Our Commitment
5D Smiles Dental Implant Center (“the Practice”) is required by law to maintain the privacy of your protected health information (PHI) and to provide you with this notice of our legal duties and privacy practices. We are required to follow the terms of the notice currently in effect.
How We Use and Disclose Your PHI
The Practice may use and disclose your PHI for the following purposes without your written authorization:
- Treatment — to provide you with dental care, coordinate treatment with specialists, and consult with other providers.
- Payment — to bill and collect payment for treatment, verify insurance benefits, and process claims.
- Healthcare Operations — for quality assessment, staff training, audits, and administrative activities required to run the Practice.
- Appointment Reminders — to contact you by phone, text, or email about appointments and follow-up care.
- Required by Law — disclosures required by federal, state, or local law, including public health activities and judicial proceedings.
Your Rights
You have the right to:
- Inspect and copy your medical and billing records (we may charge a reasonable fee for copies).
- Request amendments to your records if you believe information is incorrect or incomplete.
- Request an accounting of certain disclosures we have made of your PHI.
- Request restrictions on how we use or disclose your PHI for treatment, payment, or operations.
- Request confidential communications at an alternative address or phone number.
- Receive a paper copy of this notice, even if you have agreed to receive it electronically.
- Be notified if there is a breach of your unsecured PHI.
Uses That Require Your Authorization
Most uses and disclosures of psychotherapy notes, uses for marketing purposes, and sales of PHI require your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already relied on it.
Changes to This Notice
We reserve the right to change this notice. The revised notice will apply to information we already have about you as well as any information we receive in the future. The current notice will always be available at our office and on this website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.
Contact Us
For questions about this notice or to exercise your rights, contact:
Privacy Officer — 5D Smiles Dental Implant Center
8500 Florence Ave, Ste 100
Downey, CA 90240
Phone: (562) 923-4538