HIPAA Statement

Our Responsibilities

This Notice applies to the protected health information we maintain about you, including identifiable dental, medical, and payment information, whether oral, written, or electronic.

We are required by law to maintain its privacy, provide this Notice of our legal duties and privacy practices, notify affected individuals following a breach of unsecured protected health information, and follow the Notice currently in effect.

Uses and Disclosures Without Your Written Authorization

The following describes when we may use or disclose your health information without your written authorization. Each permission is subject to applicable legal conditions, including the stricter protections described under “Specially Protected Information” below.

Treatment

We may use and disclose information to provide, coordinate, or manage your care, including referrals, consultations, appointment reminders, and other treatment-related communications. For example, we may send your dental X-rays and relevant medical history to a specialist treating you.

Payment

We may use and disclose information to obtain payment for care, including billing, collection, coverage determinations, and claim review. For example, we may send information about your treatment to your health plan to obtain payment.

Health Care Operations

We may use and disclose information for quality assessment and improvement; professional training and review; credentialing and licensing; legal, accounting, audit, and compliance services; business planning, management, and administration; creating de-identified information; and activities relating to a sale, transfer, or merger of all or part of our practice with another covered entity or an entity that will become a covered entity through the transaction.

For example, we may review treatment records to evaluate the quality of care. We may share information with service providers acting on our behalf under required confidentiality arrangements, and with another covered entity for its operations when the legal conditions for that sharing are met.

People Involved in Your Care; Disaster Relief

We may share information directly relevant to a family member’s, friend’s, or other person’s involvement in your care or payment when you agree, have an opportunity to object and do not, or circumstances reasonably indicate that you do not object.

If you are unavailable or unable to decide, we may share relevant information based on professional judgment about your best interests. We may also disclose limited information to assist with notifying appropriate people of your location, general condition, or death, including through authorized disaster-relief organizations.

These permissions do not replace a written authorization when California law requires one.

Public Health and Safety

As authorized by law, we may disclose information to authorized recipients for preventing or controlling disease, injury, or disability; reporting suspected abuse, neglect, or domestic violence; and reporting product problems, adverse reactions, or recalls.

We may disclose information to someone able to prevent or lessen a serious and imminent threat when the disclosure satisfies applicable legal requirements.

Health Oversight and Compliance

We may disclose information for legally authorized audits, investigations, inspections, licensing, and disciplinary activities involving health care or government benefit programs.

We must disclose information to the U.S. Department of Health and Human Services when required to determine our compliance with federal privacy requirements.

Legal Requirements and Proceedings

We disclose information when applicable law requires it. We may disclose information in judicial or administrative proceedings in response to a valid order or other legally sufficient process.

A subpoena or similar request that is not a court order may require notice to you, a protective order, or other safeguards before disclosure. California restrictions and the special protections below may prohibit disclosure even when a request otherwise appears valid.

Law Enforcement

We may disclose information to law enforcement when required by law or compelled by a court order, search warrant, or other legally sufficient process, and for other law-enforcement purposes to the extent both federal and California law permit, such as legally required reports of specified injuries or suspected crimes.

Research

We may use or disclose information for research without authorization only when the applicable requirements are met, such as an approved waiver of authorization or a qualifying review to prepare research.

Deceased Individuals and Donation

We may disclose information to coroners, medical examiners, and funeral directors for their legally authorized duties, and to appropriate organizations for organ, eye, or tissue donation and transplantation.

Workers’ Compensation and Specialized Government Functions

We may disclose information as authorized for workers’ compensation and similar programs.

We may also disclose information for legally authorized military, national-security, intelligence, protective-service, and government-benefit functions, or to correctional institutions or officials with lawful custody when necessary for permitted health, safety, or security purposes.

Specially Protected Information

California Protections

Identifiable HIV test results generally require a specific written authorization for each disclosure, except for treatment and other statutory exceptions.

When we maintain information about outpatient psychotherapy, certain disclosures require a signed request specifying the information and intended use. A copy of that request must be furnished to you unless notice is lawfully waived; treatment and other statutory exceptions apply.

Records of services to which a minor may independently consent are subject to restrictions on parental access and disclosure.

California law prohibits certain disclosures in response to out-of-state demands or investigations concerning abortion or gender-affirming care lawful in California. It also restricts disclosures through electronic health records or health information exchanges to out-of-state recipients identifying lawful abortion care, subject to specific exceptions, such as permitted payment activities.

Medical information may not be disclosed for immigration enforcement without your express authorization unless a specific California statutory provision requires or permits the disclosure.

Substance Use Disorder Records

Additional federal protections apply to records received from a substance use disorder program subject to 42 CFR Part 2.

When we receive those records under a valid consent for treatment, payment, and health care operations, we may use and redisclose them as HIPAA permits while that consent remains effective, subject to Part 2 and other applicable restrictions. Other uses or disclosures require your consent unless a specific Part 2 exception applies.

Those records, and testimony describing their contents, may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without your separate written consent for that purpose or a court order issued after you or the record holder received notice and an opportunity to be heard.

A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the record is used or disclosed.

Uses and Disclosures Requiring Authorization

Written authorization is required for most uses and disclosures of psychotherapy notes, uses and disclosures for marketing, and disclosures constituting a sale of your health information, except where an applicable legal exception permits the activity without authorization.

California authorization requirements also apply. Other uses and disclosures not described in this Notice will be made only with your written authorization.

You may revoke an authorization or Part 2 consent by notifying the privacy contact in writing. Revocation does not affect actions already taken in reliance on it.

Fundraising

We may use limited information to contact you to raise funds for our practice, subject to applicable authorization requirements.

You have the right to opt out of fundraising communications. Before using Part 2 records for fundraising, we must give you a clear and conspicuous opportunity to elect not to receive those communications.

Your Rights

Contact the privacy contact identified above to exercise these rights or obtain further information. Identify the right you wish to exercise and the information involved.

Access and Copies

You have the right to inspect and obtain copies of your health information in your dental and billing records and other records used to make decisions about you, subject to limited legal exceptions.

Where permitted by applicable law, we may require a written request. You may request paper or electronic copies in a readily producible format; when the requested format is not readily producible, we will provide a readable alternative as applicable law requires.

We may charge a reasonable, legally permitted cost-based copying fee; copies are free when the law requires. A written denial will explain its basis and any available review rights.

Amendment and Addendum

You may request amendment of information you believe is incorrect or incomplete. Submit the request in writing and explain the reason.

We may deny a request on a legally permitted ground, including when the record is accurate and complete. A denial will explain the reason and your right to submit a written statement of disagreement.

After inspecting your records, you may also submit a written addendum of up to 250 words for each item you believe is incomplete or incorrect, requesting that it become part of your record. The addendum must accompany disclosures of the disputed portion as California law requires.

Restrictions

You may request limits on information used or disclosed for treatment, payment, or health care operations, or shared with people involved in your care.

We are not required to agree, except that we must agree to restrict disclosure to a health plan for payment or health care operations when the information relates solely to an item or service that you, or someone other than the health plan on your behalf, paid for in full, unless disclosure is required by law.

Confidential Communications

You may request communications by an alternative means or at an alternative location. Submit your request in writing, specifying how or where you wish to be contacted.

We must accommodate reasonable requests. When appropriate, we may require information about how payment will be handled, but not an explanation of why you are making the request.

Accounting of Disclosures

You may request an accounting of certain disclosures during the six years before your request, or a shorter period you specify.

The accounting excludes disclosures for treatment, payment, or health care operations; disclosures authorized by you; and other legally excluded disclosures.

The first accounting in any 12-month period is free. We may charge a reasonable, cost-based fee for additional accountings within that period, after notifying you and allowing you to withdraw or modify the request.

Paper Notice

You may obtain a paper copy of this Notice on request, even if you agreed to receive it electronically.

Personal Representatives and Minors

A person with legal authority to act for you may exercise rights concerning information within that authority.

A parent’s or guardian’s access to a minor’s records is subject to California confidentiality rules, applicable court orders, and legally permitted limitations involving harm, abuse, neglect, or endangerment.

Complaints

If you believe your privacy rights have been violated, you may complain to us by sending a written description of your concern to the privacy contact identified above. You may also complain to the Secretary of the U.S. Department of Health and Human Services through its Office for Civil Rights. We will not retaliate against you for filing a complaint.

Changes to This Notice

We reserve the right to change this Notice and our privacy practices within the limits of applicable law and to apply the revised Notice to information we already maintain and information we receive in the future.

Changes will not override restrictions that remain legally binding under an earlier notice.

The revised Notice will state its effective date, will be posted at our offices and on our website, and will be available upon request.