HIPAA Notice of Privacy Practices (NOPP)

Notice of Privacy Practices

Effective Date: May 9th, 2025

This Notice describes how your health information may be used and disclosed and how you can access it. Please review it carefully.

Your Health Information Rights

Request a copy of your health record
Request corrections or amendments
Request restrictions on certain uses
Request corrections or amendments
Request communications by alternative means or locations
Receive a paper copy of this Notice at any time

How We May Use and Disclose Health Information

For Treatment: To provide and coordinate your care
For Payment: To bill and receive payment from insurance or others
For Payment: To bill and receive payment from insurance or others
As Required by Law: For public health, legal proceedings, or law enforcement
With Your Authorization: For any other use not listed here

Our Responsibilities

We are required to:

Maintain the privacy of your health information
Provide this Notice of our legal duties and privacy practices
Provide this Notice of our legal duties and privacy practices
Provide this Notice of our legal duties and privacy practices

Contact for Questions or Complaints

If you believe your privacy rights have been violated, contact:
Privacy Officer: Dr. Tommy G. Hillman, DDS
📍 201 West Pine Street, Lafayette, LA 70501
📞 [Insert Phone Number]
📧 [Insert Email Address]

You also have the right to file a complaint with the U.S. Department of Health & Human Services.