Notice of Privacy Practices

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.

Effective Date: May 23, 2026

Our Commitment to Your Privacy

Our practice is committed to protecting the privacy of your health information. We create a record of the care and services you receive so we can provide quality treatment and comply with legal requirements. This Notice applies to all records of your care generated by our practice and describes how we may use and disclose your protected health information (“PHI”) and the rights you have regarding that information.

We are required by law to maintain the privacy of your PHI, to give you this Notice of our legal duties and privacy practices, to follow the terms of the Notice currently in effect, and to notify you following a breach of unsecured PHI.

How We May Use and Disclose Your Health Information

The following categories describe the ways we may use and disclose your PHI without a separate written authorization from you.

Treatment

We use and disclose your PHI to provide, coordinate, and manage your dental care. For example, we may share information with another dentist, a specialist, a dental laboratory, or another provider involved in your treatment.

Payment

We use and disclose your PHI so that we can bill and collect payment for the services you receive. For example, we may send claims or information about treatment to your dental or medical insurance company, or obtain prior authorization for a procedure.

Health Care Operations

We use and disclose your PHI to support the business activities of our practice, such as quality assessment, staff training and evaluation, licensing, accreditation, and general administration.

Appointment Reminders and Treatment Information

We may contact you by telephone, text message, email, or mail to remind you of an appointment, or to tell you about or recommend treatment options, alternatives, or other health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care

Unless you object, we may share relevant PHI with a family member, friend, or other person you identify who is involved in your dental care or in payment for that care. We may also disclose PHI in a disaster-relief situation so that your family can be notified of your location and condition.

Business Associates

We may disclose PHI to third parties, known as “business associates,” that perform services on our behalf – such as billing, information technology, or document storage. Our business associates are required by written contract to protect the privacy and security of your information.

Other Uses and Disclosures Permitted or Required by Law

We may use or disclose your PHI without your authorization in the following circumstances, subject to the conditions and limits set by law:

• When required by federal, state, or local law;
• For public health activities, such as preventing or controlling disease, injury, or disability;
• To report suspected abuse, neglect, or domestic violence to authorities permitted by law to receive such reports;
• For health oversight activities, such as audits, investigations, inspections, and licensure;
• In response to a court or administrative order, subpoena, discovery request, or other lawful process;
• For law enforcement purposes as permitted or required by law;
• To coroners, medical examiners, and funeral directors as necessary to carry out their duties;
• For organ, eye, or tissue donation purposes;
• For approved research, when privacy protections required by law are in place;
• To avert a serious and imminent threat to the health or safety of a person or the public;
• For specialized government functions, including military, veterans’, national security, and protective services;
• For workers’ compensation purposes, as authorized by law; and
• To a correctional institution or law enforcement official if you are an inmate or in custody, as permitted by law.

Special Confidentiality Protections – Substance Use Disorder Records

Health information related to substance use disorder (SUD) diagnosis, treatment, or referral for treatment may be subject to additional federal confidentiality protections under a law known as 42 C.F.R. Part 2, which provides greater privacy protections than HIPAA for certain records. When these additional protections apply, our practice may be more limited in how we use or disclose this information – even for treatment, payment, or health care operations – unless you provide written consent or another legal exception applies.

Additional Protections Under Florida Law

In certain situations, Florida law provides greater privacy protection than federal law – for example, for HIV and AIDS test results, mental health and psychiatric records, and other categories of sensitive information. Where Florida law is more protective than HIPAA, we will follow the more protective standard.

Uses and Disclosures That Require Your Written Authorization

Most uses and disclosures of psychotherapy notes (if our practice maintains them), uses and disclosures of PHI for marketing purposes, and any disclosure that constitutes a sale of PHI require your written authorization. Any other use or disclosure not described in this Notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already taken action in reliance on it.

Your Rights Regarding Your Health Information

You have the following rights with respect to your PHI:

• Right to inspect and copy. You may request access to and a copy of the health information used to make decisions about your care. We may charge a reasonable, cost-based fee, and in limited circumstances may deny a request.
• Right to request an amendment. If you believe information in your record is incorrect or incomplete, you may ask us to amend it. We may deny the request in certain circumstances and will explain our reasons in writing.
• Right to an accounting of disclosures. You may request a list of certain disclosures of your PHI that we have made.
• Right to request restrictions. You may ask us to limit how we use or disclose your PHI for treatment, payment, or health care operations. We are not required to agree, except as described in the next item.
• Right to restrict disclosures to your health plan. If you pay for a service or item in full, out of pocket, you may request that we not disclose PHI related to that service to your health plan. We must honor that request unless the disclosure is otherwise required by law.
• Right to request confidential communications. You may ask us to communicate with you about medical matters in a specific way or at a specific location.
• Right to a paper copy of this Notice. You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
• Right to be notified of a breach. You have the right to be notified if a breach occurs that may have compromised the privacy or security of your information.

To exercise any of these rights, please submit your request in writing to our Privacy Officer at the contact information below.

Our Responsibilities

Our practice is required by law to:

• Maintain the privacy and security of your protected health information;
• Provide you with this Notice of our legal duties and privacy practices;
• Follow the terms of the Notice that is currently in effect;
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your information; and
• Not use or disclose your information other than as described in this Notice unless you tell us we may do so in writing. If you give us written permission and later change your mind, you may revoke that permission in writing at any time.

Changes to This Notice

We reserve the right to change this Notice and to make the revised Notice effective for health information we already have about you as well as any information we receive in the future. The current Notice will be posted in our office and on our website, and will show its effective date. You may request a copy of the current Notice at any time.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our practice by contacting our Privacy Officer at the telephone number below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201; toll-free 1-877-696-6775; or online at www.hhs.gov/ocr/privacy/. You will not be penalized, and we will not retaliate against you, for filing a complaint.

Contact Information

If you have any questions about this Notice or wish to exercise any of your rights, please contact our Privacy Officer:

Privacy Officer
Dr. Ernesto J. Perez, DMD
3201 SW 107th Ave., Miami, FL 33165
Telephone: (305) 220-9393