Notice of Privacy Practices

Century Smile Maker is required by law to protect the privacy of your protected health information (“PHI”), to give you this Notice of our legal duties and privacy practices, to notify you if a breach of your unsecured PHI occurs, and to follow the terms of the Notice currently in effect.

How we may use and share your health information

Treatment

We use and share your PHI to provide and coordinate your dental care. For example, we may share information with a specialist, dental laboratory, or your physician.

Payment

We use and share PHI to bill and get paid for services, such as verifying your benefits and sending claims to your dental plan.

Health care operations

We use PHI to run our practice and improve care, such as quality review, staff training, scheduling, and business planning.

Appointment reminders and communications

We may contact you by phone, text message, email, or mail to remind you of appointments, follow up on treatment, or share information about services we offer. You can ask us to contact you a specific way, and you may opt out of text messages at any time by replying STOP. See our SMS Terms.

Business associates

Some services are provided by outside companies, such as our phone and texting provider, billing services, and technology vendors. They must sign agreements to protect your information.

Family and friends involved in your care

Unless you object, we may share information with a family member, friend, or other person you identify who is involved in your care or helps pay for it.

Uses and disclosures permitted or required by law

We may use or share your PHI without your written permission when the law allows or requires it, including:

• Public health and safety activities, such as reporting disease or adverse reactions;
• Reporting suspected abuse, neglect, or domestic violence;
• Health oversight activities, such as audits, inspections, and licensure;
• Lawsuits and legal proceedings, in response to a court order or subpoena;
• Law enforcement purposes, in limited circumstances;
• Coroners, medical examiners, and funeral directors;
• Preventing a serious threat to health or safety;
• Specialized government functions, such as military or national security;
• Workers’ compensation claims;
• Organ and tissue donation;
• Responding to the U.S. Department of Health and Human Services when it is checking our compliance.

Uses that require your written authorization

We will not use or share your PHI for marketing purposes, sell your PHI, or use it in any way not described in this Notice without 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

• Get a copy of your records. You can ask to see or get a paper or electronic copy of your dental and billing records. We may charge a reasonable, cost-based fee.
• Ask us to correct your records. If you believe information is incorrect or incomplete, you can ask us to amend it. We may say no, and we will tell you why in writing.
• Request confidential communications. You can ask us to contact you in a specific way or at a specific address or number. We will agree to reasonable requests.
• Ask us to limit what we use or share. We are not required to agree, except that if you pay for a service in full out of pocket, you can ask us not to share that information with your health plan, and we will agree unless the law requires us to share it.
• Get a list of disclosures. You can ask for a list of times we shared your PHI in the six years before your request, other than for treatment, payment, operations, and certain other purposes.
• Get a copy of this Notice. You can ask for a paper copy at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. A person with your medical power of attorney or your legal guardian can exercise your rights.
• Be notified of a breach. We will notify you if a breach affects your unsecured PHI.

California privacy protections

California’s Confidentiality of Medical Information Act (CMIA) and other state laws may give you additional protections. When state law is more protective of your privacy than HIPAA, we follow state law.

Changes to this Notice

We may change this Notice, and the changes will apply to all information we hold. The current Notice is posted in our office and on this page, and you may request a copy at any visit.

Questions or 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, 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or online at hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.

Effective date of this Notice: October 2, 2026.