Effective Date: February 15, 2026
This Notice describes how medical and dental information about you may be used and disclosed and how you can access this information. Please review it carefully.
This Notice is provided in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Health Information Technology for Economic and Clinical Health Act (HITECH), 42 C.F.R. Part 2 (where applicable), and the California Confidentiality of Medical Information Act (CMIA).
Our Legal Duties
We are required by law to:
• Maintain the privacy of your protected health information (PHI)
• Provide you with this Notice of our legal duties and privacy practices
• Abide by the terms of this Notice
• Notify you in the event of a breach of unsecured PHI
• Comply with applicable federal and California laws
We reserve the right to change this Notice. Any revised Notice will apply to all information we maintain and will be available in our office and on our website.
How We May Use and Disclose Your Information
We may use and disclose your PHI without written authorization for:
Treatment
To provide, coordinate, or manage your dental care.
Payment
To obtain payment for services rendered.
Health Care Operations
For administrative, quality improvement, training, licensing, accreditation, and compliance purposes.
As Required by Law
When disclosure is required by federal or California law.
Public Health and Safety
For public health reporting, abuse reporting, or health oversight activities.
Special Protections for Substance Use Disorder Records
Some health information relating to substance use disorder diagnosis, treatment, or referral for treatment may be protected under federal law (42 U.S.C. § 290dd-2 and 42 C.F.R. Part 2).
If we receive such records:
• They will be handled in accordance with applicable federal law.
• They may not be redisclosed without your written authorization unless otherwise permitted by law.
• Federal law prohibits unauthorized redisclosure of substance use disorder treatment records.
Your Rights
You have the right to:
• Inspect and obtain a copy of your health records (subject to lawful limitations)
• Request amendments to your records
• Request restrictions on certain uses or disclosures
• Request confidential communications
• Receive an accounting of certain disclosures made in the six (6) years prior to your request
• Receive notice of a breach of unsecured PHI
We may deny certain requests as permitted by law.
Electronic Communications
We may communicate with you via electronic means, including email, text messaging, and patient portals. While reasonable safeguards are used, electronic communication carries inherent risks.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
California Dental Innovations
450 Sutter Street, Ste. 808
San Francisco, CA 94108
415-513-5066
Or with:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/ocr
You will not be retaliated against for filing a complaint.