Notice of privacy practices

This notice applies to Beverly Hills Periodontal Institute, its doctors, and its staff.

If we receive your substance use disorder treatment records from a program covered by 42 CFR Part 2, additional protections apply. We will not use or disclose those records in civil, criminal, administrative or legislative proceedings against you without your written consent or a qualifying court order and subpoena.

Your rights

Contact our privacy officer using the details below to exercise any of these rights.

Get a copy of your record

You can ask to see or receive an electronic or paper copy of your dental record and other health information we hold about you. We generally respond within 30 days. You may request a summary instead. A reasonable, cost-based fee may apply.

Ask us to correct your record

If you believe information in your record is incorrect or incomplete, you can ask us to amend it. We will respond in writing within 60 days and explain any denial.

Request confidential communications

You may ask us to use a particular phone number or mailing address. We will accommodate reasonable requests.

Ask us to limit what we use or share

You may ask us to limit certain uses or disclosures for treatment, payment, or practice operations. We may decline unless the restriction concerns a service you paid for in full.

If you pay for a service in full yourself, you may ask us not to disclose information about that service to your health plan for payment or practice operations. We must honor that request unless the law requires disclosure.

Get a list of those with whom we have shared information

You may request a list of certain disclosures of your health information from the past six years, including whom we shared it with and why. The list excludes disclosures for treatment, payment, and practice operations, among other legal exceptions. One list per year is free; an additional list within twelve months may carry a reasonable, cost-based fee.

Get a copy of this notice

You can request a paper copy at any time, even if you received this notice electronically.

Choose someone to act for you

A person with legal authority to act for you, such as a guardian or someone holding a medical power of attorney, may exercise these rights. We will verify that authority first.

File a complaint if you feel your rights are violated

You may complain to our privacy officer by phone or mail using the details below. You may also complain to the U.S. Department of Health and Human Services Office for Civil Rights online. We will not retaliate against you for filing a complaint.

Your choices

Tell us your preferences about sharing information in these situations:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation

If you cannot tell us your preference, we may share information when we believe it is in your best interest or necessary to prevent a serious and imminent threat to health or safety.

We need your written authorization for:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

We seek any required authorization before using identifiable treatment photographs on this website, on social media, or in a lecture. You may decline without affecting your care.

Our uses and disclosures

We use or share health information to provide care, run the practice, and bill for services.

To treat you

We use your health information to provide your care, and we share it with other professionals who are treating you, such as your general dentist, restorative dentist, physician, or dental laboratory.

To run our practice

We use and share health information for practice operations, such as appointment reminders, periodontal maintenance recalls, and quality review.

To bill for your services

We use and share your health information to bill and obtain payment from health plans or other entities, including for pre-treatment estimates and claim submission.

How else can we use or share your health information?

The law also permits or requires certain disclosures for public health, safety, research, and other purposes. These disclosures are subject to legal conditions. See hhs.gov/hipaa/for-individuals .

The additional protections described above still apply if we hold records protected by 42 CFR Part 2, including when a use or disclosure below involves a legal proceeding against you.

Help with public health and safety issues

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect or domestic violence
• Preventing or reducing a serious threat to anyone's health or safety

Do research

Health information may be used or shared for research when the law permits it. Depending on the circumstances, this may require your authorization, an approved waiver or de-identification.

Comply with the law

We will share information about you if state or federal law requires it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We may share health information with a coroner, medical examiner, or funeral director after a person's death.

Address workers' compensation, law enforcement, and other government requests

• For workers' compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law, including the Dental Board of California
• For special government functions such as military, national security and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

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 give you 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 — let us know in writing.

California law

California's Confidentiality of Medical Information Act may provide additional protections. We follow the more protective rule when state and federal law differ. Some information, including mental health, substance use treatment, and HIV records, has further restrictions.

Changes to the terms of this notice

We can change the terms of this notice, and the changes will apply to all information we hold about you. The new notice will be available on request, in our office, and on this page.

Questions and complaints

To exercise a right described here, ask a question, or make a complaint, contact our privacy officer:

Beverly Hills Periodontal Institute
Privacy Officer
350 S Beverly Drive, Suite 160
Beverly Hills, CA 90212

Telephone (310) 553-2940