HIPAA NOTICE OF PRIVACY PRACTICES - NextGen Dental Smiles
This Notice describes how your protected health information (PHI) may be used and disclosed, and how you can access your information. Please review it carefully.
This Notice remains in effect until replaced. We may revise this Notice and the terms of our privacy practices at any time, as permitted by law. The new Notice will apply to PHI we already have as well as any we receive in the future.
1. Our Legal Duties & Promise to You
• We are required by federal and state laws to maintain the privacy and security of your PHI.
• We must provide you this Notice describing our privacy practices and your rights.
• We must follow the terms of this Notice (or the version currently in effect).
• We reserve the right to change our privacy practices and the terms of this Notice at any time, provided that those changes comply with applicable law.
• If we make material changes, we will post the revised Notice on our website and make it available at our office.
• You may request a copy of our current Notice at any time by contacting our Privacy Officer (contact information given below).
2. Uses and Disclosures of PHI (How We May Use or Share Your Health Information)
Below are examples (not exhaustive) of how we may use or disclose your PHI without your express written authorization:
A. Treatment: We may use and disclose PHI to provide, coordinate, or manage your dental care or related services. For example, we may share relevant medical/dental information with specialists, laboratories, or other health care providers involved in your treatment.
B. Payment: We may use and disclose PHI to obtain payment for services provided to you. This may involve billing your insurance, submitting claims, verifying eligibility, or collecting payment.
C. Health Care Operations: We may use and disclose PHI for operational functions necessary to run our practice. This includes quality assessment, staff training, accreditation, licensing, audits, business planning, and administrative tasks.
D. Individuals Involved in Your Care: With your consent (or if allowed by law), we may share PHI with family members, friends, or other persons you designate who are involved in your care or payment. If you are present, we will provide an opportunity to object. In emergencies or incapacitated situations, disclosures will be based on professional judgment.
E. Appointment Reminders & Health Notifications: We may contact you via phone, mail, email, or text to remind you of appointments or to inform you of treatment alternatives or other health-related benefits or services.
F. Required by Law: We may disclose PHI when required by law, such as public health reporting, law enforcement requests, court orders, reporting abuse or neglect, or government oversight.
G. Public Health & Safety: We may disclose PHI to public health authorities to prevent or control disease, injury, or disability, or to notify individuals exposed to disease or involved in a product recall.
H. Research: We may disclose PHI to researchers when their project is approved by an Institutional Review Board (IRB) and privacy protections are in place.
I. Organ or Tissue Donation: If applicable, we may share PHI with organizations involved in organ, eye, or tissue procurement or transplantation.
J. Law Enforcement & Judicial Proceedings: We may disclose PHI in response to subpoenas, court orders, or for law enforcement purposes as permitted by law.
K. Military, National Security, & Government Functions: We may disclose PHI for authorized military, national security, or correctional institution purposes.
L. Workers' Compensation: We may disclose PHI as necessary to comply with workers’ compensation or similar programs.
M. Change of Ownership: If our practice is sold or merged, your PHI may be transferred to the successor entity, subject to applicable protections. You will be notified.
3. Uses & Disclosures That Require Your Authorization
Except as described above, other uses or disclosures of PHI will be made only with your written authorization. These include but are not limited to:
• Use or disclosure of psychotherapy notes (if maintained separately).
• Use or disclosure for marketing purposes (unless narrowly permitted).
• Sale of PHI.
• Any other uses or disclosures not permitted by law.
You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.
4. Your Rights Regarding Your PHI
You have the following rights under HIPAA. To exercise any right, submit a written request to our Privacy Officer: (see contact section below):
• Right of Access / Inspection / Copy - You can inspect or request copies of your PHI in the designated record set (with some exceptions). We will provide the information in the form you request if feasible (e.g. electronic or paper). We may charge reasonable cost-based fees for copying, postage, or labor.
• Right to Amend - If you believe information is incorrect or incomplete, you may request an amendment. We may deny the request under certain conditions (e.g. if the information was not created by us or is not part of the records held). If denied, you may submit a statement of disagreement.
• Right to an Accounting of Disclosures - You may request a listing of disclosures of your PHI made by us (excluding certain types, such as those for treatment, payment, or operations) over the last six years (or as otherwise required by law). The first accounting in a 12-month period is free; we may charge a reasonable fee for subsequent requests.
• Right to Request Restrictions - You may request restrictions on how we use or disclose your PHI (for treatment, payment, or operations). We are not required to agree to your requested restriction, except in limited cases (e.g. you pay out-of-pocket in full for a service and ask that we not share the PHI with your health plan). If we agree, we must abide by that restriction (unless in emergency).
• Right to Confidential Communications / Alternative Means or Locations - You may request that communications of PHI occur by alternative means (e.g. no mail to home address, use email, etc.) or at alternative locations. We will accommodate reasonable requests.
• Right to a Paper Copy of this Notice - Even if you have agreed to receive this Notice electronically, you have the right to request a paper copy.
• Right to Notification of a Breach - We are required to notify you (and, in some cases, regulatory authorities) if we discover a breach of unsecured PHI. The notification will include a brief description of what occurred, the time period involved, steps to protect yourself, and what we are doing to remedy it.
5. Special Privacy Protections
Certain categories of health information may be subject to additional protections under federal or state laws (e.g., HIV/AIDS, mental health, substance abuse, genetic information). We comply with all stricter rules where applicable.
6. Authorization & Consent (Optional)
You may be asked to sign a consent or acknowledgment form stating that you received this Notice. Signing does not waive any rights.
7. Miscellaneous ProvisionsEffective Period
This Notice is effective from the date listed below until replaced.Applicability: This Notice applies to PHI we create, receive, or maintain.Business Associates: We may use third-party service providers (“business associates”) who must also protect your PHI.Inadvertent / Incidental Disclosures: Minor disclosures that occur incidentally despite reasonable safeguards are permitted.State Law Supremacy: If state law provides more protection than HIPAA, we follow the stricter law.
8. Complaints & Contact Information
If you believe your privacy rights have been violated, you may:Submit a written complaint to our Privacy Officer.File a complaint with the U.S. Department of Health and Human Services (OCR).We will not retaliate against you for filing a complaint.
Privacy Officer / Contact – NextGen Dental Smiles
Website: https://nextgendentalsmiles.com/
Address: 110 Nut Tree Pkwy, Vacaville, CA 95687, United States
Phone: 707-416-4875
Email: info@nextgendentalsmiles.com
Last Updated: November 13, 2025
Schedule an appointment with us today to discover the difference of advanced, proven technologies, a full suite of services, and exceptional quality in dental care – all tailored to give you a healthier, happier smile.
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