Notice of HIPAA 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.

Your Rights

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

1. Right to Inspect and Copy

You have the right to inspect and obtain a copy of your paper or electronic medical record and other health information we maintain about you.

Requests must be submitted to our office.

We will provide a copy or summary within 30 days of your request.

A reasonable, cost-based fee may apply.

2. Right to Request Amendment

You have the right to request correction of health information you believe is incorrect or incomplete.

Requests must be submitted in writing.

We may deny your request, but we will provide a written explanation within 60 days.

3. Right to Request Confidential Communications

You have the right to request that we contact you in a specific manner or at an alternative address.

We will accommodate all reasonable requests.

4. Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your health information.

We are not required to agree to all requests.

If we agree, we will comply except in emergency situations.

5. Right to an Accounting of Disclosures

You have the right to request a list of disclosures we have made of your health information during the six (6) years prior to your request.

One accounting per 12-month period is free. Additional requests may incur a fee.

6. Right to a Paper Copy of This Notice

You may request a paper copy of this Notice at any time.

7. Right to Choose a Personal Representative

If someone has legal authority to act on your behalf, that person may exercise your rights.

8. Right to File a Complaint

If you believe your rights have been violated, you may file a complaint:

With Our Office:
Sarasota Pediatric Dentistry
6003 Honore Ave Ste 102
Sarasota, FL 34238
Phone: (941) 529-0345

With the U.S. Department of Health and Human Services:
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
File a complaint

We will not retaliate against you for filing a complaint.

Your Choices

You have the right to tell us your preferences about what we share in certain situations.

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

If you are unable to communicate, we may share information if it is in your best interest.

Marketing

We will not use or disclose your information for marketing without your written authorization.

Our Uses and Disclosures

Treatment

We may use your information to provide and manage your care.

Health Care Operations

We may use your information to improve our services and contact you when necessary.

Payment

We may use your information to bill and receive payment.

Other Permitted Uses

  • Public health and safety activities
  • Research (when allowed by law)
  • Compliance with legal requirements
  • Organ and tissue donation
  • Medical examiner or funeral director duties
  • Workers’ compensation and law enforcement
  • Legal proceedings

Special Protections for Substance Use Disorder Records

We will not disclose such records without your written consent or a valid court order, as required by law.

Our Responsibilities

  • Maintain the privacy and security of your health information
  • Notify you of any breach
  • Follow this notice
  • Provide you with a copy upon request

We will not use or share your information other than as described unless you provide written authorization.

For more information, visit:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to This Notice

We may change the terms of this notice at any time. Updates will apply to all information we maintain and will be available in our office and on our website.

Effective Date: February 16, 2026

Sarasota Pediatric Dentistry
6003 Honore Ave Ste 102
Sarasota, FL 34238
Phone: (941) 529-0345