HIPAA Notice of Privacy Practices

This notice describes how medical and dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully. We are required by law to maintain the privacy of your protected health information (PHI), give you this notice, follow its terms, and notify you after a breach of unsecured PHI.

• Treatment: sharing records with specialists, dental labs and other providers involved in your care.
• Payment: billing you, your dental insurance or a financing company.
• Health care operations: quality review, training, scheduling and appointment reminders.
• As required by law, including public health reporting, abuse reporting, health oversight, court orders and law enforcement where permitted.
• To avert a serious threat to health or safety.
• To business associates who sign agreements to protect your information.

We will not use or disclose your PHI for marketing, sell your PHI, or use it for most other purposes without your written authorization. You may revoke an authorization in writing at any time, except to the extent we already acted on it.

The California Confidentiality of Medical Information Act (Cal. Civ. Code § 56 et seq.) provides protections that are in some cases stricter than HIPAA. Under California law:

• We generally need your written authorization before disclosing medical information to employers, insurers for non-payment purposes, or other third parties not involved in your care.
• Information related to reproductive or sexual health, gender-affirming care, HIV test results, mental health and substance use receives heightened protection, and we will not disclose it in response to out-of-state subpoenas or law enforcement requests that relate to care lawful in California (AB 352, AB 1242, SB 107).
• You may inspect your records within 5 working days of a written request and receive copies within 15 days (Cal. Health & Safety Code § 123110). We may charge a reasonable, cost-based copying fee.
• You may submit a written addendum of up to 250 words for any item in your record you believe is incomplete or incorrect (§ 123111).
• Minors may have independent privacy rights for certain types of care as allowed by California law.
• If a breach of your medical information occurs, we will notify you and, as required, the California Department of Public Health.

• Get a paper or electronic copy of your dental record.
• Ask us to correct or amend your record.
• Request confidential communications, such as contacting you at a different number or address.
• Ask us to limit what we use or share. If you pay out of pocket in full, you can ask us not to share that information with your insurer.
• Receive an accounting of certain disclosures.
• Get a copy of this notice at any time.
• Choose someone to act for you, such as a legal guardian or medical power of attorney.

Please do not send health information through our website chat, contact forms, text messages or regular email; these channels are not intended for PHI. Call our office instead. We do not place advertising tracking technologies on pages where PHI would be entered.

If you believe your privacy rights have been violated, contact our Privacy Officer at (949) 919-6140 or 26501 Rancho Pkwy S, Ste 202, Lake Forest, CA 92630. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights (hhs.gov/ocr), the California Department of Public Health, or the Dental Board of California. We will not retaliate against you for filing a complaint.

We may change this notice, and changes will apply to all information we hold. The current notice is posted in our office and on this page.