Effective date: April 14, 2026. This notice replaces the version dated March 1, 2019.
Our commitment
Brightburrow Pediatric Dentistry, LLC is required by law to maintain the privacy of protected health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
“Protected health information,” or PHI, means information that identifies your child and relates to their past, present, or future dental care or payment for that care.
How we may use and disclose information without your authorization
Treatment. To provide, coordinate, or manage your child’s dental care. For example, sending x-rays to an orthodontist we have referred you to, or discussing premedication with your child’s cardiologist.
Payment. To bill and collect payment. For example, sending claim information to your dental insurer, or verifying benefits before an appointment.
Health care operations. To run the practice. For example, quality review, training our team, or arranging an audit by an accountant bound by confidentiality.
Appointment reminders. By phone, text, or email, using the contact details you gave us. Tell us if you would prefer we not leave detail in a voicemail or use a particular number, and we will honor it.
As required by law. Including reporting suspected child abuse or neglect, responding to a court order or subpoena, reporting to public health authorities, and complying with health oversight investigations.
To avert a serious threat. To prevent a serious and imminent threat to the health or safety of your child or another person.
Uses that always require your written authorization
- Any marketing communication
- Any sale of protected health information
- Most uses or disclosures of psychotherapy notes
- Any use or disclosure not otherwise described in this notice
You may revoke an authorization in writing at any time. Revocation does not undo disclosures already made in reliance on it.
Your rights
To inspect and copy. You may see and get a copy of your child’s dental record. Request it in writing; we respond within 30 days and may charge a reasonable cost-based fee for copies.
To an electronic copy. If we hold the record electronically, you may ask for it in an electronic format, or ask us to send it directly to a person you name.
To amend. If you believe something in the record is incorrect or incomplete you may ask us to amend it. We may deny the request, and if we do we will explain why in writing and you may file a statement of disagreement that becomes part of the record.
To an accounting of disclosures. You may request a list of certain disclosures we made in the six years before your request. The first accounting in any 12-month period is free.
To request restrictions. You may ask us to limit how we use or disclose information. We are not required to agree, with one exception: if you pay for a service in full out of pocket, we must honor a request not to share information about that service with your health plan.
To confidential communications. You may ask us to contact you at a particular number or address. We will accommodate reasonable requests without asking why.
To be notified of a breach. We will notify you if a breach compromises the privacy or security of your child’s information.
To a paper copy of this notice. Ask at the front desk and we will hand you one, even if you have already read this page.
Parents and guardians
In most cases a parent or legal guardian exercises these rights on behalf of a minor child. Ohio law provides limited exceptions where a minor may consent to their own care, and in those situations the minor controls the information relating to that care.
Where parents are separated or divorced, either parent may generally access the record and act on the child’s behalf unless a court order provides otherwise. Give us a copy of any order that limits this.
Our duties
We are required to maintain the privacy of PHI, provide this notice, follow its terms, and notify you of a breach. We reserve the right to change this notice and to make the new terms apply to all information we maintain. A revised notice will be posted in the reception area and on this page.
Complaints
If you believe your privacy rights have been violated, tell us. Contact Rosa Iturbe, Practice Manager and Privacy Officer, at (216) 555-0148 or hello@brightburrowkids.com, or write to the address below.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at 200 Independence Avenue SW, Washington, DC 20201, by calling 1-877-696-6775, or at hhs.gov/ocr/privacy/hipaa/complaints.
We will not retaliate against you for filing a complaint. Nobody has ever been dismissed from this practice for making one.
Contact
Rosa Iturbe, Privacy Officer Brightburrow Pediatric Dentistry, LLC 1420 Alder Mill Road, Suite 200, Cedarfield, OH 44119 (216) 555-0148
Last updated April 14, 2026.