Notice of Privacy Practices

Marble Arch Dentistry (777 Dental and Implants Inc)

Applies to care provided by the practice and its personnel at the address below.

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.

Privacy official: Dr. Ehsan Asadi, DDS

Contact through practice reception: +1 (310) 299-7333 | info@marblearchdentistry.com

436 N Roxbury Dr, Suite 203, Beverly Hills, CA 90210, United States

Your rights

Access and copies: Ask to inspect or receive a paper or electronic copy of the health records available to you. For records covered by California Health and Safety Code section 123110, we generally allow inspection within five working days and transmit requested copies within 15 days, subject to applicable exceptions. We follow applicable format, fee and free-copy rules; unpaid treatment bills do not by themselves justify withholding access.

Corrections: Ask us to amend inaccurate or incomplete information. A permitted denial is explained in writing, generally within 60 days, with your options. Under California law, after inspecting your record you may request an addendum of up to 250 words per disputed item. We attach it and include it when disclosing the relevant portion of the record.

Confidential contact: Ask us to communicate by a reasonable alternative method or at a different location. We accommodate reasonable requests.

Limits on use or disclosure: You may request restrictions for treatment, payment or healthcare operations. We do not have to accept every restriction. If we agree, emergency-treatment exceptions may apply. If you pay an item or service in full out of pocket and request that it not be disclosed to your health plan for payment or operations, we honor that restriction unless disclosure is required by law.

Disclosure accounting: Request an accounting of disclosures that must be included under applicable law, generally for the preceding six years. This excludes treatment, payment, operations and certain other disclosures. One accounting in 12 months is free; we explain any permitted charge for additional requests.

A representative and a copy: A legally authorized representative may exercise rights, subject to verification and exceptions. California law limits parental access to certain minor records. Ask for a paper notice at any time, even if you accepted an electronic copy.

How health information may be used

Care, payment and running the practice

Treatment: We may use and disclose information to provide or coordinate care, such as sharing relevant information with another clinician treating you.

Payment: We may disclose relevant treatment information to a health plan to obtain payment, subject to your restriction rights.

Healthcare operations: We may use information to manage services and review care quality. Providers handling protected health information for us must have the safeguards and agreements required for their role.

Other legally permitted or required purposes

We may use or disclose information for the following purposes only when the legal conditions are satisfied. These permissions do not override stricter state law or the protected-record restrictions below.

• Public health and safety: required reporting, disease prevention, product recalls, adverse reactions, suspected abuse or neglect, and permitted action concerning serious threats to health or safety.
• Oversight and legal duties: health oversight, required government reviews, workers’ compensation, lawful law-enforcement requests and authorized government functions. A request does not automatically authorize release.
• Proceedings and other purposes: legally sufficient court processes; health research under applicable conditions; organ/tissue donation; and permitted disclosures to coroners, medical examiners or funeral directors.

Additional protections

California law: We follow the California Confidentiality of Medical Information Act. Greater state protections control where applicable. We do not disclose medical information for immigration enforcement except as specifically authorized by the patient or permitted or required by California law. A request alone does not establish authority to disclose.

Special records: Identifiable HIV test results require written authorization unless a statutory exception applies, including specified treatment disclosures. Certain requests about outpatient psychotherapy require additional written-request safeguards and patient notification, subject to legal exceptions. These protections apply if we hold such information; they do not mean that this dental practice provides those services.

Choices, responsibilities and complaints

Your choices and written permission

Tell us your preferences about information shared with family, friends or others involved in your care or payment, and in disaster-relief situations. When you cannot express a preference, limited disclosures may be permitted based on professional judgment and your interests, subject to applicable law.

Written authorization is required for uses or disclosures not otherwise permitted by law and described in this notice, including marketing, sale of protected health information and most disclosures of psychotherapy notes where authorization is required. You may revoke an authorization in writing. Revocation does not undo actions already taken in reliance on it.

Fundraising: Under this notice, we will not use your health information for fundraising.

Substance-use-disorder records: If we hold records protected by 42 CFR Part 2, we do not use or disclose them in civil, criminal, administrative or legislative investigations or proceedings against you without your written consent or a qualifying court order and subpoena. Other disclosures of these records remain subject to applicable Part 2 requirements.

Our responsibilities

We are required to protect the privacy and security of your protected health information, follow the duties and practices in this notice, and provide the notice to you. We will notify you as required by law following a breach of unsecured protected health information. We will not use or disclose information beyond the permissions described here and applicable law without the required written authorization.

Questions or a complaint

Contact Dr. Ehsan Asadi, DDS, through practice reception at +1 (310) 299-7333 or info@marblearchdentistry.com, or write to the practice at 436 N Roxbury Dr, Suite 203, Beverly Hills, CA 90210, United States. We will not retaliate against you for raising a privacy concern or filing a complaint.

You may also complain to the U.S. Department of Health and Human Services, Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201; telephone 1-877-696-6775. Online complaint instructions are available below.

HHS Office for Civil Rights — filing a privacy complaint

Changes to this notice

We reserve the right to revise this notice and make revised practices apply to information we already hold, as permitted by law. The revised notice will show its effective date and be available on request, at the practice and on our website. Changes cannot remove rights protected by applicable law.