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.
This notice describes the privacy practices of Super Smile Dental, located at 1739 S San Gabriel Blvd, San Gabriel, CA 91776, and all employees, staff, and other dental care personnel — including Dr. Min Lwin D.D.S. and Dr. Tin Tin Htwe — involved in your care and treatment at our facility.
We understand that health information about you and your dental health is personal. We are committed to protecting health information about you. We create a record of the dental care and services you receive at our office. We need this record to provide you with quality dental care and to comply with certain legal requirements.
This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.
We are required by law to:
The following categories describe different ways that we use and disclose health information. Not every use or disclosure in a category will be listed; however, all of the ways we are permitted to use and disclose information will fall within one of the categories.
We may use health information about you to provide you with dental treatment or services. We may disclose health information to doctors, hygienists, technicians, or other personnel involved in your care. For example, we might share information with a specialist to whom we refer you.
We may use and disclose health information about your dental treatment and services to bill and collect payment from you, your insurance company, or a third party payer.
We may use and disclose health information about you for dental care operations — such as evaluating quality of care, evaluating staff performance, and running our practice efficiently.
We may use and disclose health information to contact you as a reminder that you have an appointment for dental treatment or care at our office.
We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.
There are some services provided in our organization through contracts with business associates (e.g., billing services). When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we've asked them to do. We require business associates to appropriately safeguard your information.
We will disclose health information about you when required to do so by federal, state, or local law.
We may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
We may release health information about you for workers' compensation or similar programs providing benefits for work-related injuries or illness.
We may disclose health information for public health activities such as preventing or controlling disease, reporting births and deaths, reporting child abuse or neglect, and notifying people of product recalls.
We may disclose health information to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure.
If you are involved in a lawsuit or dispute, we may disclose health information in response to a court or administrative order, or in response to a subpoena or other lawful process.
We may release health information if asked to do so by a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness, or missing person.
Under certain circumstances, we may use and disclose health information about you for research purposes. We will ask for your written authorization before using your health information for research.
You have the following rights regarding health information we maintain about you:
You have the right to inspect and copy health information that may be used to make decisions about your care, including dental and billing records. Submit your request in writing to our Privacy Officer. We may charge a fee for copying and related supplies.
If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. Requests must be made in writing and submitted to our Privacy Officer.
You have the right to request a list of disclosures we made of health information about you. Submit your request in writing to our Privacy Officer specifying a time period (not longer than six years).
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations.
You have the right to request that we communicate with you about dental matters in a certain way or at a certain location. Make your request in writing to our Privacy Officer.
You have the right to a paper copy of this notice at any time. You may obtain a copy at our front desk or by contacting our Privacy Officer.
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. We will post a copy of the current notice in our office. Each time you register for treatment, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact our Privacy Officer at the address below. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
Other uses and disclosures of health information not covered by this notice will be made only with your written permission. You may revoke that permission, in writing, at any time. We are unable to take back any disclosures already made with your permission, and we are required to retain our records of the care we provided to you.
In addition to our HIPAA obligations above, this section describes how Super Smile Dental collects, uses, and shares information through our website and communication channels.
When you interact with our website or contact our office, we may collect the following types of information:
We use the information we collect for the following purposes:
We do not sell your personal information. We may share your information only in the following limited circumstances:
Mobile Opt-In, SMS Consent, and phone numbers collected for SMS communication purposes will not be shared with any third party or affiliates for marketing purposes.
If you have consented to receive SMS messages from Super Smile Dental, your mobile number and consent record are used solely to deliver the messages you requested. You may withdraw consent at any time by replying STOP to any message. For help, reply HELP or call (626) 288-5777. Message and data rates may apply.
Our website may use cookies and similar technologies to improve your browsing experience and analyze site traffic. You may disable cookies through your browser settings; however, some features of the site may not function properly as a result.
We retain personal information for as long as necessary to fulfill the purposes described in this policy and to comply with applicable legal, regulatory, and professional obligations.
Our website is not directed to children under the age of 13. We do not knowingly collect personal information from children without verified parental consent.
We may update this privacy policy from time to time. Updates will be posted on this page with a revised effective date. We encourage you to review this page periodically.
For questions about this notice or to exercise your privacy rights, please contact:
Privacy Officer — Super Smile Dental
1739 S San Gabriel Blvd, San Gabriel, CA 91776
You may also contact the U.S. Department of Health & Human Services Office for Civil Rights at 1-800-368-1019 or www.hhs.gov/ocr.