HIPAA Notice of Privacy Practices

Our responsibilities

Pacific Dental Group is required by law to maintain the privacy and security of your protected health information (PHI), to give you this notice of our legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

How we may use and disclose your information

Treatment: we may use and share your PHI with other providers involved in your care, such as a specialist or dental laboratory.

Payment: we may use and share your PHI to bill and get payment from health plans, including PPO carriers and Denti-Cal.

Health care operations: we may use your PHI to run our practice, improve your care and contact you when necessary, including appointment reminders.

As required by law: we will share information when required by federal, state or local law, including for public health and safety, health oversight, law enforcement, lawsuits, workers’ compensation and to coroners or funeral directors.

Uses that require your written authorization

We will not use or share your information for marketing, sell your information, or share psychotherapy notes without your written permission. Before-and-after photos are used publicly only with a separate signed consent. You may revoke an authorization at any time in writing.

Your rights

Get a copy of your dental and medical records, in paper or electronic form, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct records you believe are incorrect or incomplete.

Request confidential communications, for example by contacting you at a different phone number or address.

Ask us to limit what we use or share. We are not required to agree in all cases, but we must agree if you pay out of pocket in full and ask us not to share that information with your health plan.

Get a list of those with whom we have shared your information in the six years prior to your request.

Get a copy of this notice and choose someone, such as a legal guardian, to act for you.

Complaints

If you believe your rights have been violated, you may contact our Privacy Officer at (323) 405-1491, or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or online at hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

Website and online tools

Website visits and general chat questions are not part of your designated record set. Please do not send detailed health information through the website chat. Appointment forms are processed by a HIPAA-capable form provider under a business associate agreement.

Changes to this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office and on this website.