Notice of Privacy Practices

Effective Date: February 16, 2026

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.

Questions or concerns about this Notice

Privacy Officer: Dr. Sneha Xavier
Phone: 832-422-8020
Office Address: Dept. Of Smiles, 9250 Broadway St, #170, Pearland, TX 77584

External HIPAA Privacy & Security Resource: David Wornica, CHPSE, 469-342-8300 ext. 628

Our Commitment to Your Privacy

We are required by federal law to maintain the privacy of your Protected Health Information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to comply with the terms of this Notice currently in effect.

We reserve the right to change the terms of this Notice and to make the new Notice effective for all PHI we maintain. If we revise this Notice, the updated version will be available upon request and, when applicable, on our website.

A. Uses and Disclosures of Protected Health Information

We may use and disclose your PHI for treatment, payment, and healthcare operations. In general, we are permitted to use and disclose PHI for these purposes without a separate written authorization.

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your dental care and related services, including sharing information with specialists, laboratories, and other providers involved in your care.

We may utilize HIPAA-compliant artificial intelligence (AI) tools to support care, including review of dental images (such as X-rays) and other clinical data. AI is used to assist—not replace—clinical judgment. All AI-assisted findings are reviewed and approved by a licensed dentist before being used in your care.

Payment

We may use and disclose your PHI as needed to obtain payment for services, including eligibility and coverage determinations, preauthorization, claims processing, utilization review, and activities required by your health plan.

Healthcare Operations

We may use and disclose your PHI to support business activities, including quality assessment, staff training, compliance activities, auditing, and administrative functions.

We may share PHI with third-party Business Associates (for example, billing, IT, transcription) that perform services on our behalf. Business Associates are required by contract to safeguard your information.

Uses and Disclosures Requiring Written Authorization

Other uses and disclosures of your PHI will be made only with your written authorization unless otherwise permitted or required by law. You may revoke an authorization at any time in writing, except to the extent we have already acted in reliance on it.

Other Permitted and Required Disclosures

We may use or disclose your PHI without your authorization in certain situations permitted or required by law, including public health activities, health oversight, abuse or neglect reporting, legal proceedings, law enforcement requests, and workers’ compensation.

Special Protections

Substance Use Disorder Records: If we maintain records subject to 42 CFR Part 2, those records receive additional confidentiality protections and are disclosed only as permitted by law.

Reproductive Health Information: We will not use or disclose reproductive health information for the purpose of investigating or imposing liability on an individual for seeking, obtaining, providing, or facilitating lawful reproductive health care.

B. Your Rights

You have rights regarding your PHI, including the right to inspect and obtain a copy of your records, request amendments, request restrictions in certain circumstances, request confidential communications, and receive an accounting of certain disclosures, subject to applicable legal requirements.

To exercise these rights, please contact our Privacy Officer. Requests should be made in writing where required by law or our policies.

C. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us and/or with the entities listed below. We will not retaliate against you for filing a complaint.

Texas Office of the Attorney General (Consumer Protection Division)

Office of the Attorney General of Texas
Consumer Protection Division
PO Box 12548
Austin, TX 78711-2548
Phone: (800) 621-0508

U.S. Department of Health and Human Services (Office for Civil Rights)

You may file online or by mail/email:

Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, D.C. 20201
Email: OCRComplaint@hhs.gov

Southwest Region (Texas):

Office for Civil Rights (OCR) – Southwest Region
U.S. Department of Health and Human Services
1301 Young Street, Suite 106
Dallas, TX 75202
Customer Response Center: (800) 368-1019
Email: OCRMail@hhs.gov