Award-Winning Orthodontists &
Pediatric Dentists In Kansas City, MO


“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”
Effective August 1, 2013

Confidentiality Practices:
Burleson Orthodontics & Pediatric Dentistry is committed to protecting your health information. This notice explains how we will use, share and protect your health information. It also explains your rights to privacy of your health information as required by law. If our confidentiality practices change, a new notice will be mailed to you within sixty (60) days of the change.

Uses, Sharing and Protection of Health Information
The law only allows our staff to use your health information when doing their jobs or to share your information when it is necessary to run the program. When health information is shared with other agencies or organizations, our office requires them to keep your health information confidential. Your health information will be shared to approve or deny treatment, and to determine if you are getting the right dental treatment. For example, doctors and assistants employed by our practice may review the treatment plan created for you by your health care provider to make sure the care you receive is covered by your dental insurance.

The Practice Will Use and Share Your Health Information Without Authorization to:

  • Make payments to your health care providers for dental services provided to you.
  • Coordinate payment for your care between the practice, other health plans, and other insurance companies that may be responsible for the cost of your care.
  • Coordinate your care between the practice, other health plans, and health care providers to improve the quality of your health care.
  • Evaluate the performance of your health care provider. For example, the practice contracts with consultants to review office and other facilities’ medical records to check on the quality of care you received.
  • Release information to its attorneys, accountants, and consultants so that the practice is run efficiently and to detect and prosecute insurance fraud and abuse.
  • Send you helpful information such as insurance benefit updates, free orthodontic exams and consumer protection information.
  • Share information with government agencies or organizations that provide benefits or services when the information is necessary in order for you to receive those benefits or services.

The Program May Disclose Your Health Information Without Authorization:

  • To public health agencies for activities such as disease control and prevention, problems with medical products or medications.
  • If you are the victim of abuse, neglect or domestic violence.
  • To health oversight agencies responsible for the Medicaid Program such as the U.S. Department of Health and Human Services and its Office of Civil Rights.
  • In court cases or judicial and administrative hearings when required by law to run the practice.
  • To coroners, medical examiners, and funeral directors so they can carry out their jobs as required by law.
  • To organizations involved with organ donation and transplantation, communicable disease registries and cancer registries.
  • To entities authorized to conduct a research project.
  • To prevent a serious threat to a person’s or the public’s health and safety.
  • To the military if you are or have been a member of the armed services.
  • To a correctional facility or law enforcement officials to maintain the health, safety, and security of the corrections systems, if you are held in custody.
  • To workers’ compensation programs that provide benefits for work-related injuries or illness without regard to fault.
  • To law enforcement or national security and intelligence agencies, and to protect the President and others as required by law.


Uses and Disclosures of Protected Information Based on Your Written Authorization
All other uses and disclosures will be made only with your written authorization. These may include:

  • Most uses and disclosures of your treatment notes will require your authorization
  • Any use or disclosure for marketing purposes will require your authorization.
  • Any use or disclosure that would constitute a sale of your information will require your authorization.

Your Other Rights Concerning Your Health Information Includes the Right to:

  • See and get copies of your records. You may be charged a fee for the cost of copying your records.
  • Request to have your records amended or corrected if you think there is a mistake. You must provide a reason for your request.
  • Receive a list of disclosures. This list will not include the time that information was disclosed for treatment, payment or health care operations. The list will not include information provided to you or your family directly, or information that was sent with your authorization.
  • Further restrict uses and disclosures of your health information. You must tell our office what information you want to limit and to whom you want the limits to apply. Our office is not required to agree to the restriction.
  • Cancel authorizations previously provided by you to our office. This cancellation, however, will not affect any information that has already been shared.
  • Receive a written notification in the event of a breach of your protected information.
  • Choose how the program communicates with you in a certain way or at a certain place.
  • Opt out of receiving fundraising communications.
  • File a complaint if you do not agree with how our office has used or disclosed information about you.
  • Receive a paper copy of this notice at any time.

How to Contact Our Office Regarding Your Privacy Rights:
Mail all written forms, requests and correspondence to:

Burleson Orthodontics & Pediatric Dentistry
Chief Privacy Officer
4135 N Mulberry Drive
Kansas City, MO 64116

The Privacy Officer may deny your request to look at, copy or change your records. If our office denies your requests, we will send you a letter that tells you why your request is being denied and if you can request a review of that denial.

How to File a Complaint:
You may file a complaint with our office or the U.S. Department of Health and Human Services-Office of Civil Rights: (You will not be retaliated against for filing a complaint)

Send correspondence to:

Burleson Orthodontics & Pediatric Dentistry
4135 N Mulberry Drive
Kansas City, MO 64116
-OR- Department of Health and Human Services
200 Independence Avenue, SW
HHH Building, Room 509H
Washington, D.C. 20201

For More Information:

If you have any questions about this notice or need more information, please contact the office Privacy Officer. Burleson Orthodontics & Pediatric Dentistry may change its Notice of Privacy Practices. Any changes will apply to information we already have, as well as any information we may get in the future. A copy of any new notice will be posted at our office as well as on our web site. You may ask for a copy of the current notice at any time, or get it on-line at www.BurlesonOrthodontics.com

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Easy Ways To Get Started

If you want to explore our orthodontic practices - where we offer wide and generous payment options, where we give back to the community every day with our patients’ enthusiastic support, where we offer convenient hours and “drop in” service, and where we guarantee your or your child’s beautiful new smile for a lifetime … Burleson Orthodontics can help you in a number of ways:
1. Instantly answer these short online questions to tell whether Burleson Orthodontics is a good fit for you or your child.
2. Download Dr. Burleson’s popular report: Does Your Child Really Need Braces?
3. Call 816.759.0123 to schedule a completely free exam, consultation & digital X-rays (regularly $249).
4. Contact the office via our online form or call 816.759.0123 with your questions.

Kansas City's Award-Winning Orthodontist...
“The service at Burleson Orthodontics is amazing! I love it there and recommend them to everyone.“Lori Stuteville5 star
“We had several friends recommend them to us and we are extremely glad that they did. They do a great job!“Jennifer Bedard5 star
“We’ve had a great experience with Dr. Burleson and his staff! Both my kids’ teeth look great!“Julie Bonacorso5 star
“I could not be more pleased with the staff and the care and attention I have been given.“Pat Clyma5 star
“Thanks Dr. B for giving me a great smile in time for my wedding.”Christy5 star
“Now I am proud of my smile, which I wear all the time.“Dr. Emily D.5 star
Thank you for everything. I know it’s me when I look in the mirror, but I never thought I would look this good!Juan M.5 star
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*The reviews listed are from actual patients of Burleson Orthodontics. Individual results may vary. Reviews are not claimed to represent results for everyone.
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