Notice of Privacy Practices

1. How we use and disclose your information

Treatment. We may use or share dental and medical information to provide and coordinate care. Example: we send relevant radiographs and treatment notes to an oral surgeon for an implant consultation.

Payment. We may use or share information to bill and obtain payment. Example: we send treatment records, radiographs, and supporting documentation to a dental or medical insurer for claim processing.

Health care operations. We may use or share information to operate our practice, assess quality, train authorized personnel, and manage services. Example: we review clinical charts to evaluate the quality of care.

We may contact you about appointments, follow-up care, treatment options, billing, and related services by permitted communication methods. You may request confidential communications as described below. We may use vendors that perform services for us, subject to required business associate agreements and safeguards.

2. Other uses and disclosures allowed or required by law

Subject to applicable conditions and more protective laws, we may disclose information for public health activities, reporting abuse or neglect, health oversight and licensing, judicial or administrative proceedings, lawful law enforcement requests, workers’ compensation, research with legally required approvals or safeguards, organ or tissue donation, coroners or medical examiners, certain government functions, and preventing or lessening a serious and imminent threat to health or safety. We may disclose information when required by law and to the U.S. Department of Health and Human Services for a compliance investigation. These permissions are not unlimited.

We may share relevant information with people involved in your care or payment if you agree, do not object when given an opportunity, or if otherwise permitted. We may share information for disaster relief as permitted by law.

3. Your choices; authorization

You may tell us your preferences about sharing information with family, friends, and other people involved in your care. We will obtain written authorization for uses or disclosures that require it, including most marketing involving protected health information, sale of protected health information, and most uses of psychotherapy notes if we maintain them. Other uses and disclosures not described in this notice will be made only with your written authorization. You may revoke an authorization in writing, except to the extent we already acted in reliance on it.

If we use protected health information to contact you for fundraising, you may opt out of future fundraising communications. We will honor that choice.

4. Your privacy rights

Access. You may inspect or request a paper or electronic copy of your dental and billing records, subject to legal exceptions. California law generally requires access for inspection within five working days and copies within 15 days after a qualifying written request. Applicable federal requirements may require earlier action. Fees, if any, will be limited to those permitted by law; some copies must be free.

Amendment. You may request correction of information you believe is inaccurate or incomplete. We generally act within 60 days under HIPAA, with a permitted written extension when applicable. We will explain a denial and your right to submit a statement of disagreement.

Confidential communications. You may ask us to contact you in a particular way or at a different address or phone number. We will accommodate reasonable requests.

Restrictions. You may request limits on information used or disclosed for treatment, payment, operations, or to people involved in your care. We do not have to agree to every request. If you pay in full out of pocket for a service or item, we must honor your request not to disclose related information to your health plan for payment or health care operations unless disclosure is required by law.

Accounting. You may request a list of certain disclosures made in the previous six years. Disclosures for treatment, payment, and operations and other specified purposes generally are excluded. The first accounting in a 12-month period is free; we will advise you of permitted charges for additional requests.

Notice and representative. You may obtain a paper copy of this notice at any time. A person legally authorized to act for you may exercise your rights, subject to verification and applicable laws governing minors and confidential care.

5. Specially protected information

California or other applicable law may impose stricter requirements for certain information, including mental health, HIV-related information, and confidential services for minors. We follow the more protective law when applicable.

If we receive records protected by 42 CFR Part 2 concerning substance use disorder treatment, we will apply applicable additional protections. Such records, and testimony describing them, may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you except as permitted under Part 2, including written consent or a qualifying court order accompanied by a subpoena or other legally required process. If Part 2 information is used for fundraising, we will provide advance clear notice and an opportunity to opt out as required by law. This paragraph does not mean Royalty Dental operates a Part 2 treatment program.

6. Our responsibilities

We are required by law to maintain the privacy and security of your protected health information, provide this notice, and follow the notice currently in effect. We will notify affected individuals following a breach of unsecured protected health information when required by law. We will not use or share information except as described here, as permitted or required by law, or as you authorize in writing.

7. Changes to this notice

We reserve the right to change this notice and apply revised terms to information we already maintain as well as information received later. The updated notice will show its effective date and be available on request, in our office, and on our website.

8. Questions and complaints

Contact Dr. Kambiz Kamangar, Privacy Officer, Royalty Dental, 17300 Saticoy Street, Lake Balboa, CA 91406; telephone (818) 705-6565; email info@royaltydental.com. You may also complain to the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201; telephone 1-877-696-6775. We will not retaliate against you for making a complaint.