting records for another person.

We will respond as required by HIPAA, Texas law, and Texas dental board rules. Fees may apply only as permitted by law.

Texas Dental Licensing Authority

Texas State Board of Dental Examiners
1801 Congress Ave., Suite 8.600
Austin, TX 78701
Licensing Phone: (737) 363-2320
Licensing Email: licensinghelp@tsbde.texas.gov

Dental Complaints

Complaints about dentists, dental hygienists, or dental assistants may be submitted to the Texas State Board of Dental Examiners.

The Texas State Board of Dental Examiners states that it does not accept anonymous complaints.

Dental Record Retention

Texas dental records are generally kept for at least five years from the last date of treatment. If the patient was under 18 at the last treatment, records are generally kept until the patient reaches age 21 or for five years from the last treatment date, whichever is longer.

Certain orthodontic records may be subject to longer retention. We may also keep records longer when required by law, contract, insurance, risk-management policy, or professional standards.

Electronic Health Record Storage

Electronic health records under our control that contain patient information are maintained in the United States or a U.S. territory, including when stored through third-party or cloud service providers, as required by Texas law.

Breach Notification

If we discover a privacy or security incident involving unsecured PHI, we will investigate, take appropriate steps to reduce harm, and provide legally required notices to affected individuals, HHS, the Texas Attorney General, TSBDE, or other authorities when required.

Changes to This Notice

We may change this Notice at any time. The updated Notice will apply to all PHI we maintain. The current Notice will be available on our website and at our office. You may request a paper copy at any time.

Contact

Lucas Elite Dental Studio, PLLC
Attn: Privacy Officer
2730 Country Club Road, STE C
Lucas, TX 75002
Phone: (972) 905-0786
Email: office@lucaselitedental.com