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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.

Shafi Dental Care is committed to protecting the privacy of your health information. This Notice describes how we may use and disclose your medical information, your rights regarding that information, and our legal duties with respect to protecting it.

Our Responsibilities

We are required by law to:

  • maintain the privacy and security of your protected health information
  • provide you with this Notice of our legal duties and privacy practices
  • follow the terms of the Notice currently in effect
  • let you know promptly if a breach occurs that may have compromised the privacy or security of your information

How We May Use and Disclose Your Health Information

We may use and disclose your health information for purposes of treatment, payment, and healthcare operations. These are common and permitted uses under HIPAA. HHS’s model notice for healthcare providers uses this same structure.

For Treatment

We may use and share your health information to provide, coordinate, or manage your dental care.

Example: We may share information with another dentist, specialist, physician, dental laboratory, or pharmacy involved in your care.

For Payment

We may use and share your health information to bill and receive payment for the services we provide.

Example: We may send information to your dental plan or other payer to process claims, determine benefits, or obtain payment.

For Healthcare Operations

We may use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We may use your information to evaluate staff performance, conduct quality assessments, review treatment outcomes, or manage our business operations.

How Else We May Use or Share Your Health Information

We may also use or disclose your health information in certain situations permitted or required by law, including:

Appointment Reminders

We may contact you with appointment reminders.

Treatment Alternatives and Health-Related Benefits or Services

We may tell you about treatment options or health-related services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care

We may share relevant information with a family member, friend, or other person involved in your care or payment for your care, unless you object where permitted by law.

As Required by Law

We will share information about you if state or federal law requires it.

Public Health and Safety

We may disclose health information for public health activities, to prevent or control disease, to report adverse events, or to help prevent a serious threat to health or safety.

Health Oversight Activities

We may disclose information to health oversight agencies for activities authorized by law, such as audits, investigations, inspections, and licensure matters.

Judicial and Administrative Proceedings

We may disclose information in response to a court order, subpoena, or other lawful process, when permitted by law.

Law Enforcement

We may disclose information for certain law enforcement purposes, as permitted or required by law.

Workers’ Compensation

We may disclose health information for workers’ compensation claims or similar programs.

Coroners, Medical Examiners, and Funeral Directors

We may disclose information as authorized by law to these parties when necessary.

Organ and Tissue Donation

If applicable, we may share information with organizations involved in organ and tissue donation.

Research

We may use or share information for certain research purposes when allowed by law and appropriate privacy protections are in place.

Uses and Disclosures That Generally Require Your Written Authorization

For uses and disclosures not described in this Notice, we will obtain your written authorization when required by law.

You may revoke a written authorization at any time in writing, except to the extent we have already acted in reliance on it.

Your Rights Regarding Your Health Information

Under HIPAA, patients have specific rights concerning their protected health information. HHS’s provider notice model organizes these rights under “Your Rights.”

You Have the Right to:

  • get a copy of your paper or electronic medical record, subject to applicable law
  • ask us to correct your medical record if you think it is incorrect or incomplete
  • request confidential communications, such as asking us to contact you in a specific way
  • ask us to limit certain uses or disclosures, although we are not always required to agree
  • get a list of certain disclosures we have made of your information
  • get a paper copy of this Notice at any time, even if you have agreed to receive it electronically
  • choose someone to act for you, if that person has legal authority to do so
  • file a complaint if you believe your privacy rights have been violated

Your Choices

For certain health information, you may tell us your choices about what we share. For example, you may ask us not to share information with certain family members or others involved in your care, where permitted by law.

Our Duties

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices. We will not use or disclose your information other than as described here unless you tell us in writing that we can. If you tell us we can, you may change your mind at any time by notifying us in writing. HHS’s model notice and HIPAA guidance reflect these obligations.

Changes to This Notice

We may change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

To file a complaint with us, contact:

Shafi Dental Care
538C Cynwood Dr
Easton, MD 21601
United States
Phone: (410) 770-9590
Email: [email protected]

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

Effective Date

Effective Date: 18/03/2026