Effective Date: June 1, 2026

Your Information. Your Rights. Our Responsibilities.

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.

Your Rights

You have the right to:

Get an electronic or paper copy of your dental record. You can ask to see or get a copy of your dental record and other health information we have about you. We may charge a reasonable, cost-based fee.

Ask us to correct your dental record. You can ask us to correct health information about you that you think is incorrect or incomplete. We may say no, but 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. We will say yes to reasonable requests.

Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to every request.

Get a list of those with whom we have shared information. You can ask for a list of certain times we have shared your health information, who we shared it with, and why.

Get a copy of this privacy notice. You can ask for a paper copy of this notice at any time.

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

File a complaint if you believe your rights are violated. You can complain to us using the contact information in this notice. You can 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.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, tell us what you want us to do and we will follow your instructions when we can.

• Share information with your family, close friends, or others involved in your care.

• Share information in a disaster relief situation.

• Contact you for fundraising efforts, if applicable.

We will not use or share your information for marketing purposes or sell your information unless you give us written permission, except as allowed by law.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

Treatment. We can use your health information and share it with other professionals who are treating you. Example: We share information with a dental specialist or lab involved in your care.

Payment. We can use and share your health information to bill and get payment from health plans or others. Example: We send information to your dental insurance plan so it will pay for your services.

Health care operations. We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information to manage treatment quality and scheduling.

Other Ways We May Use or Share Information

We may also use or share your health information when allowed or required by law, including:

• To help with public health and safety issues, such as preventing disease or reporting adverse events.

• To comply with workers' compensation laws and other laws that apply to us.

• For health oversight activities, such as audits, investigations, and licensure reviews.

• In response to court or administrative orders, subpoenas, or other lawful processes.

• For law enforcement purposes or with a law enforcement official when permitted or required by law.

• To coroners, medical examiners, or funeral directors when permitted by law.

• For organ or tissue donation organizations, if applicable.

• For research purposes under specific rules, if applicable.

• To address serious threats to health or safety.

• For specialized government functions, such as military, national security, or protective services, when permitted by law.

Reproductive Health Care Privacy

When required by federal law, we will not use or disclose protected health information for a prohibited purpose related to investigating or imposing liability on a person for seeking, obtaining, providing, or facilitating lawful reproductive health care. When required, we may request a signed attestation before disclosing information potentially related to reproductive health care for certain purposes.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly 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 this notice and give you a copy of it.

• We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time by telling us in writing.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Source Note

This patient notice is based on the U.S. Department of Health and Human Services model Notice of Privacy Practices for covered health care providers and has been customized for Aram Dental Studio.