Welcome to 170th Dental Family Dentistry

• NOTICE OF PRIVACY PRACTICES

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.

Effective Date: February 16, 2026 (Replaces all previous versions)

Our Commitment to Your Privacy

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires all medical records and other individually identifiable health information used or disclosed by us, whether electronically, on paper, or orally, are kept confidential. We are required by law to maintain the privacy of your protected health information (PHI) and to provide you with notice of our legal duties and privacy practices.

How We May Use and Disclose Your Health Information

We may use and disclose your medical records for the following purposes:

-Treatment: Coordination or management of health care and related services. Example: Sharing x-rays with a specialist.

-Payment: Activities such as billing, insurance confirmation, and collections. Example: Sending a bill to your insurance company.

-Health Care Operations: Business aspects of running our practice, such as quality assessments and auditing.

Special Protections for Substance Use Disorder (SUD) Records

For any information we receive from a federal Substance Use Disorder treatment program (a "Part 2 Program"):

Consent: We may use and disclose these records for Treatment, Payment, and Health Care Operations if you provide a single, combined written consent.

Legal Proceedings: We will not use or disclose these records for civil, criminal, administrative, or legislative proceedings against you without your specific written consent or a court order.

Accounting: You have the right to an accounting of disclosures of these records for up to 3 years prior to your request.

Your Rights Regarding Your Information

Restrictions: The right to request restrictions on certain disclosures.

Confidential Communications: The right to receive communications by alternative means (must be in writing).

Inspection and Copies: The right to inspect and copy your PHI.

Amendments: The right to request an amendment to your records.

Accounting of Disclosures: The right to receive a list of disclosures for the last six years (or 3 years for SUD records used for TPO).

Breach Notification: You have the right to be notified following a breach of your unsecured protected health information.

Important Notices

Redisclosure: Information disclosed pursuant to this notice may be subject to redisclosure by the recipient and may no longer be protected by federal privacy regulations.

Fundraising: If we contact you for fundraising, you have the right to opt out of receiving such communications.

Other Uses: Any other uses and disclosures will be made only with your written authorization, which you may revoke at any time.

Complaints and Contact

We reserve the right to change the terms of this Notice. We will post the revised Notice in our office and on our website. If you believe your privacy rights have been violated, you may file a written complaint with our office or the U.S. Department of Health & Human Services. We will not retaliate against you for filing a complaint.

Privacy Official Name/Title: Priya Parasher_____________________

Phone Number: 718-293-7670______________________________