Century Smile Maker is required by law to maintain the privacy of your protected health information (“PHI”), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect. PHI is information that may identify you and that relates to your past, present, or future physical or mental health, dental care, or payment for care.
How we may use and disclose your health information
For treatment
We use and disclose your PHI to provide, coordinate, and manage your dental care — for example, sharing information with dentists, hygienists, specialists, laboratories, or other providers involved in your treatment.
For payment
We use and disclose your PHI to bill and obtain payment for the care we provide — for example, sending claims and supporting information to your dental or health insurer.
For healthcare operations
We use and disclose your PHI to run our practice — for example, quality assessment, staff training, scheduling, appointment reminders, and business management.
Appointment reminders and communications
We may contact you (by phone, text, email, or mail, including through our scheduling provider) to remind you of appointments or to provide information about treatment alternatives or other health-related benefits and services.
Uses and disclosures that do not require your authorization
We may use or disclose your PHI without your authorization in the following circumstances, as permitted or required by law:
- When required by federal, state, or local law;
- For public health activities, such as preventing or controlling disease;
- To report suspected abuse, neglect, or domestic violence;
- For health oversight activities, such as audits or investigations;
- In response to a court or administrative order, subpoena, or other lawful process;
- For law enforcement purposes as permitted by law;
- To coroners, medical examiners, and funeral directors;
- For organ and tissue donation, if applicable;
- For approved research under privacy safeguards;
- To avert a serious threat to health or safety;
- For specialized government functions, including military and veterans’ activities and national security;
- For workers’ compensation as authorized by law.
Uses and disclosures that require your written authorization
Other uses and disclosures — including most uses for marketing, any disclosure that is a sale of PHI, and disclosure of psychotherapy notes (where applicable) — will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.
Your rights regarding your health information
- Access and copies. You may inspect and request a copy of your PHI, including an electronic copy where we maintain it electronically.
- Amendment. You may request that we correct PHI you believe is incomplete or inaccurate.
- Accounting of disclosures. You may request a list of certain disclosures we have made of your PHI.
- Restrictions. You may request restrictions on how we use or disclose your PHI. We are not required to agree, except that we must honor a request to restrict disclosure to a health plan for an item or service you paid for in full out of pocket.
- Confidential communications. You may ask us to communicate with you in a specific way or at a specific location.
- Paper copy. You may obtain a paper copy of this Notice at any time, even if you agreed to receive it electronically.
- Breach notification. You have the right to be notified if a breach of your unsecured PHI occurs.
To exercise any of these rights, contact our Privacy Officer using the information below.
Our duties
We are required by law to maintain the privacy of your PHI, to provide this Notice, and to abide by its terms. We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as information we receive in the future. If we make a material change, we will post the updated Notice in our office and on our website and make copies available upon request.
Special protections under California law
California’s Confidentiality of Medical Information Act (CMIA) and other state laws may provide additional protection for your medical information. Where state law is more protective than HIPAA, we follow the more protective standard.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.
- Practice Privacy Officer: Dr. Ali Esfahani, Century Smile Maker, 2080 Century Park East, Suite 1103, Los Angeles, CA 90067, (310) 553-2233, info@centurysmilemaker.com
- U.S. HHS Office for Civil Rights: 200 Independence Avenue SW, Washington, D.C. 20201, or www.hhs.gov/ocr/privacy/hipaa/complaints/
Effective date and contact
This Notice is effective as of June 25, 2026. For questions or to exercise your rights, contact our Privacy Officer at (310) 553-2233 or info@centurysmilemaker.com.