We look forward to meeting with you and hope to make your first visit as seamless and comfortable as possible.  To help us serve you better as well as to help you understand what to expect, here are some tips and information.

Nisqually Reach Family Dentistry Notice of Privacy Practices/HIPAA

Effective Date: February 16, 2026

2521 Marvin Rd NE Ste
Lacey WA 98516
Phone: 360-200-5590
Our Legal Responsibilities:
Nisqually Reach Family Dentistry is required by federal law (HIPAA Privacy Rule) to:
Maintain the privacy and security of your Protected Health Information (PHI).
Provide you this Notice describing our legal duties and privacy practices.
Follow the terms of this Notice currently in effect.
Notify you if a breach of unsecured PHI occurs.
We may revise this Notice and make changes effective for all PHI we maintain. You may obtain any
revised Notice by contacting our office.
We also comply with applicable Washington State law governing dental records. Under Washington law,
licensed dentists must keep patient records accessible and respond to written requests to examine or copy
records within 15 working days, following chapter 70.02 RCW and Washington Administrative Code
requirements. Licensure rules require retention of records for at least six years from the last date of
treatment.
What Is Protected Health Information (PHI)?
PHI is your health information that can identify you and relates to your past, present, or future physical or
oral health condition, treatment, or payment for healthcare.
Special Confidentiality for Substance Use Disorder (SUD) Records:
Some information we receive may include records related to Substance Use Disorder (SUD) treatment
from programs covered under 42 CFR Part 2; federal confidentiality regulations that offer heightened
protections beyond HIPAA.
If Yelm Dental receives or maintains Part 2 SUD information:
We will use and disclose it only as permitted by HIPAA and Part 2, consistent with the consent you
provide. Part 2 records generally may be used for treatment, payment, and healthcare operations when a
valid general treatment, payment, and operations (TPO) consent accompanies the disclosure. These SUD
records or testimony about their contents cannot be used in civil, criminal, administrative, or legislative
proceedings against you without your specific written authorization or a qualifying court order.
You have the right to request restrictions on how we use or disclose your SUD information and to request
an accounting of disclosures as permitted by law.

How We May Use and Disclose PHI:
We may use and disclose your PHI, including SUD records subject to Part 2, for:
Treatment: To coordinate your dental care and share PHI with other providers involved in your care.
Payment: To obtain payment for services or coordinate benefits with insurers.
Health Care Operations: For training, quality improvement, compliance activities, and other internal
operations.
Other disclosures may occur if permitted or required by law, and in some cases may require your written
authorization. You may revoke authorization in writing except to the extent we have already taken action
in reliance on it.
How we may use your PHI to Contact You:
We may use email, phone, text messages, or paper mail to remind you of an appointment, ask questions
regarding your insurance coverage, send you a statement or treatment plan, inform you of closures due to
weather or power outages. We do not use your information for marketing purposes.
To Those You Authorize to Have Access to Your PHI: We may share your health information with a
family member, friend, or other authorized person if necessary to help you with your dental or healthcare
or with payment for your healthcare, but only if you agree that we may do so with signed consent, or
Power of Attorney.
Your Rights Regarding Your PHI:
You have the right to:
Inspect and copy your health information and dental records.
Request amendments to your records.
Request restrictions on certain uses and disclosures.
Request confidential communications or alternative contact methods.
Receive an accounting of disclosures.
Obtain a paper or electronic copy of this Notice at any time.
Complaints:
If you believe your privacy rights have been violated, you may file a complaint with:
Nisqually Reach Family Dentistry Privacy Officer:
Daniel Blackner
Nisqually Reach Family Dentistry Privacy Officer
2521 Marvin Rd NE Ste #G&H
Lacey WA 98516
Or
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, SW
Washington, DC 20201
Toll-Free: 877-696-6775
You will not be retaliated against for filing a complaint.