Policies & Disclosures

Statement of Privacy Practices

Last Updated April 2026

This statement of privacy practices describes how medical information about you may be disclosed and how you can get access to this information. Please read carefully.

This statement applies to the following affiliated entities: Center for TMJ & Sleep Solutions NW, Sleep Solutions NW, TMJ Solutions NW, DME Solutions NW, and Sleep Medicine Solutions NW. Each entity maintains its own operations but shares these privacy practices and policies. Throughout this document, “the Practice” refers to all affiliated entities listed above.

The Practice collects and maintains a record of the health care services we provide you. In keeping with the Health Insurance Portability and Accountability Act (HIPAA), and the State of Washington, we are dedicated to protecting your rights of privacy and the confidential information entrusted to us.

The commitment of each employee to ensure that your health information is never compromised is a principal concept of our practice. We will not disclose your protected health information unless you direct or authorize us to do so or unless it is otherwise allowed or compelled by law. We may, from time to time, amend our privacy policies and practices but will always inform you of any changes that might affect your rights.

You may see your record or get more information about it at the “Your Individual Rights about Patient Health Information” section of this Notice. You may request to review and copy your personal record and you may also request that we make corrections to the record.

Overview & Your Rights

Our Statement of Privacy Practices is currently in effect and provides information about the use and disclosure of protected health information by the Practice and our employees. It is applicable in all instances wherein individually identifiable health information is collected from you and services are provided for you. Our Statement:

1. Defines your rights and our obligations when using your health information,
2. Informs you about laws that provide special protections,
3. Explains how your protected health information is used and how, under certain circumstances, it may be disclosed,
4. Tells you how changes in this statement will be made available to you.

In synopsis form, you have a right to:

1. Request restricted use of your health information (please understand that we may not agree to your request),
2. Request that we not disclose to your health plan of services for which you self-pay in full,
3. Request that we communicate with you by alternate methods,
4. Review and receive copies of your personal health record,
5. Request for amendments and/or changes be made to your record,
6. Request an accounting of disclosures of your health information,
7. File complaints related to failure to protect of privacy of your health information,
8. Direct us not to share information with your family members,
9. Request that you not be listed in/on our facility directory.

Protected Healthcare Information

It is important that you know not only that we limit requests for your personal information to that needed to provide quality health care, implement payment activities, and conduct normal health practice operations, but understand what “Protected Healthcare Information” is. This may include your name, address, telephone number(s), Social Security Number, employment data, medical history, health records, and/or any personal information that is unique to you.

While most of the information will be collected from you, we may obtain information from third parties if it is deemed necessary. Regardless of the source, your personal information will always be protected to the full extent of the law.

Protecting Your Personal Healthcare Information

We use and disclose the information we collect from you only as allowed by HIPAA and the State of Washington. This includes when it is used and disclosed to perform treatment, obtain payment, and conduct operational activities. Your personal health information will never be otherwise given to anyone — even family members — without your written consent. You, of course, may give written authorization for us to disclose your information to anyone you choose, for any purpose.

Our Statement of Privacy Practices applies to all personal health information collected or created by the Practice or received from outside healthcare providers. This information may identify you, relate to your past, present or future physical or mental condition, the care provided, or any reference to payment for your health care.

For example, protected health information includes symptoms, test results, diagnoses, health information from other providers, as well as billing and payment information relating to these services. This information is protected because it is often part of your health or medical record, which we can use as:

1. A method of communication among health professionals who contribute to your care,
2. A legal record describing the care you received,
3. A means by which you can verify that services billed were provided,
4. A tool to educate health professionals,
5. A source of data for medical research,
6. A source of information for public health officials,
7. A source of information for facility planning,
8. A tool to assess and improve the care we provide,
9. A method by which we can provide a better understanding of your record,
10. A method by which we can ensure your record’s accuracy,
11. A system to assist you to more clearly understand the circumstances and conditions in and by which others may have access to your personal information,
12. A tool for us to make more informed decisions when authorizing disclosures to others.

Use & Disclosure Without Your Authorization

We may, under allowed circumstances, use and disclose protected health information (PHI) without your specific authorization. Examples of such instances are included below:

Treatment

We may use and disclose your PHI to provide treatment. For example, we can:

1. Use your information to find out whether certain tests, therapies, and medicines should be ordered,
2. Provide your information to staff members to better understand what your healthcare needs are and how to evaluate your response to treatment,
3. Disclose your PHI to another one of your treatment providers in order to provide you with the best possible health care.

Payment

We may use your health information for payment purposes. Such instances may include:

1. Preparation of claims for payment of services,
2. Billing your insurance directly, including information that identifies you, as well as your diagnosis, the procedures performed, and supplies used so that we can be paid for the treatment provided,
3. Collection activities (if necessary) to obtain payment for services.

