Privacy Policy

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.

Practice: San Marcos Kids Dentistry

Effective: February 16, 2026

Regulation: 45 CFR §164.520 | HIPAA Privacy Rule

Published by: HHS OCR Model Notice — Revised February 13, 2026

This notice is required by the HIPAA Privacy Rule. Signing an acknowledgment of receipt does not limit your rights. Questions? Contact us or visit hhs.gov/hipaa.

Section 1 – Your Rights

Get an Electronic or Paper Copy of Your Medical Record

You can ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. Ask us how to do this.

We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask Us to Correct Your Medical Record

You can ask us to correct health information about you that you believe is incorrect or incomplete. Ask us how to do this.

We may say “no” to your request, but we will explain why in writing within 60 days.

Request Confidential Communications

You can ask us to contact you in a specific way (for example, at home, work, or on your cell phone) or to send mail to a different address.

We will say “yes” to all reasonable requests.

Ask Us to Limit What We Use or Share

You can ask us not to use or share certain health information for treatment, payment, or healthcare operations. We are not required to agree to your request, and we may say “no” if it could affect your care. If we agree, we may still share information if you require emergency treatment.

If you pay for a healthcare service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or healthcare operations. We will honor your request unless a law requires us to share the information.

Get a List of Those With Whom We’ve Shared Information

You can ask for a list (an accounting) of the times we’ve shared your health information during the six years before the date of your request, including who received the information and why it was shared.

The list will not include disclosures made for treatment, payment, healthcare operations, or certain other disclosures permitted by law, including disclosures you asked us to make. We provide one accounting each year at no cost. Additional requests within a 12-month period may be subject to a reasonable, cost-based fee.

Get a Copy of This Privacy Notice

You may request a paper copy of this notice at any time, even if you previously agreed to receive it electronically. We will provide you with a paper copy promptly.

Choose Someone to Act for You

If someone has legal authority to act on your behalf, such as a parent, legal guardian, or an individual with medical power of attorney, that person may exercise your rights and make choices regarding your health information.

We will verify that the individual has the appropriate authority before honoring any request.

Note for parents of pediatric dental patients: When a parent or legal guardian accompanies a minor patient, we will provide this notice to the parent or guardian and make a good-faith effort to obtain written acknowledgment of receipt, as required by 45 CFR §164.520(c)(2)(ii).

Section 2 – Your Choices

For certain health information, you have the right to tell us your preferences about what we share. If you have a clear preference for how your information is shared in the situations described below, let us know, and we will follow your instructions whenever possible.

You have both the right and the choice to tell us to:

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

If you are unable to tell us your preference, for example, if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when necessary to lessen a serious and imminent threat to the health or safety of you or others.

We will never share your information without your written permission for:

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

Fundraising

We may contact you regarding fundraising efforts, but you may tell us not to contact you again. If we maintain substance use disorder patient records subject to 42 CFR Part 2, we will provide you with clear notice and a meaningful choice before using that information for fundraising communications.

Section 3 – Our Uses & Disclosures

How We Typically Use or Share Your Health Information

Treat You

We can use your health information and share it with other healthcare professionals who are involved in your care.

Example: Your dentist may coordinate with your child’s pediatrician, general dentist, oral surgeon, dental specialist, or other healthcare providers to help plan and provide the best possible care.

Run Our Practice

We can use and share your health information to operate our practice, improve the quality of care we provide, and contact you when necessary.

Example: We use health information about you to manage your care, improve our services, conduct quality reviews, and train our staff.

Bill for Your Services

We can use and share your health information to bill and receive payment from health plans or other entities.

Example: We provide information about you to your dental or health insurance plan so it can process payment for your dental services and treatment.

How Else We May Use or Share Your Health Information

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We must meet all applicable legal requirements before we can share your information for these purposes.

Important – Substance Use Disorder Records (42 CFR Part 2): In all of the situations described below, if we maintain substance use disorder patient records that are subject to 42 CFR Part 2, we cannot use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings without either (1) your written consent or (2) a court order and subpoena.

Help with Public Health and Safety Issues

We may share health information for certain situations, including:

• Preventing disease
• Assisting 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

Conduct Research

We may use or share your health information for research purposes, subject to applicable legal requirements and privacy protections.

Comply with the Law

We will share information about you if state or federal laws require it, including with the U.S. Department of Health and Human Services if it requests information to verify our compliance with federal privacy laws.

Respond to Organ and Tissue Donation Requests

We may share health information 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 when an individual has passed away.

Address Workers’ Compensation, Law Enforcement, and Other Government Requests

We may use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes
• With health oversight agencies
• For special government functions such as military, national security, and presidential protective services

Respond to Lawsuits and Legal Actions

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

Redisclosure Notice

Please be aware that protected health information disclosed by our practice may be redisclosed by the recipient and may no longer be protected under the HIPAA Privacy Rule unless stronger federal confidentiality protections, such as those provided under 42 CFR Part 2 for substance use disorder records, apply.

Section 4 – Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.

We will notify you 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 provide you with a copy of it.

We will not use or share your information other than as described in this notice unless you authorize us to do so in writing. If you give us permission, you may change your mind at any time by notifying us in writing.

For more information, please visit:

www.hhs.gov/hipaa/for-individuals/notice-privacy-practices

Section 5 – Changes to the Terms of This Notice

We may change the terms of this notice, and the changes will apply to all health information we maintain. The updated notice will be available upon request, in our office, and on our website. Any material changes will be posted with an updated effective date, consistent with 45 CFR §164.520(b)(1)(v)(C).

Section 6 – File a Complaint If You Feel Your Rights Have Been Violated

You may file a complaint if you believe your privacy rights have been violated by contacting us using the information in the Contact section below.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

By Mail
200 Independence Avenue, S.W.
Washington, D.C. 20201

By Phone
1-877-696-6775

Online
www.hhs.gov/hipaa/filing-a-complaint

We will not retaliate against you for filing a complaint.

Section 7 – Contact & Privacy Officer

Privacy Officer

Dr. Nikki Shafiei

Phone

(760) 744-8600

Email

drehsani@eliteorthodonticsgroup.com

Mailing Address

833 W San Marcos Blvd, Suite 102
San Marcos, CA 92078, US

Office Hours

Monday: 8:30 AM – 5:00 PM
Tuesday: 8:30 AM – 5:00 PM
Wednesday: 8:30 AM – 5:00 PM
Thursday: 8:30 AM – 5:00 PM
Friday: 8:30 AM – 5:00 PM
Saturday: Closed
Sunday: Closed

Fax

N/A

U.S. Department of Health & Human Services – Office for Civil Rights

200 Independence Avenue, S.W.
Washington, D.C. 20201

Phone: 1-877-696-6775

Website: www.hhs.gov/hipaa/filing-a-complaint

If you participate in a patient portal for accessing your records online, you may also contact us through the portal’s secure messaging system in addition to the methods listed above.

This notice was prepared in accordance with the HIPAA Privacy Rule (45 CFR §164.520) and 42 CFR Part 2. Content is based on the HHS Office for Civil Rights Model Notice for Health Care Providers, last reviewed February 13, 2026.

Effective Date: February 16, 2026