Notice of Privacy Practices

Effective Date: April 23, 2026

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

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we maintain about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee where permitted by law.

Ask us to correct your medical record

You can ask us to correct health information about you that you believe is incorrect or incomplete. We may deny your request in some circumstances, but if we do, we will explain why in writing within the time required by law.

Request confidential communications

You can ask us to contact you in a specific way, such as at a certain phone number, by email, or at a different mailing address. We will accommodate 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 health care operations. We are not always required to agree to your request. If you pay for a service or health care item out of pocket in full, you may ask us not to share that information with your health insurer for payment or operations purposes, and we will honor that request unless the law requires otherwise.

Get a list of disclosures

You can ask for a list of certain times we have shared your health information during the six years prior to the date of your request, who we shared it with, and why. This list will not include disclosures for treatment, payment, health care operations, and certain other disclosures allowed by law. We will provide one accounting each year at no charge; additional requests within 12 months may be subject to a reasonable, cost-based fee.

Get a copy of this notice

You may ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide one promptly.

Choose someone to act for you

If you have given someone medical power of attorney, or if someone is your legal guardian, that person may exercise your rights and make choices about your health information, consistent with applicable law.

File a complaint

If you believe your privacy rights have been violated, you may contact us using the information below. You may 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 may tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, please let us know.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Contact you for appointment reminders, treatment alternatives, or health-related benefits and services

If you are unable to tell us your preference, for example if you are unconscious or in an emergency, we may share your information if we believe it is in your best interest or necessary to lessen a serious and imminent threat to health or safety.

In these cases, we do not share your information unless you give us written permission:

• Marketing purposes, except as permitted by law
• Sale of your information
• Any use or disclosure that requires written authorization under HIPAA or other applicable law

How We Typically Use or Share Your Health Information

Treat you

We can use your health information and share it with other professionals who are treating you. For example, a dentist treating you for a procedure may need to share relevant information with a specialist, lab, or another health care provider involved in your care.

Run our practice

We can use and share your health information to run our practice, improve your care, maintain our records, and contact you when necessary.

Bill for your services

We can use and share your health information to bill and obtain payment from health plans or other entities.

How Else We May Use or Share Your Health Information

We are allowed or required to share your information in other ways, usually for reasons related to public interest or public benefit and as permitted or required by law. For example, we may share your information to:

• Comply with federal, state, or local law
• Respond to public health and safety issues
• Report suspected abuse, neglect, or domestic violence where required or permitted
• Help with health oversight activities
• Respond to court orders, subpoenas, or legal proceedings
• Address law enforcement requests in certain circumstances
• Respond to workers’ compensation claims
• Participate in health research where permitted by law
• Work with medical examiners, coroners, or funeral directors when permitted by law

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 provide you with 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. If you tell us we can, you may change your mind at any time by notifying us in writing.

Changes to This Notice

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

Contact Information

If you have questions about this notice, want to exercise your rights, or wish to file a complaint with our practice, please contact:

ParkSide Dental
Brooklyn, NY
Phone: (718) 462-7436
Email: [email protected]

File a Complaint with HHS

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Information about how to file is available through HHS.