Effective Date: November 2025
This Notice describes how medical and dental information about you may be used and disclosed and how you can access this information. Please review it carefully.
Our Legal Duty
Mint Dental Loft (“we,” “our,” or “us”) is required by law to maintain the privacy of your protected health information (“PHI”), provide you with this Notice explaining our legal duties and privacy practices, and notify you if a breach of unsecured PHI occurs. We must follow the terms of this Notice currently in effect.
How We May Use and Disclose Health Information
We may use and disclose your PHI for the following purposes without your written authorization:
1. Treatment
We may use and share your PHI to provide, coordinate, or manage your dental care, including consultation with specialists, dental laboratories, pharmacies, or other providers involved in your treatment.
2. Payment
We may use and disclose PHI to obtain payment for services. This may include submitting insurance claims, verifying coverage, billing, or coordinating benefits.
3. Health Care Operations
We may use or disclose PHI for administrative functions such as quality improvement, accreditation, audits, staff training, internal reviews, and compliance purposes.
4. Appointment Reminders and Communications
We may contact you by phone, voicemail, text message, email, or mail regarding appointments, billing matters, or follow-up instructions.
5. Individuals Involved in Your Care
We may share PHI with family members, caregivers, or others involved in your care unless you request that we do not.
6. Public Health and Safety
We may disclose PHI to public health authorities or other authorized agencies for reporting disease, preventing or controlling illness, or responding to adverse events.
7. Health Oversight Activities
Oversight agencies may receive PHI for audits, inspections, investigations, and licensure purposes as required by law.
8. Law Enforcement and Legal Requirements
We may disclose PHI when required by law, such as for court orders, subpoenas, identifying individuals, or cooperating with law enforcement investigations.
9. Coroners, Medical Examiners, and Funeral Directors
We may release PHI to these professionals as necessary for them to perform their authorized duties.
10. Research
We may use or disclose limited PHI for approved research projects that comply with strict privacy protections and legal requirements.
11. Workers’ Compensation
PHI may be disclosed as required to comply with workers’ compensation laws or similar programs.
12. Required by Law
We will disclose PHI when required by federal, state, or local laws.
13. Other Uses and Disclosures with Your Authorization
Any other use or disclosure of your PHI will require your written authorization. You may revoke an authorization at any time in writing, unless we have already relied on it.
Your Rights Regarding Your Health Information
1. Right to Access
You may request to inspect or obtain a copy of your health and billing records. Reasonable fees may apply for copying, mailing, or preparing records.
2. Right to Request Amendment
You may request corrections to your PHI if you believe it is incomplete or inaccurate. Requests may be denied under specific circumstances, but you will be informed of the reason.
3. Right to an Accounting of Disclosures
You may request a list of certain disclosures of your PHI made in the past six years, excluding those related to treatment, payment, or healthcare operations.
4. Right to Request Restrictions
You may request limits on how we use or disclose your PHI. While we are not required to agree to all requests, we will comply with approved restrictions.
5. Right to Request Confidential Communications
You may request that we communicate with you through specific methods or at alternative locations. We will accommodate reasonable requests.
6. Right to a Paper Copy of This Notice
You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
7. Right to Notification of a Breach
You will be notified if your unsecured PHI is compromised in a manner not permitted by law.
Our Responsibilities
- We are required by law to maintain the privacy and security of your PHI.
- We will notify you promptly if a breach occurs that may compromise your information.
- We will use and disclose your PHI only as described in this Notice unless you authorize otherwise.
- We will never sell your PHI or use it for marketing purposes without your written authorization.
Changes to This Notice
We may update this Notice at any time. The revised version will apply to all PHI we maintain and will be available on our website and in our office.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
Mint Dental Loft – Privacy Officer
2095 Lincoln Ave. #201
Altadena, CA 91001
Phone: 626-610-4413
Email: mintdentalloft@gmail.com
U.S. Department of Health and Human Services
Office for Civil Rights (OCR)
200 Independence Avenue SW
Washington, DC 20201
Phone: 1-877-696-6775
Website: https://www.hhs.gov/ocr/privacy/hipaa/complaints/
Acknowledgment of Receipt
You may be asked to sign a separate form acknowledging that you received this Notice. Your signature does not indicate agreement with its terms—only that you received it.
