Manlucu Dental Group, P.C.

Notice of Privacy Practices

Effective Date: June 9, 2025

THIS NOTICE IS REQUIRED BY REGULATION UNDER THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (“HIPAA”). 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. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your health information (this “Notice”). We must follow the privacy practices that are described in this Notice while it is in effect. We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made such changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

Uses and Disclosures of Health Information

The following describes the circumstances under which we may disclose your information, including protected health information (“PHI”) about you. Note that, to the extent information is disclosed under the circumstances described below, there may be a possibility of redisclosure of such information by a third party in receipt of such information.

1. Treatment, Payment, and Healthcare Operations: We may use and disclose health information about you for treatment, payment, and healthcare operations. For example:

   1. Treatment: We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
   2. Payment: We may use and disclose your health information to obtain payment for services we provide to you (for example, as part of an insurance claim).
   3. Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, and conducting training, accreditation, certification, licensing, or credentialing activities.

    

2. Your Authorization: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not impact any use or disclosures permitted by your authorization while it was in effect. Unless you give us written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.

    

3. Electronic Communications: To the extent you authorize us to do so, we may communicate with you via electronic means, including by electronic mail, text message, or secure electronic portal. Such communications will be governed by our internal policies and procedures regarding privacy and security of PHI and electronic communications of PHI.

    

4. Persons Involved in Care: We may use or disclose health information to notify, or assist in the notification of (including identifying or locating), a family member, your personal representative, or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, you will have an opportunity to object to such uses or disclosures. In the event of your incapacity or in emergency circumstances, we may disclose health information based on our professional judgment in connection with obtaining or providing you with emergency care. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interests in disclosing information to those involved in your care if you are not present, including for notification purposes or otherwise (for example, in connection with allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information).

    

5. Disaster Relief: We may use or disclose your health information to assist in disaster relief efforts. Under such circumstances, we will use our professional judgement to determine whether disclosures are appropriate in connection with responding to an emergency circumstance.

    

6. Required by Law; Disclosures to Secretary of HHS: We may use or disclose your health information when we are required to do so by law. To that end, we will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA.

    

7. Public Health Activities: We may disclose your health information for public health activities, including disclosures to:

   1. Prevent or control disease, injury, or disability;
   2. Report child abuse or neglect;
   3. Report reactions to medications or problems with products or devices;
   4. Notify a person of a recall, repair, or replacement of products or devices;
   5. Notify a person who may have been exposed to a disease or condition; or
   6. Report information to an employer in connection with certain employment-related illnesses or injuries with respect to which the employer requested us to provide an evaluation.

    

8. Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.

    

9. Health Oversight Activities: We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and credentialing activities as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

    

10. Judicial and Administrative Proceedings: If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the request or to obtain an order protecting the information requested.

     

11. Law Enforcement: We may disclose your PHI for law enforcement purposes as permitted by HIPAA.

     

12. Coroners, Medical Examiners, and Funeral Directors: We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to enable them to carry out their duties.

     

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

     

14. Serious Threat to Health or Safety: We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.

     

15. National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. Under certain circumstances, we may disclose protected health information to a correctional institution or law enforcement official having lawful custody of an inmate or patient.

     

16. Worker’s Compensation: We may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.

     

17. Reproductive Information: Note that HIPAA prohibits disclosure of reproductive health information under certain circumstances, including in connection with criminal investigation or prosecution relating to an individual seeking reproductive care. Relatedly, disclosure of such information may require the provision of an attestation indicating that disclosure is not for a prohibited purpose.

     

18. Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).

     

19. Other Uses and Disclosures of PHI: Your authorization is required, with a few exceptions, for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI. We will also obtain your written authorization before using or disclosing your PHI for purposes other than those provided for in this Notice (or as otherwise permitted or required by law). You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization. We do not share text message opt-in information with affiliates or third parties for their marketing purposes.

Your Rights in Connection With Health Information

The following describes your rights in connection with your PHI.

1. Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).

    

2. Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information listed at the end of this Notice. You may also request access by sending us a letter to the address at the end of this Notice.

    

3. Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information over the last six years for purposes other than treatment, payment, healthcare operations and certain other activities. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.

    

4. Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. You must make your request in writing. Your request must specify the alternative means or location and provide a satisfactory explanation how payments will be handled under the alternative means or location you request.

    

5. Amendment: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.

    

6. Electronic Notice: If you receive this Notice on our website or by electronic mail (email), you are entitled to receive this Notice in paper form.

    

QUESTIONS AND COMPLAINTS: If you want more information about our privacy practices or have questions or concerns, please contact us at the address/phone number below.

If you are concerned that we may have violated your privacy rights or  disagree with a decision we made: 1. About access to your health information; 2. In response to a request to amend or restrict the use or disclosure of your health information; or 3. In response to a request for us to communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

For communications relating to your PHI and the other contents of this Notice, please contact our Practice Manager at the following address/phone number:

Manlucu Dental Group, P.C.

16815 Crabbs Branch Way, Rockville, MD 20855

Office Phone: (301) 963-4330