THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Commitment to Your Privacy
Roseville Dental Company is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of protected health information (PHI), provide you with notice of our legal duties and privacy practices, and notify affected individuals following a breach of unsecured protected health information.
We are required to follow the privacy practices described in this Notice while it is in effect. This Notice takes effect March 6, 2026, and will remain in effect until it is replaced.
We reserve the right to change our privacy practices and the terms of this Notice at any time, as permitted by law. Any changes will apply to all health information we maintain. When significant changes are made, we will update this Notice and post it prominently in our office and make copies available upon request.
If you would like more information about our privacy practices or would like an additional copy of this Notice, please contact us using the information listed at the end of this document.
How We May Use and Disclose Your Health Information
We may use and disclose your health information for the following purposes:
Treatment
We may use and disclose your health information to provide, coordinate, or manage your dental and healthcare treatment. For example, we may share information with specialists, laboratories, or other healthcare providers involved in your care.
Payment
We may use and disclose your health information to obtain payment for services provided to you. This may include billing insurance companies, processing claims, verifying coverage, or collecting payment.
Healthcare Operations
We may use and disclose your health information for healthcare operations necessary to run our practice. These activities may include quality assessment, staff training, licensing activities, and business management.
Individuals Involved in Your Care
We may disclose health information to family members, friends, or other individuals you identify as being involved in your care or payment for your care. If someone has legal authority to make healthcare decisions for you, we will treat that person as your personal representative.
Disaster Relief
We may disclose your health information to authorized organizations to assist in disaster relief efforts.
As Required by Law
We may disclose your health information when required to do so by federal, state, or local law.
Public Health Activities
We may disclose health information for public health purposes such as:
Preventing or controlling disease, injury, or disability
Reporting abuse or neglect
Reporting reactions to medications or problems with medical products
Notifying individuals of recalls or safety concerns
Preventing or reducing a serious threat to health or safety
Law Enforcement
We may disclose your health information to law enforcement officials as required by law or in response to a subpoena, court order, or other legal process.
Health Oversight Activities
We may disclose health information to government agencies responsible for oversight of the healthcare system, including audits, investigations, and licensing activities.
Judicial and Administrative Proceedings
If you are involved in a legal matter, we may disclose your health information in response to a court or administrative order, subpoena, or other lawful process.
Research
We may disclose health information for approved research purposes when safeguards are in place to protect your privacy.
Coroners, Medical Examiners, and Funeral Directors
We may release health information to identify a deceased individual or determine the cause of death, and to assist funeral directors in carrying out their duties.
Workers’ Compensation
We may disclose health information as authorized by laws related to workers’ compensation or similar programs.
National Security and Military Activities
We may disclose health information to authorized federal officials for national security activities or to military authorities when required.
Special Protections for Certain Information
Some types of health information, such as mental health records, genetic information, HIV-related information, or substance use disorder treatment records, may be subject to additional legal protections. We will comply with all applicable laws regarding the protection of this information.
Other Uses and Disclosures
Uses and disclosures not described in this Notice will generally require your written authorization. For example, authorization is required for:
Use or disclosure of psychotherapy notes
Use of health information for marketing purposes
Sale of protected health information
You may revoke an authorization at any time in writing, except to the extent that we have already relied on the authorization.
Your Health Information Rights
You have several rights regarding your health information.
Right to Access
You have the right to inspect or obtain copies of your health information, with certain limited exceptions. Requests must be submitted in writing.
Right to an Accounting of Disclosures
You may request a list of certain disclosures we have made of your health information.
Right to Request Restrictions
You may request restrictions on how we use or disclose your health information. While we are not required to agree to all requests, we will comply with applicable legal requirements.
Right to Request Confidential Communications
You may request that we communicate with you about your health information by alternative means or at alternative locations. We will accommodate reasonable requests.
Right to Request an Amendment
If you believe your health information is incorrect or incomplete, you may request that we amend it. Requests must be made in writing and include a reason for the amendment.
Right to Notification of a Breach
You will be notified if a breach occurs that compromises the privacy or security of your protected health information.
Right to a Paper Copy
You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
Questions or Complaints
If you have questions about this Notice or believe your privacy rights have been violated, you may contact us using the information below.
You also have the right to file a complaint with the U.S. Department of Health and Human Services. We will provide the contact information upon request. We will not retaliate against you for filing a complaint.
Privacy Contact Information
Privacy Official Name: Adam L. Haney D.D.S., Inc.
Practice Name: Roseville Dental Company
Address: 1613 Eureka Rd, Roseville, CA 95661
Phone: (916) 773-8200
