Notice of Information Practices and Privacy Statement

Last updated: September 1, 2018


Your privacy is very important to us. By entering your full name, email address, and phone number, you are providing personal information that will be used by Mansour's Dental Office for the sole purpose of returning your request to be contacted by us. We will only use this information to contact you in order to assist you in scheduling an appointment to be seen by Dr. Mansour, and/or to answer any of your questions.

We do not sell your information for any reason and only share your information when required as listed below.

Notice to Website Viewers

This web site is provided for information and education purposes only. No doctor/patient relationship is established by your use of this site. No diagnosis or treatment is being provided. The information contained here should be used in consultation with a doctor of your choice. No guarantees or warranties are made regarding any of the information contained within this web site. This web site is not intended to offer specific medical, dental or surgical advice to anyone.

The Dental Practice Covered by this statement

This Statement describes the privacy practices of Mansour's Dental Office ( "We", "Us" and "Our" refer to the dental office, and "You" and "your" refers to the patient.

How to contact us

Dr. Mansour's Dental Office
803 Washington Dr
Arlington, TX 76011
(817) 275-2229

Our Use and Disclosure of Your Health Information

Common Reasons for Our Use and Disclosure of Patient Health Information

Treatment. We will use your health information to provide you with dental treatment or services, such as cleaning or examining your teeth or performing dental procedures. We may disclose health information about you to dental specialists, physicians, or other health care professionals involved in your care.

Payment. We may use and disclose your health information to obtain payment from health plans and insurers for the care that we provide to you.

Health Care Operations. We may use and disclose health information about you in connection with health care operations necessary to run our practice, including review of our treatment and services, training, evaluating the performance of our staff and health care professionals, quality assurance or financial or billing audits.

Appointment Reminders. We may use or disclose your health information when contacting you to remind you of a dental appointment, using a postcard, letter, voicemail, or email.

Treatment Alternatives and Health - Related Benefits and Services. We may use and disclose your health information to tell you about treatment options or alternatives or health related benefits and services that may be of interest to you.

Disclosure to Family Members and Friends. We may disclose your health information to a family member or friend who is involved with your care or payment for your care if you do not object or, if you are not present, if we believe it is in your best interest to do so.

Less Common Reasons for Use and Disclosure of Patient Health Information

Disclosures Required by Law. We may use or disclose patient health information to the extent we are required by law to do so. For example, we are required to disclose patient health information to the U.S. Department of Health and Human Services so that it can investigate complaints or determine our compliance with HIPAA.

Public Health Activities. We may disclose patient health information for public health activities and purposes, which include: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting adverse reactions to medications or foods; reporting product defects; enabling product recalls; and notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.

Victims of Abuse, Neglect or Domestic Violence. We may disclose health information to the appropriate government authority about a patient whom we believe is a victim of abuse, neglect or domestic violence.

Health Oversight Activities. We may disclose patient health information to a health oversight agency for activities necessary for the government to provide appropriate oversight of the health care system, certain government benefit programs, and compliance with certain civil rights laws.

Lawsuits and Legal Actions. We may disclose patient health information in response to (i) a court or administrative order or (ii) a subpoena, discovery request, or other lawful process that is not ordered by a court if efforts have been made to notify the patient or to obtain an order protecting the information requested.

Law Enforcement. We may disclose patient health information to a law enforcement official for law enforcement purposes, such as to identify or locate a suspect, material witness or missing person, or to alert law enforcement of a crime.

Serious Threat to Health or Safety. We may use or disclose patient health information if we believe it is necessary to do so to prevent or lessen a serious threat to anyone’s health or safety.

Your Written Authorization for Any Other Use or Disclosure of Your Health Information. We will make other uses and disclosures of health information not discussed in this Notice only with your written authorization. You may revoke that authorization at any time in writing. Upon receipt of the written revocation, we will stop using or disclosing your health information for the reasons covered by the authorization going forward.

We Have the Right to Change Our Privacy Practices and This Statement. We reserve the right to change the terms of this Notice at any time. Any change will apply to the health information we have about you or create or receive in the future. We will promptly revise the Statement when there is a material change to the uses or disclosures, individual's rights, our legal duties, or other privacy practices discussed in this Statement. We will post the revised Statement on our website and in our office and will provide a copy of it to you on request.