Health Care Operations

We may use and disclose your health information to support the daily activities related to health care. Examples include:

1. Use and disclosure to monitor and improve our health services,
2. Use by authorized staff to review portions of your record to perform administrative activities.

Train Staff and Students

We may use and disclose your information to teach and train staff how to review patient health information.

Contact You for Information

Your PHI may also be used to contact you. For example, we may call you or send you a letter to remind you about your appointment, provide test results, inform you about treatment options, or advise you about other health-related benefits and services.

Business Associates

Your PHI may be used by the Practice and disclosed to individuals, organizations, or companies that assist us or to comply with our legal obligations as described in this Notice. An example is disclosure of your PHI to consultants, attorneys or third parties to assist in our business activities. All such entities must sign a Business Associate Agreement to protect the confidentiality of your private information.

Additional Uses & Disclosures

We also use and disclose your information to enhance health care services, protect patient safety, safeguard public health, ensure that our facilities and staff comply with government and accreditation standards, and when otherwise compelled or allowed by law. For example, we provide or disclose information:

1. About FDA-regulated drugs and devices to the U.S. Food and Drug Administration.
2. To government oversight agencies with data for health oversight activities such as auditing or licensure.
3. To public health authorities with information on communicable diseases and vital records.
4. To your employer, findings relating to the evaluation of work-related illnesses or injuries.
5. To workers’ compensation agencies and self-insured employers for work-related illness or injuries.
6. To appropriate government agencies when we suspect abuse or neglect.
7. To appropriate agencies or persons when we believe it necessary to avoid a serious threat to health or safety or to prevent serious harm.
8. To organ procurement organizations to coordinate organ donation activities.
9. To law enforcement when required or allowed by law, including the Office of Civil Rights to conduct OCR investigations.
10. For court order or lawful subpoena.
11. To coroners, medical examiners, and funeral directors.
12. To government officials when required for specifically identified functions such as national security.
13. When otherwise required by law, such as to the Secretary of the United States Department of Health and Human Services for purposes of determining compliance with our obligations to protect the privacy of your health information.
14. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

Your Rights to Object

Disclosure to Family, Friends, or Others. You may object to our disclosing your general health condition (“good”, “fair”, “critical”, etc.) to an individual, or individuals, you have identified who have an active interest in your care, payment for your health care, or who may need to notify others about your general condition, location, or death. If you do not so indicate, we will use our best professional judgment to provide relevant protected health information to your family member, friend, or another identified person.

Use & Disclosure Requiring Your Authorization

Our offices and electronic systems are secure from unauthorized access and our employees are trained to make certain that the confidentiality of your records is always protected. Our privacy policy and practices apply to all former, current, and future patients, so you can be confident that your protected health information will never be improperly disclosed or released.

Other than the uses and disclosures described above, we will not use or disclose your protected health information without your written authorization. You may revoke your written authorization at any time unless prohibited by law, or disclosure is required for us to obtain payment for services already provided, or we have otherwise relied on the authorization.

Additional Protection of Your Patient Health Information

Special state and federal laws apply to certain classes of patient health information. For example, additional protections may apply to information about sexually transmitted diseases, drug and alcohol abuse treatment records, mental health records, and HIV/AIDS information. When required by law, we will obtain your authorization before releasing this type of information.

Your Individual Rights About Patient Health Information

You may contact the Practice to exercise your rights related to the use and disclosure of your protected health information. You may contact us at:

Center for TMJ & Sleep Solutions NW
10513 Silverdale Way NW Suite 201
Silverdale, WA 98383
ATTN: Dr. Kushner 360-779-7711

Your specific rights include:

1. The right to request restricted use: You may request in writing that we not use or disclose your information for treatment, payment, and/or operational activities except when authorized by you, when required by law, or in emergency circumstances. We are not legally required to agree to your request. If you request that we restrict the use of your private information, we will provide you with written notice of our decision about your request.
2. The right to request non-disclosure to health plans: You have the right to request in writing that health care items or services for which you self-pay for in full in advance of your visit not be disclosed to your health plan.
3. The right to receive confidential communications: You have the right to request that we communicate with you about medical matters in a particular way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will grant all reasonable requests. Your request must specify how or where you wish to be contacted.
4. The right to inspect and receive copies: In most cases, you have the right to inspect and receive a copy of certain health care information including certain medical and billing records. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
5. The right to request an amendment to your record: If you believe that information in your record is incorrect or that important information is missing, you have the right to request in writing that we make a correction or add information. In your request for the amendment, you must give a reason for the amendment. We are not required to agree to the amendment of your record, but a copy of your request will be added to your record.
6. The right to know about disclosures: You have the right to receive a list of instances in which we have disclosed your health information. Certain instances will not appear on the list, such as disclosures for treatment, payment, or health care operations or when you have authorized the use or disclosure. Your first accounting of disclosures in a calendar year is free of charge. Any additional request within the same calendar year requires a processing fee.
7. The right to make complaints: If you believe that we have violated your privacy, or you disagree with a decision we made about access to your records, you may file a complaint using the contact information above. No employee of the Practice will retaliate against anyone for filing a complaint.

