Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

OUR LEGAL DUTY

We are required by law to maintain the privacy of your protected health information (PHI) and to provide you with this notice of our legal duties and privacy practices. We must follow the privacy practices described in this notice while it is in effect. This notice takes effect February 16, 2026, and will remain in effect until replaced.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use and disclose your health information for the following purposes:

Treatment: We may disclose your health information to a physician or other healthcare provider providing treatment to you.

Payment: We may use and disclose your health information to obtain payment for services we provide to you.

Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations, such as quality assessment, improvement activities, and staff training.

Substance Use Disorder (SUD) Records: If we receive records protected by 42 CFR Part 2, we will maintain their confidentiality. We may use or disclose these records for treatment, payment, or healthcare operations only as permitted by law. We will not use these records in civil, criminal, administrative, or legislative proceedings against you without your specific written consent or a court order.

Individuals Involved in Your Care: We may disclose your health information to a family member or friend to the extent necessary to help with your healthcare or payment, but only if you agree.

Required by Law: We may use or disclose your health information when required to do so by law (e.g., reporting abuse/neglect or for public health activities).

PATIENT RIGHTS

Access: You have the right to look at or get copies of your health information, with limited exceptions. You must make the request in writing.

Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than treatment, payment, or healthcare operations.

Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your PHI. We are not required to agree unless you pay for a service in full out-of-pocket and request we not share that info with your health plan.

Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or locations.

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.

QUESTIONS AND COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Official or the U.S. Department of Health and Human Services.

Privacy Official Name: James Lin DMD

Address: 14777 Los Gatos Blvd, STE #103, Los Gatos, CA 95032

Telephone: 408-358-2161

Email: info@dentistinlosgatos.com

Effective Date: February 16, 2026