Privacy Statement

Your Privacy Is Important to Us

Layman, Shirman & Associates is committed to respecting your privacy by protecting the information you share with us. This
Privacy Statement will explain the type of information we collect, how we use that information and how we protect that information.

Layman, Shirman & Associates reserves the right to change this Privacy Statement at any time and will notify you of any
changes as required by law.

What Information We Collect

Layman, Shirman & Associates understands your concerns regarding the confidentiality of information you share with us. We
collect information from you through written questionnaires, oral histories and financial transactions. This information may include
contact and identity information such as name, address, phone number and social security number. We will also ask you for
thorough and detailed medical history information. We collect this information to:
• Provide the highest quality of care to you and your family
• Accurately apply for insurance benefits on your behalf
• Efficiently communicate with other health care providers such as pharmacists, physicians and other dental professionals

What Information We May Disclose

We do not disclose any nonpublic personal information about our patients or former patients to anyone, except as permitted by law.
We may use the information you share with us internally to respond to your requests for records, financial and benefit data, or to
provide you with information about our practice.
We may share the information we collect from you with non-affiliated entities, but only to the extent permitted by law. This can
include sharing information with the following types of entities:
• Third parties that provide services necessary to effect, administer or enforce transactions that you request or authorize
• Law enforcement officers and governmental agencies and courts as required by subpoena, court order or law
• Third parties that perform services on our behalf such as laboratories and billing and collection agencies

Protecting Your Personal Information

Layman, Shirman & Associates takes the security of your information very seriously and has established security standards
and procedures to prevent unauthorized access to customer information. We maintain physical, electronic and procedural
safeguards to protect your information. Only authorized personnel within our organization who need to service your account see
your information. These individuals are trained to properly handle personal information and must abide by the terms of a
confidentiality agreement.

Former Customers

If you end your relationship with Layman, Shirman & Associates, we will adhere to the information policies and practices
described in this policy. If you have any questions regarding this notice, please contact 330-422-0011. The information in this notice
as well as any updated information about this and other practice policies may be found at www.LSDental.net