You may also contact:

U.S. Department of Health and Human Services
Office for Civil Rights
2201 Sixth Avenue — Mail Stop RX-II
Seattle, WA 98121-1831
206-615-2290  |  206-615-2296 (TTY)  |  206-615-2297 (fax)
Toll free: 1-800-362-1710  |  1-800-537-7697 (TTY)

Breach Notification & Privacy Notice Changes

Breach Notification

If it is found that your patient information is used or disclosed in a manner that is not consistent with the practices described in this notice, Center for TMJ & Sleep Solutions NW will fully investigate the matter to assess if there was a breach in the protection of your PHI. The assessment will be conducted to determine whether the information that was used or disclosed has significant risk of physical, financial, or reputational harm to you. If so, the Practice will notify you and Health and Human Services in writing.

Privacy Notice Changes

We are required by law to protect the privacy of your information, to provide this Statement of Privacy Practices and to follow the privacy practices that are described herein. We reserve the right to change the privacy practices described and the right to make the revised or changed Statement effective for protected health information we already have as well as any information we may receive in the future.

We have posted a copy of our current Statement for your review and reference. Additionally, each time you visit our office for treatment or health care services, you may request a copy of our current Statement of Privacy Practices. An electronic version of the notice is posted at our website.

Privacy Policy

Last Updated April 2026

We maintain health information in accordance with HIPAA and Washington State law. We protect the confidential information entrusted to us and do not disclose protected health information unless you direct or authorize us to do so, or unless disclosure is otherwise permitted or required by law.

Protected health information may include your name, address, telephone number, medical history, health records, billing and payment information, and other information that identifies you and relates to your care.

We may use and disclose your health information for treatment, payment, and healthcare operations.

For complete details on how we use, disclose, and protect your health information — including your individual rights — please review our full Statement of Privacy Practices (HIPAA Notice).

Terms & Conditions

Last Updated April 2026

These terms govern text message communications between you and Center for TMJ & Sleep Solutions NW (“the Practice”). By opting in to receive SMS messages, you agree to the following terms.

Program Description

When you provide your phone number and opt in, you agree to receive text messages from the Practice. Messages may include:

• Appointment reminders and scheduling confirmations
• Office notifications and operational updates
• Follow-up care instructions and treatment-related communications
• Billing and insurance-related notifications

Message Frequency & Rates

Message frequency varies based on your appointment schedule, treatment plan, and office communications. Standard message and data rates from your wireless carrier may apply. The Practice is not responsible for any charges incurred through your mobile carrier.

Consent

Your consent to receive text messages is not a condition of purchasing any goods or services from the Practice. You may receive care and services regardless of whether you opt in to SMS communications.

Opt-Out & Help

To stop messages: Reply STOP to any message at any time. You will receive a confirmation and no further messages will be sent.

To get help: Reply HELP to any message, or contact our office directly at (360) 860-8038.

Carrier Disclaimer

The Practice is not responsible for delayed or undelivered messages caused by your wireless carrier, phone service issues, network outages, or third-party communication platforms. Carriers are not liable for delayed or undelivered messages.

Privacy

Your phone number and messaging data will not be shared with or sold to third parties or affiliates for marketing or promotional purposes. All personal information collected through SMS is handled in accordance with our Privacy Policy and HIPAA protections.

Contact Information

Center for TMJ & Sleep Solutions NW
10513 Silverdale Way NW, Suite 201 · Silverdale, WA 98383
(360) 860-8038

SMS Consent

Last Updated April 2026

We use text messaging to help you stay informed about your care. Here’s what to know about opting in to receive SMS messages from our practice.

What You’re Agreeing To

When you opt in, you agree to receive text messages from Center for TMJ & Sleep Solutions NW related to your appointments, scheduling, and office notifications. These are service-related messages only — we will never send marketing or promotional texts.

Quick Reference

• Frequency: Varies based on your appointments and care plan
• Cost: Standard message and data rates may apply
• Required? No — consent is not a condition of purchase
• Opt out: Reply STOP at any time
• Need help? Reply HELP or call (360) 860-8038

Your Information Is Protected

Your phone number will not be shared with or sold to third parties for marketing purposes. All information is handled in accordance with our Privacy Policy and the Terms & Conditions governing our SMS program.

Consent language shown at intake

By checking this box, you agree to receive SMS messages from Center for TMJ & Sleep Solutions NW related to appointments, scheduling, and office notifications. Message frequency may vary. Message and data rates may apply. Consent is not a condition of purchase. Reply STOP to opt out and HELP for assistance. View our Privacy Policy and Terms & Conditions.