HIPAA Notice of Privacy Practices

Important Information About Your Privacy Rights

The following Notice of Privacy Practices describes how medical and dental information about you may be used and disclosed, and how you can access this information. This notice is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Please read it carefully.

At Elite Prosthetic Dentistry under the care of Dr. Gerald Marlin, DMD, MSD, we are committed to protecting the privacy of your protected health information (PHI). We understand that your health information is sensitive and personal, and we take our responsibility to safeguard your information very seriously.

As a patient of our practice, you have important rights regarding your protected health information. This notice explains those rights and our obligations to you.

Notice of Privacy Practices

Overview of Your Privacy Rights

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. You may request a revised version by accessing our website, or calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.

1. Uses and Disclosures of Protected Health Information

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of your physician's practice.

Following are examples of the types of uses and disclosures of your protected health information that your physician's office is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

Treatment

We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with another provider. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.

Payment

Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided by us. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Health Care Operations

We may use or disclose, as needed, your protected health information in order to support the business activities of your physician's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, fundraising activities, and conducting or arranging for other business activities.

We will share your protected health information with third party "business associates" that perform various activities (for example, billing or transcription services) for our practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. You may contact our Privacy Officer to request that these materials not be sent to you.

We may use or disclose your demographic information and the dates that you received treatment from your physician, as necessary, in order to contact you for fundraising activities supported by our office. If you do not want to receive these materials, please contact our Privacy Officer and request that these fundraising materials not be sent to you.

Special Protections for Substance Use Disorder Records (42 CFR Part 2)

Some of the protected health information we maintain may include records related to the diagnosis, treatment, or referral for treatment of a Substance Use Disorder ("SUD"). These records may be protected by federal law under 42 CFR Part 2, which provides additional privacy protections beyond HIPAA.

When applicable, Substance Use Disorder records are subject to stricter confidentiality requirements and generally may not be used or disclosed without your written consent, except as permitted or required by law.

Uses and disclosures of SUD records may be made for treatment, payment, and health care operations only as permitted by 42 CFR Part 2 and applicable HIPAA regulations. Any use or disclosure will be limited to the minimum necessary and consistent with federal law.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Agree or Object

We may use or disclose your protected health information in the following situations without your authorization or providing you the opportunity to agree or object. These situations include:

Required By Law

We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if required by law, of any such uses or disclosures.

Public Health

We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. For example, a disclosure may be made for the purpose of preventing or controlling disease, injury or disability.

Communicable Diseases

We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight

We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect

We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration

We may disclose your protected health information to a person or company required by the Food and Drug Administration for the purpose of quality, safety, or effectiveness of FDA-regulated products or activities including, to report adverse events, product defects or problems, biologic product deviations, to track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

Legal Proceedings

We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), or in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement

We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of our practice, and (6) medical emergency (not on our practice's premises) and it is likely that a crime has occurred.

Coroners, Funeral Directors, and Organ Donation

We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Research

We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

Criminal Activity

Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security

When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

Workers' Compensation

We may disclose your protected health information as authorized to comply with workers' compensation laws and other similar legally-established programs.

Limitations on Use of Substance Use Disorder Information

Federal law strictly limits the use of Substance Use Disorder records in civil, criminal, administrative, or legislative proceedings. SUD records may not be used to initiate or substantiate criminal charges against a patient, or to conduct investigations, without proper authorization or a court order that meets the requirements of 42 CFR Part 2.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your protected health information for the reasons covered by your written authorization. Please understand that we are unable to take back any disclosures already made with your authorization.

Other Permitted and Required Uses and Disclosures That Require Providing You the Opportunity to Agree or Object

We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgement, determine whether the disclosure is in your best interest.

Facility Directories

Unless you object, we will use and disclose in our facility directory your name, the location at which you are receiving care, your general condition (such as fair or stable), and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name. Your religious affiliation will be only given to a member of the clergy, such as a priest or rabbi.

Others Involved in Your Health Care or Payment for your Care

Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

2. Your Rights

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

Right to Inspect and Copy

You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you for so long as we maintain the protected health information. You may obtain your medical record that contains medical and billing records and any other records that your physician and the practice uses for making decisions about you. As permitted by federal or state law, we may charge you a reasonable copy fee for a copy of your records.

Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and laboratory results that are subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.

Right to Request Restrictions

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or health care operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request. If your physician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician.

Right to Confidential Communications

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer.

Right to Amendment

You may have the right to have your physician amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for so long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending your medical record.

