NOTICE OF PRIVACY PRACTICES

Effective Date: January 27, 2024

This Notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

This Notice of Privacy Practices (this “Notice”) explains how Dental Cosmetic Miami LLC (“we” or “us”) may use and disclose your medical information, and how you can gain access to this information. This Notice is being provided as required by federal law, including the Health Insurance Portability and Accountability Act (HIPAA).

During your treatment with us, doctors, nurses, and other caregivers may gather information about your medical history and your current health. Each time you are treated at our facility, we create a record of your visit. This record may contain your health history, current symptoms, examination and test results, diagnoses, treatment, and plans for future care. This information is referred to as Protected Health Information (PHI). PHI is information about you that may identify you and relates to your past, present, or future physical or mental health, as well as related healthcare services.

We are required by law to maintain the privacy and security of your PHI. We will promptly notify you if a breach occurs that may compromise the privacy or security of your information. We must follow the duties and privacy practices described in this Notice and provide you with a copy upon request. We will not use or share your information in ways not covered by this Notice without your written permission.

We may update this Notice from time to time. A current copy of this Notice is available upon request in our office, on our website, or by contacting us at legal@dentalcosmeticmiami.com or (305) 823 9982.

Uses and Disclosures of PHI

We may use and disclose PHI in the following ways:

• For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your healthcare. For example, we may share your information with a pharmacy to fill a prescription or with a laboratory to order tests. We may also disclose PHI to other healthcare providers who are involved in your care.
• For Payment: We will use your PHI to obtain payment for the services we provide. For example, we may share your PHI with your insurance company to process your claims.
• For Healthcare Operations: We may use or disclose your PHI for our healthcare operations, such as quality improvement, staff training, and compliance reviews. These activities help ensure that we provide high-quality care to our patients.

Additional Uses and Disclosures

As part of treatment, payment, and healthcare operations, we may also use your PHI for the following purposes:

• To remind you of upcoming appointments or surgery dates.
• To inform you about treatment alternatives or other health-related benefits that may be of interest to you.

Disclosures Without Authorization

We may use or disclose your PHI without your authorization in certain situations, such as:

• When legally required: We will disclose your PHI when required by federal, state, or local law.
• Public health risks: We may disclose PHI for public health purposes, such as preventing or controlling disease, reporting adverse events, or conducting recalls.
• Abuse or neglect: We may disclose PHI to government authorities if we believe you are a victim of abuse, neglect, or domestic violence, as required by law.
• Health oversight activities: We may disclose PHI to oversight agencies for activities like audits, inspections, or investigations.
• Legal proceedings: We may disclose your PHI in response to a court order or subpoena.
• Law enforcement: We may disclose PHI to law enforcement in limited circumstances, such as reporting a crime or complying with a court order.
• Coroners, funeral directors, and organ donation: We may disclose PHI to assist with identification, cause of death determinations, or organ donation.
• Research: We may use or disclose your PHI for research purposes, provided the research has been approved and safeguards are in place to protect your privacy.
• Threats to health or safety: We may use or disclose PHI if necessary to prevent a serious threat to your health or the public’s safety.

Your Rights Regarding PHI

You have several rights regarding your PHI:

• The right to inspect and copy: You may request access to your PHI and obtain copies. We may charge a fee for this service.
• The right to request restrictions: You may ask us to restrict the use or disclosure of your PHI. We are not required to agree to your request, except in certain circumstances involving healthcare services paid for out of pocket.
• The right to request confidential communications: You may request that we contact you using alternative methods or at alternative locations.
• The right to request amendments: If you believe your PHI is incorrect or incomplete, you may request an amendment.
• The right to receive an accounting of disclosures: You may request a list of certain disclosures of your PHI made by us, except for disclosures related to treatment, payment, or healthcare operations.
• The right to a paper copy of this notice: You may request a paper copy of this Notice at any time.

Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your PHI.
• Notify you if a breach of your unsecured PHI occurs.
• Follow the terms of this Notice.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of Health and Human Services. To file a complaint with us, please contact us at legal@dentalcosmeticmiami.com or (305) 823 9982. We will not retaliate against you for filing a complaint.

Contact Us

If you have any questions about this Notice or your privacy rights, please contact us at legal@dentalcosmeticmiami.com or call (305) 823 9982. Our office is located at 266 East 49th St Hialeah, FL 33013.