Stephen Huber, DDS
13400 Roe Ave, Leawood, KS 66209 Phone: (913) 469-8884
Effective Date: February 16, 2026

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

Our practice is committed to protecting the privacy and confidentiality of your health information. This Notice of Privacy Practices explains how we may use and disclose your protected health information (PHI) for purposes of treatment, payment, and health care operations, as well as for other purposes permitted or required by law. It also describes your rights regarding your health information.

I. OUR DUTIES

We are required by law to:

  • Maintain the privacy of your protected health information;
  • Provide you with this Notice of our legal duties and privacy practices;
  • Follow the terms of this Notice currently in effect; and
  • Notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

II. HOW WE MAY USE AND DISCLOSE YOUR INFORMATION

A. Uses and Disclosures for Treatment, Payment, and Health Care Operations

We may use and disclose your health information for the following purposes:

  • Treatment – We may use and disclose your information to provide, coordinate, or manage your dental and related medical care. This may include sharing information with specialists, laboratories, pharmacies, or other health care providers involved in your care.
  • Payment – We may use and disclose your information to obtain payment for services provided to you, including submitting claims to insurance companies or other third parties.
  • Health Care Operations – We may use and disclose your information for activities such as quality assessment, staff training, licensing, accreditation, and general administrative activities.

B. Other Uses and Disclosures Allowed or Required by Law – Including Kansas-Specific Provisions

We may also use or disclose your information without your written authorization in certain circumstances, including:

  • As required by federal, state, or local law;
  • For public health activities;
  • To report abuse, neglect, or domestic violence;
  • For health oversight activities;
  • For judicial and administrative proceedings;
  • For law enforcement purposes;
  • To avert a serious threat to health or safety;
  • For workers’ compensation purposes;
  • For military, national security, or correctional institution purposes;
  • For research purposes in limited circumstances.

Additional Kansas-Specific Disclosures

In addition to federal law, Kansas law permits or requires certain uses and disclosures of health information without your authorization, including but not limited to:

  • Reporting certain communicable diseases and conditions to the Kansas Department of Health and Environment (KDHE);
  • Reporting suspected abuse, neglect, or exploitation of a child, elder, or vulnerable adult as required by Kansas statutes;
  • Reporting of injuries or wounds as required by Kansas law;
  • Disclosures to coroners, medical examiners, or funeral directors as permitted by law;
  • Disclosures required in response to a valid Kansas court order, subpoena, or other lawful process;
  • Disclosures for public health investigations, health oversight activities, or licensing activities conducted by Kansas regulatory agencies;
  • Disclosures related to workers’ compensation claims as authorized under Kansas law.

Kansas Law Concerning Minors

Under Kansas law, parents or legal guardians generally have the right to access the health information of minor children. However, in certain limited circumstances, minors may consent to specific types of health care and control related information. In such cases, access to those records may be restricted in accordance with state law.

Kansas Requirements for Dental Records

Kansas law requires dental records to be retained for specific periods of time. Our practice maintains and safeguards your records in compliance with all Kansas record retention and confidentiality requirements.

C. Uses and Disclosures Requiring Your Written Authorization

Any use or disclosure of your health information not described in this Notice will be made only with your written authorization. You may revoke your authorization at any time in writing.

III. SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER (SUD) TREATMENT INFORMATION

If our practice provides or maintains information related to the diagnosis, treatment, or referral for treatment of a substance use disorder, that information may be protected by additional federal confidentiality laws (42 CFR Part 2).

Records related to substance use disorder treatment are subject to stricter confidentiality protections than other health information. We may not disclose SUD treatment information without your specific written consent, except in very limited circumstances permitted by law, such as:

  • Medical emergencies;
  • Reporting suspected child abuse or neglect;
  • Court orders meeting specific legal requirements;
  • Qualified service organization agreements;
  • Audits or evaluations by authorized entities.

Your written consent for disclosure of SUD treatment information must include specific elements required by 42 CFR Part 2, including the name of the recipient, the purpose of the disclosure, and an expiration date or event.

Any disclosure of SUD treatment information made with your consent will be accompanied by the following notice:
“This information has been disclosed to you from records protected by federal confidentiality rules (42 CFR Part 2). The federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2.”

IV. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights with respect to your protected health information:

  • Right to Inspect and Copy – You have the right to review and obtain a copy of your dental and billing records.
  • Right to Request Restrictions – You may request limitations on how we use or disclose your information. We are not required to agree to all requests, except in certain cases involving out-of-pocket payments.
  • Right to Confidential Communications – You may request that we communicate with you in a specific way or at a specific location.
  • Right to Amend – You may request an amendment to your records if you believe they are incorrect or incomplete.
  • Right to an Accounting of Disclosures – You may request a list of certain disclosures we have made of your information.
  • Right to a Paper Copy – You may request a paper copy of this Notice at any time.

V. CHANGES TO THIS NOTICE

We reserve the right to change this Notice at any time. Any revised Notice will be posted in our office and available upon request.

VI. COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

To file a complaint with our office, contact:

Privacy Officer: Stefanie Wickliffe
Stephen Huber, DDS
13400 Roe Ave, Leawood, KS 66209 Phone: (913) 469-8884

VII. CONTACT INFORMATION

If you have any questions about this Notice or our privacy practices, please contact our Privacy Officer at the number listed above.

ACKNOWLEDGMENT OF RECEIPT

You may be asked to sign an acknowledgment that you received this Notice of Privacy Practices.

PATIENT ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

I acknowledge that I have received a copy of the Notice of Privacy Practices of Stephen Huber, DDS. I understand that this Notice describes how my health information may be used and disclosed and how I may access this information.

Patient Name (Print): ________________________________________________

Signature of Patient or Personal Representative: ________________________________

Date: ______________________

If signed by Personal Representative, please describe authority to act on behalf of the patient:

FOR OFFICE USE ONLY

We attempted to obtain written acknowledgment of receipt of our Notice of Privacy Practices, but acknowledgment could not be obtained for the following reason(s):

_____ Patient refused to sign
_____ Communication barriers prohibited obtaining the acknowledgment
_____ An emergency situation prevented us from obtaining acknowledgment
_____ Other (please specify): ___________________________________________

Employee Name: ____________________________ Date: ___________________