Right to Accounting of Disclosures

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you if you authorized us to make the disclosure, for a facility directory, to family members or friends involved in your care, or for notification purposes, for national security or intelligence, to law enforcement (as provided in the privacy rule) or correctional facilities, as part of a limited data set disclosure. You have the right to receive specific information regarding these disclosures that occur after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations.

Additional Rights Related to Substance Use Disorder Records

If we maintain records protected by 42 CFR Part 2, you have additional rights, including:

• The right to provide a single written consent for certain uses and disclosures of your SUD records, consistent with federal law.
• The right to revoke consent for disclosures of SUD records at any time, except to the extent action has already been taken.
• The right to receive information about how your SUD records may be disclosed and redisclosed.
• The right to request restrictions on certain disclosures as required by law.

Prohibition on Redisclosure of Substance Use Disorder Records

Substance Use Disorder records disclosed under 42 CFR Part 2 may not be redisclosed unless permitted by federal law. Any recipient of such information is prohibited from redisclosing it except as expressly allowed by law or with your written consent.

Right to Paper Copy

You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

3. Complaints

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint.

Substance Use Disorder Privacy Complaints

In addition to your HIPAA rights, you may file a complaint regarding the confidentiality of Substance Use Disorder records with the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). We will not retaliate against you for filing any complaint.

You may contact our office at (202) 244-2101 for further information about the complaint process.

Questions About Your Privacy Rights?

If you have questions about your privacy rights, would like to request access to your medical records, or have concerns about how your information is being used, please contact our office:

Your Rights as a Patient

As a patient of Elite Prosthetic Dentistry, you have the following rights with respect to your protected health information:

• Right to Access: You have the right to request and obtain a copy of your medical and dental records.
• Right to Amend: You have the right to request amendments or corrections to your medical records.
• Right to Accounting of Disclosures: You have the right to request a list of instances in which we have disclosed your health information.
• Right to Request Restrictions: You have the right to request restrictions on the use and disclosure of your health information.
• Right to Confidential Communication: You have the right to request that communications regarding your health information be made through alternative means or to alternative locations.
• Right to a Paper Copy: You have the right to receive a paper copy of this notice and any other privacy documents.

How to Request Your Medical Records

To request a copy of your medical records or to exercise any of your HIPAA rights, please submit your request in writing to:

Elite Prosthetic Dentistry
Attn: HIPAA Privacy Officer
4400 Jenifer St NW, Ste 220
Washington, DC 20015

You may also call us at (202) 244-2101 or email info@bethesdaimplantdentist.com to discuss your request.

Request Processing Timeline

We will process requests for your medical records within thirty (30) days of receipt, as required by HIPAA. If we need additional time to locate your records, we will notify you of the delay.

Fees for Records

We may charge reasonable fees for copying and mailing your records, consistent with District of Columbia law. We will inform you of any applicable fees before processing your request.

File a Complaint

If you believe we have not complied with this notice or your privacy rights, you have the right to file a complaint with:

United States Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-800-537-7697
Website: https://www.hhs.gov/ocr

You may also file a complaint with our office by contacting our HIPAA Privacy Officer using the contact information above.

No Retaliation

We will not retaliate or penalize you in any way for filing a complaint about our privacy practices or for exercising your HIPAA rights.

How We Protect Your Information

Elite Prosthetic Dentistry is committed to maintaining the security and confidentiality of your protected health information. We implement physical, technical, and administrative safeguards to protect your information from unauthorized access, use, or disclosure.

Security Measures Include:

• Secure record storage and restricted access to patient files
• Encryption of electronic health information
• Password protection and secure login procedures
• Regular staff training on privacy and security practices
• Business associate agreements with vendors who have access to your information
• Regular audits and risk assessments of our privacy and security practices

Security Breach Notification

In the unlikely event that your protected health information is accessed, used, or disclosed in an unauthorized manner, we will notify you promptly, as required by law. We will notify you of any security breach within sixty (60) calendar days of discovery of the breach.

Acknowledgment of Receipt

When you become a patient of Elite Prosthetic Dentistry, we will ask you to sign an acknowledgment confirming that you have received a copy of this Notice of Privacy Practices. This acknowledgment is not a waiver of your rights; it is simply a record that you have been informed about your privacy rights.

Additional Information

For additional information about HIPAA and your privacy rights, you may visit the U.S. Department of Health and Human Services website at https://www.hhs.gov/hipaa.

Effective Date

This Notice of Privacy Practices is effective as of February 16, 2026. We will notify you of any material changes to this notice.