Our Legal Duties

Signature Smiles Dental Group is required by law to maintain the privacy of protected health information, to provide you with this notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices described in this Notice while it is in effect.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make new Notice provisions effective for all protected health information that we maintain. When we make a significant change to our privacy practices, we will revise this Notice, post the new Notice clearly and prominently at our practice location and on this website, and provide copies of the new Notice upon request.

Our practice complies with both the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the California Confidentiality of Medical Information Act (“CMIA,” California Civil Code Section 56 et seq.). Where California law provides you with greater privacy protections or rights than HIPAA, we follow California law.

How We May Use and Disclose Your Health Information

We may use and disclose your health information for treatment, payment, and health care operations. Some information — such as HIV-related information, genetic information, alcohol and/or substance use disorder treatment records, and mental health records — is entitled to special confidentiality protections under applicable state or federal law, and we abide by those special protections.

Individuals Involved in Your Care or Payment for Your Care

We may disclose your health information to your family, friends, or any other individual you identify when they participate in your care or in payment for your care. If a person has legal authority to make health care decisions for you, we will treat that personal representative the same way we would treat you with respect to your health information.

Disaster Relief

We may use or disclose your health information to assist in disaster relief efforts.

Required by Law

We may use or disclose your health information when we are required to do so by federal, state, or local law.

Public Health Activities

We may disclose your health information for public health activities, including disclosures to:

• Prevent or control disease, injury, or disability;
• Report child abuse or neglect, or elder or dependent adult abuse, as required by California mandated-reporting laws;
• Report reactions to medications or problems with products or devices;
• Notify a person of a recall, repair, or replacement of products or devices;
• Notify a person who may have been exposed to a disease or condition; or
• Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.

Military and National Security

We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to a correctional institution or law enforcement official having lawful custody the protected health information of an inmate or patient.

Secretary of Health and Human Services

We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine our compliance with HIPAA.

Workers’ Compensation

We may disclose your PHI to the extent authorized by, and to the extent necessary to comply with, laws relating to workers’ compensation or similar programs established by law.

Law Enforcement

We may disclose your PHI for law enforcement purposes as permitted by HIPAA and California law, as required by law, or in response to a valid subpoena or court order.

Health Oversight Activities

We may disclose your PHI to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Judicial and Administrative Proceedings

If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your health information in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or by us, to tell you about the request or to obtain an order protecting the information requested.

Research

We may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to protect the privacy of your information.

Coroners, Medical Examiners, and Funeral Directors

We may release your PHI to a coroner or medical examiner, for example, to identify a deceased person or determine a cause of death. We may also disclose PHI to funeral directors consistent with applicable law to enable them to perform their duties.

Fundraising Communications

We may contact you with information about our sponsored activities, including fundraising programs, as permitted by applicable law. You have the right to opt out of receiving these communications, and each fundraising communication will include instructions for opting out.

Appointment Reminders and Treatment Alternatives

We may use and disclose your health information to contact you with appointment reminders by phone, text message, or email, and to tell you about treatment alternatives or other health-related benefits and services that may be of interest to you. You may ask us to use a specific method of contact or to stop these communications.

Uses and Disclosures That Require Your Written Authorization

Your written authorization is required, with limited exceptions, for the disclosure of psychotherapy notes, the use or disclosure of your PHI for marketing purposes, and any sale of your PHI. Signature Smiles Dental Group does not sell patient health information.

We will also obtain your written authorization before using or disclosing your PHI for any purpose not described in this Notice or otherwise permitted or required by law. Under the California Confidentiality of Medical Information Act, many disclosures to third parties who are not involved in your treatment, payment, or health care operations also require your specific written authorization.

You may revoke an authorization in writing at any time. Upon receipt of your written revocation, we will stop using or disclosing your PHI under that authorization, except to the extent we have already acted in reliance on it. To revoke an authorization, send your written request to our Privacy Official at 440 E Calaveras Blvd, Milpitas, CA 95035.

Substance Use Disorder (Part 2) Treatment Records

If we receive or maintain any information about you from a substance use disorder treatment program covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the Part 2 Program record for purposes of treatment, payment, or health care operations, we may use and disclose your Part 2 Program record for treatment, payment, and health care operations purposes as described in this Notice. If we receive or maintain your Part 2 Program record through a specific consent you provide to us or another third party, we will use and disclose your Part 2 Program record only as expressly permitted by you in that consent.

In no event will we use or disclose your Part 2 Program record, or testimony describing the information contained in your Part 2 Program record, in any civil, criminal, administrative, or legislative proceeding by any federal, state, or local authority against you, unless authorized by your consent or by a court order issued after the court provides you notice.

Your Federal Health Information Rights

• Right to Access and Copies. You have the right to inspect or obtain copies of your health information, with limited exceptions, by submitting a written request. If we maintain your records electronically, you have the right to an electronic copy in the form and format you request, if readily producible. We may charge a reasonable, cost-based fee for copies. If your request for access is denied, you have the right to have the denial reviewed in accordance with applicable law.
• Right to an Accounting of Disclosures. With certain exceptions, you have the right to receive an accounting of disclosures of your health information made during the six years before your request. Submit your request in writing to our Privacy Official. If you request an accounting more than once in a 12-month period, we may charge a reasonable, cost-based fee for the additional requests.
• Right to Request Restrictions. You have the right to request additional restrictions on our use or disclosure of your PHI by submitting a written request to our Privacy Official describing (1) what information you want to limit, (2) whether you want to limit our use, disclosure, or both, and (3) to whom you want the limits to apply. We are not required to agree to your request, except that we must agree not to disclose information to your health plan for payment or health care operations purposes if the information pertains solely to an item or service that you, or someone on your behalf other than the health plan, has paid for in full out of pocket.
• Right to Confidential Communications. You have the right to request that we communicate with you about your health information by alternative means or at alternative locations — for example, contacting you only at a particular phone number or address. Make your request in writing, specify the alternative means or location, and explain how payment will be handled if applicable. We will accommodate all reasonable requests.
• Right to Amendment. You have the right to request that we amend your health information. Your request must be in writing and explain why the information should be amended. We may deny your request in certain circumstances; if we do, we will provide a written explanation and describe your rights, including your right to submit a statement of disagreement.
• Right to Notification of a Breach. You have the right to be notified following a breach of your unsecured protected health information, as required by federal and California law.
• Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice at any time upon request, even if you have agreed to receive it electronically through our website or by email.

Questions and Complaints

If you want more information about our privacy practices, have questions or concerns, or believe we may have violated your privacy rights, please contact our Privacy Official using the information below. You may also file a complaint if you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information, or to have us communicate with you by alternative means or at alternative locations.

You also have the right to file a written complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR):

• Online: www.hhs.gov/ocr/complaints
• Mail: Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Room 509F, HHH Bldg., Washington, D.C. 20201
• Phone: 1-800-368-1019 (TDD: 1-800-537-7697)

You may also contact the Dental Board of California or the California Attorney General’s Office regarding state privacy law concerns.

We will never retaliate against you in any way for filing a complaint with us, with the U.S. Department of Health and Human Services, or with any state agency.

Frequently Asked Questions About Your Privacy Rights