Privacy Policy
HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date:
November 26, 2025
LA MESA PEDIATRIC DENTISTRY
6080 Lake Murray Blvd Ste A
La Mesa, CA 91942-2572
(619) 853-3429
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.
The terms of this Notice of Privacy Practices (“Notice”) apply to La Mesa Pediatric Dentistry, its affiliates, and its employees. We will share protected health information (“PHI”) as necessary to carry out treatment, payment, and health care operations as permitted by law.
We are required by law to maintain the privacy of our patients’ PHI; to provide you with this Notice of our legal duties and privacy practices; to notify you following a breach of unsecured PHI; and to abide by the terms of the Notice currently in effect. Any revisions to this Notice will apply to all PHI we maintain. You may obtain a copy of a revised Notice by submitting a request to the Privacy Officer listed at the end of this Notice.
Some state privacy laws, including California’s Confidentiality of Medical Information Act (CMIA), may be more restrictive than federal HIPAA requirements. When this occurs, we follow the more stringent law and will honor any additional rights provided under California law.
Uses and disclosures of your PHI not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time in writing, except to the extent we have already relied on it.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
1. Permitted Uses and Disclosures Without Written Authorization
We may use or disclose your PHI to provide, coordinate, or manage your health care. This may include sharing your information with specialists, imaging centers, hospitals, laboratories, DME providers, rehabilitation facilities, home health agencies, nurse case managers, or workers’ compensation representatives.
We may use or disclose your PHI to obtain payment for your health care services, including eligibility verification, prior authorization, billing, and claims management.
We may use or disclose your PHI to support administrative, quality improvement, and business functions, including:
- Quality assessment and improvement
- Credentialing and peer review
- Training and education
- Licensing and auditing
- Business management and general administrative activities
We may also:
- Use a sign-in sheet at reception
- Call your name in the waiting room
- Contact you with appointment reminders
- Inform you about treatment alternatives or health-related benefits
PHI of minors may be disclosed to parents or legal guardians unless prohibited by law. California law may grant minors exclusive rights to certain health records.
We will disclose PHI when required by federal, state, local, or international law.
We may disclose PHI to appropriate authorities if we believe a patient is a victim of abuse, neglect, or domestic violence or when disclosure is necessary to prevent a serious threat to health or safety.
We may disclose PHI in response to court orders, subpoenas, or discovery requests as permitted by law.
We may disclose PHI to law enforcement officials under legally required circumstances.
We may disclose PHI to coroners or medical examiners for identification, determining cause of death, or other lawful duties.
We may disclose PHI for public health purposes, including:
- Reporting communicable diseases
- Reporting vital events (births, deaths)
- Reporting adverse events to the FDA
- Tracking medication or product issues
- Facilitating recalls
- Preventing or controlling disease
We may disclose PHI to oversight agencies for audits, inspections, investigations, or licensure activities.
If you are in custody, we may disclose PHI to correctional or law enforcement officials as necessary for your health or safety or institutional operations.
We may disclose PHI to authorized officials for national security, intelligence, or military activities.
With your agreement (verbal or written), we may provide proof of immunizations to schools or similar institutions.
We may disclose PHI to comply with workers’ compensation or similar programs for work related injuries or illnesses.
If La Mesa Pediatric Dentistry is sold or merged, PHI may be transferred to the new owner, and your rights will remain unchanged.
If a breach of unsecured PHI occurs, we will notify you as required by federal or state law.
We may use or disclose your PHI for research that has been reviewed and approved by an institutional review board or privacy board.
We may disclose PHI to business associates (e.g., billing services, IT vendors, transcription vendors) who must safeguard your information and comply with HIPAA.
2. Uses and Disclosures You May Object To (Opt-Out Options)
Unless you object, we may disclose PHI to individuals involved in your care or payment for your care. If you are unable to agree or object, we may use our professional judgment.
Unless you object, we may disclose PHI to disaster relief organizations to help notify family or others of your location and condition.
We may contact you for fundraising activities. Any fundraising communication will include clear opt-out instructions, and your decision will not affect your care.
3. Uses and Disclosures Requiring Your Written Authorization
You must provide written authorization before we use or disclose PHI for any purpose not described in this Notice.
We will not disclose psychotherapy notes without your authorization except as permitted by law.
We will not use or disclose genetic information for underwriting purposes and will disclose it only with your specific authorization unless permitted by law.
We will not use or disclose genetic information for underwriting purposes and will disclose it only with your specific authorization unless permitted by law.
Authorization is required for marketing communications except for face-to-face interactions or nominal promotional gifts.
We will not sell your PHI without your authorization, except in limited lawful circumstances.
Any other non-routine use or disclosure requires your written authorization. You may revoke your authorization at any time in writing.
You may exercise the rights below by submitting a written request to our Privacy Officer. Certain requests may be denied as permitted by law. If denied, we will notify you of your options.
You may request to inspect or obtain a copy of your PHI in paper or electronic format. Fees may apply. Certain records—such as psychotherapy notes, information for legal proceedings, or information restricted by law—may not be accessible.
You may request a summary or explanation of your PHI instead of a full copy. Fees may apply.
If your PHI is stored electronically, you may request an electronic copy and may direct us to
transmit it to another individual or entity.
You have the right to be notified following a breach involving your unsecured PHI.
If you believe your PHI is inaccurate or incomplete, you may request an amendment. If denied, you may submit a statement of disagreement.
You may request a list of certain disclosures made in the prior six years, excluding those for treatment, payment, or health care operations.
You may request restrictions on PHI use or disclosure. We are not required to agree unless:
- The disclosure is to a health plan
- It concerns an item or service paid for in full out-of-pocket
You may request communications at a specific location or by alternative means (e.g., work number, mailing address). We will accommodate reasonable requests.
You may request a paper copy of this Notice at any time.
We may change this Notice at any time. When revised, we will:
- Post the new Notice in our office
- Post it on our website
- Provide a copy upon request
If you believe your privacy rights have been violated, you may file a complaint with:
La Mesa Pediatric Dentistry – Privacy Officer
(619) 853-3429
6080 Lake Murray Blvd Ste A
La Mesa, CA 91942-2572
or with:
Office for Civil Rights
Department of Health and Human Services
Jacob Javits Federal Building
26 Federal Plaza – Suite 3312
New York, NY 10278
Voice: (212) 264-3313
Fax: (212) 264-3039
TDD: (212) 264-2355
You will not face retaliation for filing a complaint.
For questions or to exercise your rights, contact:
La Mesa Pediatric Dentistry – Privacy Officer
(619) 853-3429
6080 Lake Murray Blvd Ste A
La Mesa, CA 91942-2572
This Notice is also available online.