Notice of Privacy Practices
Effective Date: February 16, 2026
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Gentle Dentist is required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices that are described in this Notice while it is in effect.
This Notice takes effect on February 16, 2026 and will remain in effect until we replace it.
The Gentle Dentist reserves the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make the new Notice provisions effective for all protected health information that we maintain. When we make significant changes in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice upon request.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.
How We May Use and Disclose Health Information About You
We may use and disclose your health information for different purposes, including treatment, payment, and health care operations. For each of these categories, we have provided a description and an example. Some information, such as HIV-related information, genetic information, alcohol and/or substance use disorder treatment records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they apply to our use and disclosure of these records.
Treatment
We may use and disclose your health information for your treatment or to provide, coordinate, or manage your health care and any related services. For example, we may disclose your health information to a specialist or another health care provider involved in your care.
Payment
We may use and disclose your health information so that we may bill and collect payment for the treatment and services you receive from us. For example, we may provide portions of your information to an insurance company, dental plan, or another third party to determine coverage or payment.
Health Care Operations
We may use and disclose your health information in connection with our health care operations. These uses and disclosures are necessary to run our practice and help ensure that our patients receive quality care. For example, we may use your information to review treatment and services, evaluate staff performance, conduct training programs, and support licensing or accreditation activities.
Individuals Involved in Your Care or Payment for Your Care
We may disclose your health information to a family member, close friend, or another person identified by you if that person is involved in your care or payment for your care. We may also disclose relevant information to assist in notifying such persons of your location, general condition, or death.
Disaster Relief
We may use or disclose your health information to assist in disaster relief efforts.
Required by Law
We may use or disclose your health information when we are required to do so by law.
Public Health Activities
We may disclose your health information for public health activities, including disclosures to:
- Prevent or control disease, injury, or disability
- Report child abuse or neglect
- Report reactions to medications or problems with products or devices
- Notify a person of a recall, repair, or replacement of products or devices
- Notify a person who may have been exposed to a disease or condition
- Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence
National Security
We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose health information to correctional institution or law enforcement officials having lawful custody of a patient or inmate under certain circumstances.
Secretary of Health and Human Services
We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine our compliance with HIPAA.
Workers’ Compensation
We may disclose your health information as authorized by and to the extent necessary to comply with workers’ compensation or similar programs established by law.
Law Enforcement
We may disclose your protected health information for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order.
Health Oversight Activities
We may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and licensure actions and are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings
If you are involved in a lawsuit or a dispute, we may disclose your health information in response to a court or administrative order. We may also disclose health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Research
We may disclose your protected health information to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information.
Coroners, Medical Examiners, and Funeral Directors
We may release health information to a coroner or medical examiner as necessary for identification purposes, determining cause of death, or other duties authorized by law. We may also disclose health information to funeral directors as necessary to carry out their duties.
Fundraising
We may contact you to provide you with information about our practice-related fundraising programs or events, unless you tell us you do not wish to receive such communications from us. You may opt out of receiving these communications.
Substance Use Disorder Treatment Information
If we receive records from a substance use disorder treatment program that is covered by 42 CFR Part 2, those records may be protected by special rules. If the records are received pursuant to a general consent for treatment, payment, or health care operations, we may use and disclose those records as permitted by HIPAA and as described in this Notice. If we receive those records pursuant to a more limited consent or under another Part 2 permission, we will use and disclose them only as expressly permitted by that consent or by law.
In no event will we use or disclose your Part 2 treatment records in any civil, criminal, administrative, or legislative proceeding against you unless you have provided specific written authorization or the disclosure is otherwise permitted by law.
Other Uses and Disclosures
Uses and disclosures of your protected health information for purposes other than those described in this Notice will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke an authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your health information for the reasons covered by your written authorization, except to the extent that we have already acted in reliance on it.
Your Health Information Rights
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your health information, with limited exceptions. You must make your request in writing. If we maintain your health information electronically, you may request an electronic copy if readily producible. We may charge a reasonable, cost-based fee for the costs of copying, mailing, or supplies associated with your request. If we deny your request, you may request a review of that denial where required by law.
Right to an Accounting of Disclosures
You have the right to receive an accounting of certain disclosures of your health information made by us, in accordance with applicable law. To request an accounting, you must submit your request in writing to our Privacy Officer. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first accounting you request within a 12-month period will be free. For additional accountings, we may charge you a reasonable, cost-based fee.
Right to Request Restrictions
You have the right to request additional restrictions on our use or disclosure of your health information. Your request must be in writing and must tell us what information you want to limit, whether you want to limit our use, disclosure, or both, and to whom you want the limits to apply. We are not required to agree to a requested restriction except where the disclosure is to a health plan for purposes of carrying out payment or health care operations and the information pertains solely to a health care item or service for which you, or a person on your behalf, have paid us in full.
Right to Request Confidential Communications
You have the right to request that we communicate with you about health matters by alternative means or at alternative locations. Your request must be in writing and must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to Amend
You have the right to request that we amend your health information if you believe it is incorrect or incomplete. Your request must be in writing and must explain why the information should be amended. We may deny your request under certain circumstances. If we deny your request, we will provide a written explanation and explain your rights regarding that denial.
Right to Notification of a Breach
You will receive notifications of breaches of your unsecured protected health information as required by law.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically. A copy of this Notice is also available on our website.
Electronic Notice
If you receive this Notice on our website or by electronic mail, you are still entitled to request a paper copy of it.
Questions and Complaints
If you want more information about our privacy practices or have questions or concerns, please contact:
The Gentle Dentist
Attn: Privacy Officer
Dr. Robert Antolak, DDS
15055 22 Mile Rd. Suite #2
Shelby Township, MI 48315
Phone: 586-247-3500
Email: DrAntolak@TheGentleDentist.com
If you are concerned that your privacy rights have been violated, you may file a complaint with The Gentle Dentist by contacting our Privacy Officer using the information above. You may also file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
A copy of this Notice is available on our website at /notice-of-privacy-practices.
Helpful Links
For general website data handling information, please review our Privacy Policy.
If you need to reach our office, visit our Contact Page.
To learn more about our patient-centered dental care, return to the Home Page.
You may also find additional visit-related information on our Patient Information page.