Notice Of Privacy Practices

Bespoke Dental 

2352 Meadows Blvd, Suite 160, Castle Rock, CO 80109 

Phone: 720.466.1723 | Email: office@bespokedds.com 

Privacy Official: Tom McDonough

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.

Effective Date: October 18, 2026 

Our Legal Duty

Bespoke Dental is required by applicable federal (HIPAA) and state (Colorado) law to maintain the privacy and security of your Protected Health Information (PHI). PHI includes individually identifiable clinical, demographic, and financial information related to your past, present, or future physical or mental health conditions or treatment.

We are required to:

  • Give you this Notice describing our legal duties and privacy practices regarding your PHI.

  • Follow the terms of the Notice currently in effect.

  • Notify you promptly following a breach of your unsecured PHI.

How We May Use and Disclose Your Protected Health Information (PHI)

The following categories describe the different ways we may use and disclose your PHI without requiring your specific written authorization:


Treatment

We may use and disclose your PHI to provide, coordinate, or manage your dental care and related services. This includes sharing information with dentists, dental hygienists, specialists, laboratories, or other healthcare providers involved in your treatment.

Example: We may send dental X-rays to an endodontist or oral surgeon to whom you have been referred.

Payment

We may use and disclose your PHI to bill and collect payment from you, your insurance company, or a third-party payer for services provided.

Example: We submit treatment codes and claims information to your dental insurance provider to receive payment for your routine dental cleaning or restorative care.

Healthcare Operations

We may use and disclose your PHI to support our daily business operations, quality improvement activities, staff evaluations, licensing, and compliance audits.

Example: We may use your clinical records to evaluate the quality of care provided by our dental team or conduct internal compliance reviews.

Practice Management & Digital Patient Services (Dentrix Ascend) 

We utilize secure, HIPAA-compliant third-party cloud software partners, including Dentrix Ascend, to manage electronic health records (EHR), online appointment scheduling, digital intake forms, patient account communication, and billing. All external service providers function as our legal "Business Associates" and are contractually required to maintain strict physical, technical, and administrative safeguards to protect your PHI. 

Appointment Reminders & Clinical Communications 

We may contact you via email, text message, phone, or mail to remind you of upcoming appointments, provide post-procedure care instructions, or discuss treatment options. 

Persons Involved in Your Care 

Unless you object in writing, we may disclose relevant PHI to a family member, relative, close personal friend, or legal guardian who is directly involved in your care or payment for your care. 

Special Uses and Disclosures Required or Permitted by Law 

We may disclose your PHI without your authorization under specific legal circumstances, including:

  • Required by Law: When mandated by federal, state, or local law, or judicial proceedings (court orders, subpoenas).

  • Public Health & Safety: To report disease outbreaks, product defects, or to prevent/lessen a serious and imminent threat to health or safety.

  • Abuse or Neglect: To report suspected child abuse, elder abuse, or domestic violence to authorized Colorado state agencies.

  • Health Oversight: For government audits, investigations, inspections, and licensure evaluations.

  • Law Enforcement & National Security: As authorized or required for legal enforcement proceedings or specialized government functions.

  • Workers' Compensation: As necessary to comply with Colorado workers' compensation laws.

Disclosures Requiring Your Explicit Written Authorization

Any other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization. Specifically, we will never:

  • Sell your PHI or personal health data. 

  • Use or disclose your PHI for third-party marketing purposes without your express written consent.

  • Share psychotherapy notes (if applicable) without your explicit authorization. You may revoke any written authorization at any time in writing, except to the extent that we have already acted in reliance on it. 

Your Rights Regarding Your Protected Health Information 

Under federal HIPAA regulations, you have the following rights regarding your medical and dental records: 

  1. 1. Right to Inspect and Copy Your Records
    You have the right to inspect and obtain an electronic or paper copy of your health and billing records. We will provide a copy or summary within statutory timeframes. Under HIPAA, we do not charge arbitrary access fees; we may charge only a reasonable, cost-based fee for paper copies or portable electronic media (such as USB drives). 

  2. Right to Request Amendments
    If you feel that the PHI we have about you is incorrect or incomplete, you may request in writing that we amend your record. We may deny your request under certain circumstances (e.g., if the information is accurate and complete), but we will provide you with a written explanation within 60 days. 

  3. 3. Right to Request Restrictions
    You have the right to request a restriction or limitation on how we use or disclose your PHI for treatment, payment, or operations. While we are not legally required to agree to all requests, we must agree if you request that we not disclose PHI to a health plan for payment or healthcare operations purposes, provided you have paid for the service out-of-pocket in full at the time of service. 

  4. Right to Request Confidential Communications
    You have the right to request that we communicate with you regarding your health matters in a specific way or at a specific location (e.g., requesting calls to a mobile phone instead of a home landline, or mail sent to a P.O. Box). 

  5. Right to an Accounting of Disclosures
    You have the right to request a list (an "accounting") of certain disclosures of your PHI made by us for purposes other than treatment, payment, healthcare operations, or pursuant to your written authorization. 

  6. Right to a Paper Copy of This Notice
    You have the right to receive a physical paper copy of this Notice at any time, even if you have previously agreed to receive it electronically. 

Changes to This Notice 

Bespoke Dental reserves the right to change the terms of this Notice and our privacy practices at any time. Any revisions will apply to all PHI we maintain, including records created prior to the change. Revised notices will be posted in our clinical reception area and on our website. 

Complaints and Privacy Officer Contact 

If you believe your privacy rights have been violated, or if you disagree with a decision we made about access to your records, you may file a complaint with our practice or directly with the federal government. You will not be penalized or retaliated against for filing a complaint.

To file a complaint with Bespoke Dental:

Privacy Officer
Bespoke Dental
2352 Meadows Blvd, Suite 160 Castle Rock, CO 80109
Phone: 720.466.1723 Email: office@bespokedds.com 

To file a complaint with the U.S. Department of Health & Human Services:

Office for Civil Rights (OCR)

U.S. Department of Health and Human Services 

200 Independence Avenue, S.W. Washington, D.C. 20201 

Phone: 1.800.368.1019 | TTY: 1.800.537.7697 Web Portal: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf