NOTICE OF PRIVACY PRACTICES

Prime Dental Care
Effective Date: February 5, 2026

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We are required by law to maintain the privacy of your protected health information ("PHI") and to provide you with this Notice of our legal duties and privacy practices with respect to your PHI. We are required to abide by the terms of this Notice currently in effect.

How We May Use and Disclose Your Protected Health Information

We may use and disclose your PHI for the following purposes:

For Treatment

We may use and disclose your PHI to provide, coordinate, or manage your dental care and related services. For example, we may disclose your PHI to a specialist to whom we refer you for consultation, or to a laboratory that performs tests. We may also disclose PHI to healthcare providers who will be involved in your care after you leave our office, such as oral surgeons or periodontists.

For Payment

We may use and disclose your PHI to bill and collect payment for the treatment and services we provide to you. For example, we may contact your dental insurance company to verify your coverage or to obtain pre-authorization for treatment. We may also provide your insurance company with information about your treatment to determine payment for services.

For Healthcare Operations

We may use and disclose your PHI for our healthcare operations. These uses and disclosures are necessary to run our practice and ensure that all of our patients receive quality care. For example, we may use PHI to review the quality and competence of our staff, or for training and education purposes.

Other Uses and Disclosures

We may also use and disclose your PHI in the following situations without your authorization:

As required by law: We may disclose PHI when required to do so by federal, state, or local law.
Public health activities: We may disclose PHI for public health activities such as reporting disease outbreaks, injuries, or birth and death information.
Abuse or neglect: We may disclose PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence.
Health oversight activities: We may disclose PHI to health oversight agencies for activities such as audits, investigations, inspections, and licensure.
Judicial and administrative proceedings: We may disclose PHI in response to a court order, subpoena, or other lawful process.
Law enforcement: We may disclose PHI for law enforcement purposes, such as identifying or locating a suspect, fugitive, material witness, or missing person.
Coroners, medical examiners, and funeral directors: We may disclose PHI to coroners, medical examiners, and funeral directors for identification purposes or to determine cause of death.
Workers' compensation: We may disclose PHI for workers' compensation or similar programs that provide benefits for work-related injuries or illness.
Appointment reminders: We may use and disclose PHI to contact you to remind you of appointments or to inform you about treatment alternatives or other health-related benefits and services.

Uses and Disclosures That Require Your Authorization

Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. You may revoke such authorization at any time in writing, except to the extent that we have already taken action in reliance on your authorization.

Your Rights Regarding Your Protected Health Information

You have the following rights regarding your PHI:

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your PHI that may be used to make decisions about your care. To inspect and copy your PHI, you must submit your request in writing to our Privacy Officer. If you request a copy of the information, we may charge a reasonable fee for copying, mailing, or other supplies associated with your request. We may deny your request in certain limited circumstances. If you are denied access, you may request that the denial be reviewed.

Right to Amend

If you believe that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. You must provide a reason that supports your request. We may deny your request if it is not in writing or does not include a reason to support the request. We may also deny your request if the PHI was not created by us, is not part of the PHI kept by or for the office, is not part of the information you would be permitted to inspect and copy, or is accurate and complete.

Right to an Accounting of Disclosures

You have the right to request an accounting of certain disclosures of your PHI made by us. This right applies to disclosures other than those made for treatment, payment, and healthcare operations, and certain other disclosures. To request an accounting, you must submit your request in writing to our Privacy Officer. Your request must state a time period, which may not be longer than six years. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12-month period will be provided free of charge. For additional lists, we may charge you for the costs of providing the list.

Right to Request Restrictions

You have the right to request a restriction on the PHI we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your PHI to a health plan for payment or healthcare operation purposes and such information pertains solely to a healthcare item or service for which you have paid us in full. To request restrictions, you must make your request in writing to our Privacy Officer. In your request, you must tell us what information you want to limit, whether you want to limit our use, disclosure, or both, and to whom you want the limits to apply.

Right to Request Confidential Communications

You have the right to request that we communicate with you about your health information in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy. You may obtain a paper copy from our Privacy Officer or by requesting one at your next office visit.

Right to Notification of a Breach

You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured PHI.

Changes to This Notice

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for PHI we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our office and on our website. The Notice will contain the effective date on the first page.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact our Privacy Officer at the address and phone number below. All complaints must be submitted in writing. You will not be penalized or retaliated against for filing a complaint.

Contact Information

If you have any questions about this Notice or need to exercise any of your rights, please contact:

Privacy Officer: Nari Cho
Prime Dental Care
178 E Golf Rd
Schaumburg, IL 60173
Phone: 1-847-607-1515
Email: frontdesk@primedental.care

To file a complaint with the Department of Health and Human Services, contact:

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/

PRIME

Dental Care