Notice of Privacy Practices

Effective Date: March 1, 2026

1. Our Duty to Protect Your Health Information

Island Dental Associates is required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. We are required to notify you if a breach of your unsecured PHI occurs.

2. How We May Use and Disclose Your Health Information

We may use and disclose your health information for the following purposes without your written authorization:

Treatment

We may use your health information to provide, coordinate, or manage your dental care. For example, we may share information with specialists to whom we refer you, dental laboratories that fabricate your restorations, or other healthcare providers involved in your care.

Payment

We may use and disclose your health information to obtain payment for services we provide. This includes billing your insurance company, verifying coverage, and submitting claims. We may also share information with collection agencies if necessary.

Healthcare Operations

We may use and disclose your health information for our day-to-day healthcare operations. This includes quality assessment activities, staff training, business planning, credentialing, and other activities necessary to run our practice and serve you better.

As Required by Law

We will disclose your health information when required to do so by federal, state, or local law.

Public Health Activities

We may disclose your health information for public health activities, including reporting diseases, injuries, and vital events, as well as conducting public health surveillance, investigations, and interventions as required by law.

Health Oversight

We may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure actions.

3. Uses and Disclosures That Require Your Authorization

We will obtain your written authorization before using or disclosing your health information for the following purposes:

• Marketing purposes, except for face-to-face communications and promotional gifts of nominal value
• Sale of your protected health information
• Psychotherapy notes, if applicable
• Any other uses and disclosures not described in this notice

You may revoke your authorization in writing at any time. Revocation will not affect any actions we took in reliance on your authorization before we received your revocation.

4. Your Rights Regarding Your Health Information

You have the following rights with respect to your protected health information:

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your health information maintained by our practice, including dental and billing records. We may charge a reasonable fee for copies. In certain limited circumstances, we may deny your request, and you may request a review of the denial.

Right to Amend

You have the right to request that we amend your health information if you believe it is incorrect or incomplete. We may deny your request in certain circumstances, and we will provide you with a written explanation if we do.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your health information. This accounting will not include disclosures made for treatment, payment, or healthcare operations, or disclosures you authorized in writing.

Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your health information for treatment, payment, or healthcare operations. We are not required to agree to your request, except when the disclosure is to a health plan for payment or healthcare operations purposes and the information pertains to a service for which you have paid in full out of pocket.

Right to Request Confidential Communications

You have the right to request that we communicate with you about your health information in a specific way or at a specific location. For example, you may request that we contact you only at your work phone number or by mail to a specific address.

Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this notice at any time, even if you previously agreed to receive the notice electronically. You may request a copy from our front desk at either office location.

5. Our Responsibilities

Island Dental Associates is required to:

• Maintain the privacy of your protected health information
• Provide you with this notice describing our legal duties and privacy practices
• Follow the terms of the notice currently in effect
• Notify you if a breach of your unsecured protected health information occurs

We will not use or disclose your health information without your authorization, except as described in this notice. We reserve the right to change the terms of this notice and to make new provisions effective for all PHI we maintain.

6. Changes to This Notice

We reserve the right to change this notice at any time. Any revised notice will be effective for all health information we already have about you as well as any information we receive in the future. The current notice will be posted in our offices and on our website, with the effective date clearly displayed.

7. Complaints

If you believe your privacy rights have been violated, you may file a complaint with our practice or with the U.S. Department of Health and Human Services (HHS).

To file a complaint with our practice, contact our Privacy Officer using the information below. To file a complaint with HHS, you may write to:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints

You will not be penalized or retaliated against for filing a complaint.

8. Contact Information

If you have questions about this notice or wish to exercise any of your rights, please contact our Privacy Officer:

Privacy Officer
Island Dental Associates
Phone: (516) 565-6565
Franklin Square Office: 639 Hempstead Turnpike, Franklin Square, NY 11010
Levittown Office: 3072 Hempstead Turnpike, Levittown, NY 11756
Email: privacy@islanddentalassociates.com