Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

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.

Our Commitment to Your Privacy

This Notice of Privacy Practices describes how The Ivory Dental may use and disclose your protected health information (“PHI”) and your rights regarding that information. We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable federal and state laws to maintain the privacy and security of your protected health information and to provide you with this notice of our legal duties and privacy practices.

Protected health information includes individually identifiable health information that we create, receive, maintain, or transmit in any form, including electronic, paper, and oral formats. This includes, but is not limited to, electronic health records, digital imaging, practice management software, appointment communications, billing records, and clinical documentation used in the operation of our dental practice.

We are required by law to notify you following a breach of unsecured protected health information that may compromise the privacy or security of your information, in accordance with federal and applicable state law.

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How We May Use and Disclose Your Health Information

Without your specific written authorization, we are permitted to use and disclose your protected health information for the purposes of treatment, payment, and health care operations.

Treatment

Treatment means providing, coordinating, or managing your dental care and related services by one or more health care providers. Examples include examinations, cleanings, fillings, crowns, oral sedation for dental procedures, consultations with specialists, and coordination of care with other health care professionals.

Payment

Payment includes activities necessary to obtain reimbursement for services provided to you. This may include billing your dental or medical insurance plan, verifying eligibility and coverage, claims processing, utilization review, and collection activities.

Health Care Operations

Health care operations include the business aspects of running our practice, such as quality assessment and improvement activities, auditing functions, staff training, licensing, compliance activities, cost management analysis, customer service, and administrative operations necessary to support the delivery of dental care.

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Appointment Reminders and Communications

We may use and disclose your protected health information to contact you for appointment reminders, treatment follow-ups, billing notifications, or information about treatment options and dental health-related services. These communications may occur via phone calls, voicemail, text message, email, mail, or other communication methods you authorize.

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Individuals Involved in Your Care

We may disclose your protected health information to a family member, relative, close personal friend, or other person identified by you who is involved in your care or payment for your care, unless you object.

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Uses and Disclosures Required or Permitted by Law

We may use or disclose your protected health information when required to do so by federal, state, or local law. We may also disclose your protected health information for the following purposes:

• Health oversight activities and audits

• Judicial and administrative proceedings (such as court orders, subpoenas, or lawful processes)

• Law enforcement purposes as required by law

• To medical examiners, coroners, or funeral directors as necessary

• Organ, eye, or tissue donation purposes where applicable

• To prevent or lessen a serious threat to health or safety

• Military and national security activities as authorized by law

• Correctional institutions or law enforcement officials if you are in custody

• Workers’ compensation and similar legally authorized programs

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Special Protections for Certain Records

In certain limited circumstances, our practice may receive medical records from other health care providers that are subject to additional federal confidentiality protections, including records related to substance use disorder treatment under 42 CFR Part 2. When applicable, such records will be handled in accordance with federal privacy regulations and will not be disclosed without appropriate authorization or as otherwise permitted by law. To the extent that we maintain your substance use disorder records subject to 42 CFR Part 2, we cannot use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your specific written consent or a court order and subpoena.

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Uses and Disclosures Requiring Authorization

Any other uses and disclosures of your protected health information not described in this Notice will be made only with your written authorization. You may revoke your authorization in writing at any time, except to the extent that we have already taken action in reliance on your authorization.

We will not sell your protected health information or use it for most marketing purposes without your written authorization, as required by law.

Please be aware that once we disclose your PHI to a permitted recipient, it is possible for the information to be redisclosed by that recipient and may no longer be protected by federal privacy rules.

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Your Rights Regarding Your Health Information

You have the following rights regarding your protected health information:

Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your protected health information, including disclosures to family members or others involved in your care. We are not required to agree to a requested restriction, but if we do agree, we will comply with it except in emergency situations.

Right to Confidential Communications

You have the right to request that we communicate with you about your health information by alternative means or at alternative locations, and we will accommodate reasonable requests.

Right to Access and Copy

You have the right to access, inspect, and obtain a copy of your protected health information, including electronic records, subject to limited exceptions permitted by law.

Right to Request Amendment

You have the right to request an amendment to your protected health information if you believe it is incorrect or incomplete.

Right to an Accounting of Disclosures

You have the right to receive an accounting of certain disclosures of your protected health information made outside of treatment, payment, and health care operations, as permitted by law.

Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice at any time upon request, even if you have agreed to receive it electronically.

Right to Opt-Out of Fundraising

If we contact you for fundraising purposes, you have the right to opt-out of receiving any further fundraising communications.

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Our Duties

We are required by law to:

• Maintain the privacy and security of your protected health information

• Provide you with this Notice of our legal duties and privacy practices

• Abide by the terms of the Notice currently in effect

• Notify you if a breach occurs that may have compromised the privacy or security of your information

We reserve the right to change the terms of this Notice and to make the revised Notice effective for all protected health information we maintain. Any revised Notice will be posted in our office and made available upon request, and may also be available on our website if applicable.

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Complaints

If you believe your privacy rights have been violated, you have the right to file a complaint with our office or with the U.S. Department of Health & Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.

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Contact Information

Our Privacy Officer is:

Michael Cheung

The Ivory Dental

Phone: 407-813-1788

Email: hello@theivory.dental

For more information about HIPAA or to file a complaint with the federal government:

U.S. Department of Health & Human Services

Office for Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

Toll-Free: 1-877-696-6775

Effective Date: April 15, 2026