Notice of Privacy Practices

Our Commitment to Your Privacy

Habibi Smiles Family Dentistry is committed to protecting the privacy of your health information. We create a record of the care and services you receive at our practice. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all records of your care generated by this practice.

How We May Use and Disclose Your Health Information

The following categories describe different ways we use and disclose health information. Not every use or disclosure in a category will be listed.

• Treatment. We may use your health information to provide, coordinate, or manage your dental care and related services.
• Payment. We may use and disclose your health information to bill and receive payment for the services we provide, including submitting claims to your dental insurance carrier.
• Health care operations. We may use and disclose your health information to support the business activities of our practice, such as quality assessment, staff training, and licensing activities.
• Appointment reminders. We may contact you to remind you of scheduled appointments or follow-up care.
• As required by law. We will disclose health information about you when required to do so by federal, state, or local law.

Your Rights Regarding Your Health Information

You have the following rights regarding health information we maintain about you:

• Right to inspect and copy. You have the right to inspect and obtain a copy of health information that may be used to make decisions about your care.
• Right to amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information.
• Right to an accounting of disclosures. You have the right to request a list of certain disclosures we have made of your health information.
• Right to request restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you.
• Right to request confidential communications. You have the right to request that we communicate with you about dental matters in a certain way or at a certain location.
• Right to a paper copy of this notice. You have the right to a paper copy of this notice at any time. Please ask our front desk team.

Our Responsibilities

• We are required by law to maintain the privacy of your health information.
• We are required to provide you with notice of our legal duties and privacy practices.
• We must follow the terms of the notice currently in effect.
• We will notify you if we are unable to agree to a requested restriction.

Changes to This Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed 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. The notice will contain the effective date on the first page.

Complaints

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 us using the information below. We will not retaliate against you for filing a complaint.

Contact Us

For questions about this notice or to exercise your rights, please contact: