This notice describes how health information about your child may be used and disclosed. It also describes how you can access this information. Please review it carefully.

The Health Insurance Portability & Accountability Act (HIPAA) requires dental offices to maintain the Privacy of you and your child's health information.

As required by HIPAA, we have prepared this explanation of how we maintain this privacy and in what types of situations health information may be disclosed.

We reserve the right to change our privacy practices at any time, provided such changes are permitted by applicable laws.

Before we make a significant change, we will adjust this notice and make the new form available upon request.

Uses and disclosers of health information include:

  • Treatment: providing, coordinating, or managing healthcare and related services by one or more healthcare provider.
  • Payment: health information may be disclosed to obtain payment for the services we provide. Such activities include: confirming coverage and aiding you in receiving insurance reimbursements.
  • Healthcare operations: Such as quality assessments of our practice, improvement activities, evaluating practitioner performance, conducting training programs, certification and licensure.
  • To family and friends: health information may be disclosed to a family member or a friend to help with healthcare payments if you agree to do so.
  • Appointment reminders: we may use your information to remind you of an appointment (voicemail messages, emails and letters may be used).
  • Abuse or neglect: health information maybe disclosed to appropriate authorities if we reasonably believe that your child is possible victim of abuse, neglect or domestic violence.
  • Required by law: we may disclose health information when required to do so by law.

Family's rights regarding protected health information:

  • Access: you have the right to obtain a copy of your child's health information by a written request.
  • Disclosure accounting: you have the right to receive a list of instances in which we have disclosed health information for purposes other than treatment, payment, healthcare operations and certain other activities. If you request this accounting more than once in a l2-month period, you may be charged a reasonable, cost-based fee.
  • Restriction: you have the right to request that we place additional restrictions on our use or disclosure to your child's health information. We are not required to agree to these additional restrictions. However, if we do, we will abide by our agreement except in the case of an emergency.
  • Alterative communication: you have the right to request that we communicate with you about your child's health information by alternative means or to alternative locations. Requests must be made in writing and you must specify the alterative means or location. You must also provide a satisfactory explanation of how payments will be handled in your request.
  • Amendment: you have the right to amend your protected health information. Your request must be in writing and it must explain why the information should be amended.
  • Questions and complaints: if you are concerned that we may have violated your child's privacy rights, you may contact us at: United Dental Care, 3909 Sepulveda BIvd Culver City CA 90230, Tel. 310.390.6000. Fax 310.391.9000. You may also submit a written complaint to the or U,S, Department of Health and Human Services. We will provide you with the address upon request. We will not retaliate in any way if you choose to file a complaint.
  • Paper format: you have the right to obtain a paper copy of this notice from us upon