Effective Date: June 9, 2026
THIS NOTICE DESCRIBES HOW MEDICAL AND DENTAL 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 (“Notice”) describes the privacy practices of Dr. Ernesto Perez DMD (“Practice,” “we,” “our,” or “us”) and applies to all protected health information about you that we maintain, including dental records, billing records, and any other identifiable information related to your treatment.
We are required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and Florida state law to:
- Maintain the privacy and security of your protected health information (PHI)
- Provide you with this Notice of our legal duties and privacy practices regarding your PHI
- Notify you in the event of a breach of unsecured PHI
- Follow the terms of the Notice currently in effect
How We May Use and Disclose Your Protected Health Information
We may use and disclose your PHI for treatment, payment, and healthcare operations without your written authorization. Examples include:
Treatment
We use your PHI to provide, coordinate, and manage your dental care. We may share information with referring dentists, specialists, dental laboratories, oral surgeons, anesthesiologists, or other healthcare providers involved in your treatment.
Payment
We use and disclose your PHI to bill and obtain payment from you, your insurance carrier, or other third-party payers. This may include verifying coverage, obtaining pre-authorization, and submitting claims.
Health Care Operations
We may use and disclose your PHI to operate our practice, including quality assessment and improvement, training, credentialing, business management, customer service, and risk management activities.
Appointment Reminders and Communications
We may contact you to remind you of appointments via phone, text message, email, or postal mail. We may also contact you about treatment alternatives, dental services, or other health-related benefits that may interest you.
Disclosures Required or Permitted by Law
We may use or disclose your PHI without your authorization when required by federal, state, or local law, including for:
- Public health activities (disease prevention, FDA-regulated product safety)
- Reporting victims of abuse, neglect, or domestic violence
- Health oversight activities (audits, inspections, investigations)
- Judicial and administrative proceedings (court orders, subpoenas)
- Law enforcement purposes
- Coroners, medical examiners, and funeral directors
- Organ, eye, and tissue donation
- Research with appropriate safeguards
- To avert a serious threat to health or safety
- Military, national security, and protective services
- Workers’ compensation
- Correctional institutions
Uses and Disclosures Requiring Your Written Authorization
We will obtain your written authorization before using or disclosing your PHI for marketing purposes, sale of PHI, or any other purpose not described in this Notice. You may revoke your authorization at any time in writing, except to the extent we have already taken action in reliance on it.
Your Rights Regarding Your Protected Health Information
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your dental records and billing records, with limited exceptions. Requests must be in writing. We may charge a reasonable, cost-based fee for copies.
Right to Request Amendment
You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. Requests must be in writing and include the reason. We may deny the request in circumstances permitted by law.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your PHI for purposes other than treatment, payment, or healthcare operations. The first accounting in any 12-month period is free; subsequent requests may incur a reasonable fee.
Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree, except for disclosures to a health plan for payment or operations purposes when you have paid for the service in full out-of-pocket.
Right to Request Confidential Communications
You have the right to request that we communicate with you about your PHI in a specific manner or at a specific location (e.g., by mail to a P.O. box, or by phone only). We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to obtain a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.
Right to Be Notified of a Breach
You have the right to be notified in the event of a breach of your unsecured PHI.
Right to File a Complaint
You have the right to file a complaint if you believe your privacy rights have been violated. You may file with us (see below) or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
Our Responsibilities
We are required by law to maintain the privacy and security of your PHI, notify you promptly of any breach of unsecured PHI, follow the duties and practices described in this Notice, and not use or share your information other than as described unless you give us written permission.
Changes to This Notice
We reserve the right to change this Notice at any time. The revised Notice will apply to all PHI we maintain. The current Notice will be posted in our office, on our website at drernestoperez.com, and made available upon request.
Florida State Law
In some cases, Florida state law provides greater privacy protections than HIPAA, including for information about mental health, substance abuse treatment, HIV/AIDS status, and genetic testing. Where Florida law is more protective than HIPAA, we will follow the more protective standard.
How to Contact Us
If you have questions about this Notice, wish to exercise any of your rights, or want to file a complaint, please contact our Privacy Officer:
Dr. Ernesto Perez DMD
Privacy Officer
3201 SW 107th Ave
Miami, FL 33165
Phone: (305) 220-9393
Email: info@drernestoperez.com
Filing a Complaint with the U.S. Government
You may also file a complaint with the U.S. Secretary of Health and Human Services Office for Civil Rights:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
Phone: 1-877-696-6775
Online: https://www.hhs.gov/ocr/complaints/index.html
This Notice was last updated on June 9, 2026. By receiving treatment at our office, you acknowledge that you have been provided access to this Notice of Privacy Practices.