Notice of Privacy Practices

01

Your Information

Your rights

When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities to help you exercise them.

Get a copy of your health record

You may ask to see or receive an electronic or paper copy of your dental record and other health information we maintain about you.

We will provide a copy or summary of your health information as required by applicable law. We may charge a reasonable, cost-based fee when permitted.

Ask us to correct your health record

You may ask us to correct health information about you that you believe is incorrect or incomplete.

We may deny your request in certain circumstances, but if we do, we will explain the reason in writing as required by law.

Request confidential communications

You may ask us to contact you in a particular way, such as at a specific telephone number, or to send correspondence to a different address.

We will accommodate reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or disclose certain health information for treatment, payment, or our healthcare operations. We are not required to agree to every request.

If you pay for a healthcare service or item completely out of pocket, you may ask us not to disclose information about that service to your health plan for payment or healthcare operations. We will honor that request unless disclosure is required by law.

Receive an accounting of certain disclosures

You may request a list, or accounting, of certain disclosures we have made of your health information, including who received the information and why it was disclosed.

The accounting generally covers the six years before the date of your request and does not include certain disclosures, such as many disclosures for treatment, payment, or healthcare operations.

Get a copy of this notice

You may request a paper copy of this Notice of Privacy Practices at any time, even if you previously agreed to receive it electronically.

Choose someone to act for you

If you have given someone medical power of attorney, or if someone is your legal guardian or otherwise legally authorized to act for you, that person may exercise your privacy rights and make choices about your health information.

We will verify that the person has appropriate authority before taking action on your behalf.

File a complaint

If you believe your privacy rights have been violated, you may file a complaint with our practice using the contact information provided below.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

We will not retaliate against you for filing a complaint.

02

Your Choices

You have choices about certain information

For certain health information, you may tell us your preferences about what we share.

In appropriate circumstances, you may tell us your preference regarding whether we:

Share information with your family, close friends, or others involved in your care
Share information in a disaster-relief situation
Contact you for certain marketing or fundraising purposes, when applicable

If you are unable to tell us your preference, such as when you are unconscious, we may share information when we believe doing so is in your best interest and is permitted by law.

Written authorization. Uses and disclosures of your protected health information that are not otherwise permitted by law generally require your written authorization. You may revoke an authorization in writing, subject to applicable legal limitations.

03

How We Use Information

How we typically use or share your information

Treatment

We may use your health information and share it with other healthcare professionals who are treating you.

Example: We may share relevant dental information with a specialist involved in your treatment.

Running our practice

We may use and disclose your health information to operate our practice, improve the care we provide, coordinate services, and contact you when necessary.

Example: We may use health information to manage your treatment, schedule care, or evaluate the quality of our services.

Billing and payment

We may use and disclose your health information to bill for services and obtain payment from dental plans, insurers, or other responsible parties.

Example: We may provide information about dental treatment to your dental benefit plan so it can determine coverage or payment.

04

Permitted Disclosures

Other ways we may use or share information

We may be permitted or required to use or disclose your health information for other purposes, usually when doing so contributes to public health, safety, legal, or governmental functions.

Public health and safety activities
Preventing or reducing a serious threat to health or safety
Reporting suspected abuse, neglect, or domestic violence when permitted or required by law
Complying with federal, state, or local law
Health oversight activities
Workers' compensation matters
Certain law-enforcement or governmental requests
Responding to court orders, subpoenas, lawsuits, or other legal proceedings as permitted by law
Working with coroners, medical examiners, or funeral directors when applicable
Organ and tissue donation matters when applicable
Research when applicable legal requirements have been satisfied

Additional federal or California privacy laws may provide greater protection for certain categories of health information. When another law provides greater privacy protection, we will follow the more protective requirement when it applies.

05

Additional Protections

Certain sensitive health information

Some types of health information may receive additional protection under federal or California law. When those protections apply, we will use and disclose the information only as permitted by applicable law.

To the extent we create or maintain substance use disorder patient records that are subject to 42 CFR Part 2, those records receive additional confidentiality protections. Such information will not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you except as permitted by applicable law, including with your written consent or an appropriate court order when required.

06

Our Responsibilities

Protecting your health information

We are required by law to maintain the privacy and security of your protected health information.
We will notify you as required by law if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in the Notice of Privacy Practices that is currently in effect.
We will provide you with a copy of this notice upon request.
We will not use or disclose your information other than as described in this notice or otherwise permitted or required by law unless you authorize us to do so in writing.
If you provide written authorization, you may revoke it in writing at any time, except to the extent we have already acted in reliance on it or as otherwise provided by law.

07

Updates

Changes to this notice

We may change the terms of this Notice of Privacy Practices. Changes may apply to health information we already maintain as well as information we receive in the future.

If the notice is materially revised, the current notice will be available at our office, upon request, and on our website.

08

Questions & Complaints

Contact our Privacy Officer

If you have questions about this notice, would like to exercise one of your privacy rights, or believe your privacy rights have been violated, please contact our Privacy Officer.

Marta Rudat, DDS

Privacy Officer: Nicole Rudat
Phone: (714) 665-4200
Email: nicole@martarudatdds.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights .

Filing a complaint will not affect your care, and we will not retaliate against you for exercising your privacy rights.

HHS Office for Civil Rights