HIPAA Notice of Privacy Practices
Your Rights
You have the right to:
-
Get a copy of your paper or electronic dental record
-
Request corrections to your dental record
-
Request confidential communications
-
Ask us to limit how we use or share your information (we are not required to agree in all cases)
-
Get a list of certain disclosures of your information
-
Get a copy of this privacy notice
-
Choose someone to act for you (medical power of attorney or legal guardian)
-
File a complaint if you believe your privacy rights have been violated
Your Choices
You have choices regarding how we share information related to:
-
Family members or others involved in your care
-
Disaster relief situations
We will follow your preferences whenever possible.
We never share your information without your written permission for:
-
Marketing purposes
-
Sale of your information
Our Uses and Disclosures
We may use and share your health information to:
-
Provide dental treatment
-
Operate our practice
-
Bill for services
-
Comply with legal requirements
-
Address public health and safety issues
Our Responsibilities
We are required by law to:
-
Maintain the privacy and security of your protected health information
-
Notify you promptly if a breach occurs
-
Follow the terms of this notice
We will not use or share your information other than as described unless you authorize us in writing.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights at www.hhs.gov/ocr/privacy/hipaa/complaints/ or by calling 1-877-696-6775. We will not retaliate against you for filing a complaint.
Contact Information
Privacy Officer:
Sujin Smiles Dental
📞 (352) 240-6036
📧 [email protected]
Effective Date: 01/01/2026