Notice of Privacy Practices
Magnolia Smiles Family Dentistry
Dental offices in Waynesboro, Wiggins, Purvis and Magee, Mississippi
Effective date: November 12, 2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have questions about this Notice, contact our Privacy Officer at (601) 735-5086 or waynesboro@yourmagnoliasmile.com.
Who this Notice covers
This Notice applies to Magnolia Smiles Family Dentistry and its affiliated dental offices in Waynesboro, Wiggins, Purvis and Magee, Mississippi, together called Magnolia Smiles. It covers every dentist, hygienist, assistant, employee, student and trainee who works in those offices. They all follow this Notice, and they may share your health information with one another for treatment, payment and health care operations.
In this Notice, health information means information that identifies you and relates to your health or dental condition, the care you receive, or payment for that care. It includes your dental and medical history, chart notes, X-rays and other images, treatment plans, and insurance and billing records.
Our duties to you
The law requires us to:
keep your health information private and secure;
give you this Notice of our legal duties and privacy practices;
notify you if a breach compromises the privacy or security of your unsecured health information; and
follow the terms of the Notice currently in effect.
How we may use and share your health information
We may use and share your health information for the purposes below without your written permission. Where Mississippi law or another federal law protects your information more strictly than HIPAA does, we follow the stricter law.
Treatment
We use and share health information to provide, coordinate and manage your dental care. For example, we may send X-rays and chart notes to an oral surgeon, orthodontist or other specialist we refer you to; ask your physician about a medical condition or medication that affects your dental treatment; send a prescription to your pharmacy; or send impressions or digital scans to the dental laboratory making your crown or denture.
Payment
We use and share health information to bill and collect payment for your care. For example, we send claims to your dental plan, Medicaid or CHIP that list the procedures we performed, we check your eligibility and benefits, and we may send an unpaid account to a billing service or collection agency.
Health care operations
We use and share health information to run our practice and improve the care we give. For example, we review the quality of treatment, train staff, meet licensing and credentialing requirements, and work with our accountants, attorneys, insurers and auditors.
Appointment reminders and information about your care
We may contact you by phone, voicemail, text message, email, postcard or letter to remind you of an appointment, follow up after treatment, or tell you about treatment options and health-related services that may be useful to you. Ordinary text messages and email are not encrypted. Tell us if you would like us to reach you a different way (see Confidential communications below).
Family, friends and others involved in your care
If you agree, or if you have the chance to object and do not, we may share relevant health information with a family member, friend or other person you identify who helps with your care or pays for it. For example, we may give post-operative instructions to the person who drives you home, or let someone you send pick up a prescription, dental supplies or copies of X-rays for you. If you are not present or cannot make the decision, as in an emergency, we will share information only when we judge that doing so is in your best interest. We may also use or share information to notify a family member, personal representative or caregiver of your location, general condition or death, and to assist disaster-relief organizations.
Parents, guardians and personal representatives
A parent or legal guardian generally makes health care decisions for a minor child and may exercise the child's rights under this Notice, unless Mississippi law lets the minor consent to the care on their own. A person with legal authority to act for you, such as a guardian, a health care agent under a power of attorney, or the executor of an estate, may exercise your rights for you. We may ask for proof of that authority.
Business associates
Some services are performed for us by outside companies called business associates. Examples are our practice-management software and IT vendors, claims clearinghouses and billing services, appointment-reminder, online-forms and messaging services, answering services, record-storage and shredding companies, accountants and attorneys. We share only the information they need to do their work. They must sign a contract promising to protect your information, and HIPAA applies to them directly.
When the law requires it
We share health information when federal, state or local law requires us to.
Public health
We may share health information with public health authorities to prevent or control disease, injury or disability; to report reactions to medications or problems with products and devices to the Food and Drug Administration or the manufacturer; to notify people of recalls; and to notify a person who may have been exposed to a communicable disease, when the law authorizes it.
Abuse, neglect or domestic violence
Mississippi law requires us to report suspected abuse or neglect of a child or a vulnerable adult. We may also share information with a government authority about an adult we reasonably believe is a victim of abuse, neglect or domestic violence, when the law requires or permits the report or when the person agrees.
Health oversight
We may share health information with agencies that oversee the health care system, such as the Mississippi State Board of Dental Examiners, the Mississippi Division of Medicaid and the U.S. Department of Health and Human Services, for audits, inspections, investigations, licensing and disciplinary actions.
Lawsuits and legal proceedings
We may share health information in response to a court or administrative order. We may also share it in response to a subpoena, discovery request or other lawful process, but only after the steps HIPAA requires have been taken to tell you about the request or to obtain an order protecting the information.
Law enforcement
We may share limited health information with law enforcement officials when a court order, warrant, subpoena or summons requires it; to help identify or locate a suspect, fugitive, material witness or missing person; about a person who is or may be the victim of a crime; about a death we believe may have resulted from a crime; about a crime on our premises; and in an emergency, to report a crime.
Coroners, medical examiners, funeral directors and organ donation
We may share health information, including dental records, with a coroner or medical examiner to identify a deceased person or determine the cause of death, with funeral directors so they can carry out their duties, and with organizations that handle organ, eye and tissue donation.
Serious threats to health or safety
We may use or share health information when we believe in good faith that it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Military, national security and people in custody
If you serve in the armed forces, we may share your health information as military command authorities require. We may share health information with authorized federal officials for intelligence, national security and protective-service activities. If you are an inmate or in the custody of law enforcement, we may share your health information with the correctional institution or officer when it is needed for your care or for the health and safety of others.
Workers' compensation
We may share health information as workers' compensation laws and similar programs allow, to provide benefits for work-related injuries or illnesses.
