Privacy Policy | Shrijana Shakya DDS INC

Your Rights

Access Your Records

You can request an electronic or paper copy of your medical record and health information. We may charge a reasonable, cost-based fee.

Correct Your Record

You can ask us to correct information you believe is incorrect or incomplete. We will respond in writing within 60 days.

Confidential Communications

You can ask us to contact you in a specific way or send mail to a different address. We will honor all reasonable requests.

Limit What We Share

You can request we limit sharing your info for treatment, payment, or operations. If you pay in full out-of-pocket, we will not share with your insurer.

List of Disclosures

Request an accounting of disclosures going back six years. We provide one per year free; additional requests may incur a reasonable fee.

Paper Copy of This Notice

You may request a paper copy of this notice at any time, even if you agreed to receive it electronically. We will provide it promptly.

Designate a Representative

If you have a medical power of attorney or legal guardian, that person can act on your behalf. We will verify their authority first.

⚠ File a Complaint

If you believe we have violated your rights, contact our office at 925-825-1130.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:
200 Independence Avenue, S.W., Washington, D.C. 20201 | Call: 1-877-696-6775 | www.hhs.gov/ocr/privacy/hipaa/complaints

✓ We will never retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your preferences. Tell us what you want and we will follow your instructions.

👤 You have the right and choice to tell us to:

Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
Include your information in a hospital directory

If you are unable to express a preference (e.g., if you are unconscious), we may share information when it is in your best interest or needed to address a serious threat to health or safety.

💌 Fundraising

We may contact you for fundraising efforts, but you can ask us not to contact you again at any time.

How We Typically Use Your Information

Treat You

We share your health information with other professionals involved in your care.

e.g., A specialist consulted about your overall health condition.

Run Our Organization

We use your information to manage your treatment and improve our services.

e.g., Managing your appointments and care quality.

Bill for Services

We share your information with your health plan to obtain payment for services rendered.

e.g., Submitting a claim to your dental insurance.

Other Permitted Disclosures

We are also permitted or required by law to share your information in the following situations. We must meet conditions in the law before sharing for these purposes.

Public health and safety issues (preventing disease, product recalls, reporting adverse reactions)
Reporting suspected abuse, neglect, or domestic violence
Health research under applicable legal safeguards
Compliance with state or federal law
Organ and tissue donation organizations
Coroner, medical examiner, or funeral director upon death
Workers' compensation claims
Law enforcement purposes or with a law enforcement official
Health oversight agencies authorized by law
Special government functions (military, national security, presidential services)
Court or administrative orders, or in response to a subpoena

For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

2024 HIPAA Update: Reproductive Health

Special Protections Under the 2024 HIPAA Update

We will not use or disclose your protected health information (PHI) for the purpose of:

Investigating or imposing liability on any person for seeking, obtaining, providing, or facilitating lawful reproductive health care
Identifying individuals for such investigations

When requests are made by law enforcement, courts, or government agencies, we may require a signed attestation confirming the request is not for a prohibited purpose. These protections apply where the care was lawful under applicable law.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.
We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and provide you with a copy upon request.
We will not use or share your information beyond what is described here unless you provide written permission — which you may revoke in writing at any time.

Notice of Privacy Practices