HIPAA Notice of Privacy Practices

Our Commitment to Your Privacy

Olive Dental Studio is committed to protecting the privacy of your health information. This Notice of Privacy Practices describes how medical and dental information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Protected Health Information (PHI)

We are required by law to maintain the privacy of your Protected Health Information (PHI), provide you with this Notice of our legal duties and privacy practices, and follow the terms of the Notice currently in effect.

How We May Use and Disclose Your PHI

• Treatment: We may use your PHI to provide, coordinate, or manage your dental care and related services.
• Payment: We may use and disclose your PHI to bill and collect payment for dental services, including communications with your insurance company.
• Healthcare Operations: We may use your PHI for our internal operations, including quality assessment, staff training, and practice management.
• As Required by Law: We will disclose your PHI when required to do so by federal, state, or local law.

Your Rights Regarding Your PHI

• Right to Access: You have the right to inspect and obtain a copy of your PHI maintained by our office.
• Right to Amend: You may request amendments to your PHI if you believe it is incorrect or incomplete.
• Right to Restrict: You may request restrictions on certain uses and disclosures of your PHI.
• Right to Confidential Communications: You may request that we communicate with you in a specific way or at a specific location.
• Right to an Accounting: You may request a list of disclosures we have made of your PHI.
• Right to a Copy of This Notice: You may request a paper copy of this Notice at any time.

Breach Notification

We are required to notify you if a breach of your unsecured PHI occurs. We will provide notification as required by law.

Filing a Complaint

If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

Contact Information

For questions about this Notice or to exercise your rights, contact our Privacy Officer at:

Olive Dental Studio
Burbank, California
Phone: (818) 643-6748