Notice of Privacy Practices

This is a summary of our privacy practices. The full Notice of Privacy Practices is available at the office on request.

This notice describes how medical information about you may be used and disclosed, and how you can access this information. Royale Dental is a HIPAA-covered health care provider, and we are required by law to protect the privacy of your protected health information ("PHI"), give you this notice, and follow its terms.

How we use and share your dental and health information

We use and share your PHI without your written authorization for treatment, payment, and our health care operations. Examples follow.

For treatment

We use your information to provide dental care. For example, our dentist reviews your dental and medical history before a cleaning or extraction, our hygienist records the result of your exam, and we share x-rays or treatment notes with a specialist (oral surgeon, orthodontist, endodontist, periodontist) when we refer you for additional care. We may also coordinate with your physician when a medical condition affects your dental treatment.

For payment

We use your information to bill and collect payment for the care we provide. For example, we send claims and supporting documentation (x-rays, treatment plans, narratives) to your dental or medical insurance plan, verify your benefits before a procedure, and may share information with a financing partner if you apply for a payment plan.

For health care operations

We use your information to run our practice. Examples include quality assessment, training of our team, scheduling and appointment reminders, and reviews of our care to improve service.

Other permitted or required disclosures

We may also use or share your information without your written authorization to:

• Comply with public health activities, such as reporting communicable disease or adverse reactions.
• Respond to law enforcement requests, court orders, subpoenas, or other lawful processes.
• Cooperate with health oversight agencies (audits, investigations, licensure reviews).
• Report suspected abuse, neglect, or domestic violence as required by law.
• Avert a serious threat to health or safety.
• Work with our business associates — vendors that help us operate the practice (for example, billing services, software providers, x-ray imaging systems, secure document shredders) — under written contracts that require them to protect your information.
• Comply with workers' compensation laws.

Uses and disclosures that require your written authorization

We will not use or share your PHI for marketing, sell your information, or share psychotherapy notes (where applicable) without your written authorization. You may revoke an authorization at any time, in writing, except for actions we have already taken in reliance on it.

Your rights

You have the following rights regarding the PHI we maintain about you:

• Access and copies. You may request to inspect or get a paper or electronic copy of your dental record. We will respond within 30 days. A reasonable, cost-based fee may apply.
• Amend your record. You may ask us to correct information you believe is wrong or incomplete. We may decline if we did not create the information or if we believe the record is accurate, and we will explain why in writing.
• Request restrictions. You may ask us to limit how we use or share certain information. We are not required to agree, except when you pay for a service in full out of pocket and ask us not to share information about that service with your health plan.
• Confidential communications. You may ask us to contact you in a specific way (for example, only by mobile phone, only by mail) or at a specific address. We will accommodate reasonable requests.
• Accounting of disclosures. You may request a list of certain disclosures we have made of your PHI in the prior six years (excluding disclosures for treatment, payment, operations, and a few other categories). One list per twelve-month period is free.
• A paper copy of this notice. You may request a paper copy at any time, even if you have agreed to receive it electronically.
• 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 these rights and make choices about your information.
• File a complaint. You may file a complaint with us or with the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

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

Contact our Privacy Officer

To make a request, ask a question, or file a complaint, contact our Privacy Officer:

Royale Dental — Privacy Officer

Attn: [VERIFY WITH PRACTICE]

1124 W 29th St

Hialeah, FL 33012

Phone: (305) 885-7767

Email: hello@royaledental.com

File a complaint with HHS

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not take action against you for filing.

U.S. Department of Health and Human Services — Office for Civil Rights

200 Independence Avenue, SW

Washington, D.C. 20201

Toll Free: 1-800-368-1019

TDD: 1-800-537-7697

File online: hhs.gov/hipaa/filing-a-complaint.