Research
We may use or share health information for research when an institutional review board or privacy board has reviewed the study, set rules to protect your privacy and approved going ahead without your individual authorization.
Uses and disclosures that need your written authorization
We will ask for your written authorization before we use or share your health information in these ways:
Marketing. We will not use or share your health information to market products or services, and we will not accept payment from a third party to send you marketing messages, without your authorization. We may still talk with you face to face about products and services and give you a promotional gift of small value.
Photos, testimonials and online reviews. We will not post your photo, before-and-after images, name or story on our website, on social media or in advertising without your authorization. We will not reveal your health information when replying to an online review.
Sale of health information. We will not sell your health information without your authorization.
Psychotherapy notes. We do not keep psychotherapy notes. If we ever did, most uses and disclosures of them would need your authorization.
Fundraising. We do not use or share your health information to raise funds. If that changes, you will have the right to opt out of fundraising messages.
Any other use or disclosure not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time by writing to our Privacy Officer. A revocation does not undo anything we did while the authorization was in effect.
Once we share your health information as this Notice allows, with or without your authorization, the person who receives it may share it again, and it may no longer be protected by the federal privacy rules.
Substance use disorder treatment records
A federal law, 42 CFR Part 2, gives extra protection to records created by substance use disorder treatment programs. We are a dental practice, not a treatment program. If we receive or keep records about you from one of those programs, we will use and share them only as Part 2 and your written consent allow. Records we receive under your consent for treatment, payment and health care operations may be used and shared for those purposes in the same way as your other health information.
We will not use or disclose those records, or give testimony describing what is in them, in any civil, criminal, administrative or legislative proceeding against you unless you consent in writing or a court orders it after you or the holder of the record have been given notice and an opportunity to be heard. A court order must be accompanied by a subpoena or other legal requirement compelling disclosure before we use or release the record.
We will not use those records for fundraising.
Your rights
To use any of these rights, contact our Privacy Officer or ask at the front desk of any office. Some requests must be in writing, and we can give you a form.
See and get a copy of your records
You may look at or get a paper or electronic copy of the health information we use to make decisions about you, including your dental chart, X-rays and billing records. Send us a written request. We will act on it within 30 days. If we need more time, we will tell you in writing why and when to expect an answer, and we may take up to 30 more days. We will give you the copy in the form and format you ask for if we can readily produce it. You may also direct us in writing to send a copy to another person.
We may charge a reasonable, cost-based fee for the labor of copying, for supplies and postage, and for preparing a summary if you ask for one. We will tell you the fee before we start. You receive copies, not our original records or films. We will not refuse you a copy because of an unpaid balance. In a few situations the law lets us deny a request. If we do, we will tell you why in writing and explain any right you have to a review.
Ask us to correct your records
If you believe health information we hold about you is wrong or incomplete, you may ask us in writing to amend it and tell us why. We will respond within 60 days. We may say no, for example if we did not create the information or if it is accurate and complete. If we say no, we will tell you why in writing and explain how you can file a statement of disagreement.
Get a list of disclosures
You may ask for a list (an accounting) of the times we shared your health information during the six years before your request, who received it and why. The list will not include disclosures for treatment, payment and health care operations, disclosures to you or made with your authorization, and certain others the law excludes. One list in any 12-month period is free. We may charge a reasonable, cost-based fee for additional lists and will tell you the cost first.
Ask us to limit what we use or share
You may ask us not to use or share certain health information for treatment, payment or health care operations, or with family members and others involved in your care. We are not required to agree, and we may say no if the limit would affect your care. If we do agree, we will keep to the agreement except in an emergency.
There is one request we must honor. If you pay for a service or item in full out of your own pocket, you may ask us not to share information about it with your health plan for payment or health care operations, and we will agree unless a law requires the disclosure.
Confidential communications
You may ask us to contact you in a particular way or at a particular place, for example by calling your cell phone only or by mailing to a different address. Make the request in writing and tell us how or where you want to be reached. We will not ask the reason, and we will agree to all reasonable requests. We may ask how payment will be handled if the change affects billing.
Get a paper copy of this Notice
You may ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically. Copies are available at every office and on our website, yourmagnoliasmile.com.
Be told about a breach
We will notify you without unreasonable delay if a breach compromises the privacy or security of your unsecured health information.
Changes to this Notice
We may change our privacy practices and this Notice at any time, as the law allows. The new Notice will apply to all health information we hold, including information we created or received before the change. We will post the current Notice in each office and on our website, and we will give you a copy on request.
Complaints
If you believe we have violated your privacy rights, you may file a complaint with our Privacy Officer using the contact information below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by mail at 200 Independence Avenue, S.W., Washington, D.C. 20201, by phone at 1-877-696-6775, or online at www.hhs.gov/hipaa/filing-a-complaint.
We will not retaliate against you for filing a complaint.
How to contact us
Privacy Officer
Magnolia Smiles, 806 Mississippi Drive, Waynesboro, MS 39367
Phone: (601) 735-5086 · Email: waynesboro@yourmagnoliasmile.com
Our offices
Waynesboro: 806 Mississippi Drive, Waynesboro, MS 39367. Phone (601) 735-5086. Email waynesboro@yourmagnoliasmile.com
Wiggins: 1050 Frontage Drive West, Suite C, Wiggins, MS 39577. Phone (601) 476-6280. Email wiggins@yourmagnoliasmile.com
Purvis: 101 Shelby Speights Drive, Purvis, MS 39475. Phone (769) 456-2056. Email purvis@yourmagnoliasmile.com
Magee: 1425 Simpson Highway 49, Magee, MS 39111. Phone (601) 849-4949. Email magee@yourmagnoliasmile.com