Notice of Privacy Practices

Your information. Your rights. Our responsibilities.

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.

In this notice, “you” means the patient. For a child, a parent or legal guardian generally acts on the child’s behalf, as the law allows. “We” means Dr. Nik’s Children’s Dentistry.

Effective date: October 15, 2026.

Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your dental record. You can ask to see or get an electronic or paper copy of your dental record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information within 15 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your dental record. You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say “no” to your request, but we will tell you why in writing within 60 days.

Request confidential communications. You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.

Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we have shared information. You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated. You can complain if you feel we have violated your rights by contacting our Privacy Officer at (310) 855-9920. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-800-368-1019, or visiting ocrportal.hhs.gov. We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both 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

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

Our uses and disclosures

We typically use or share your health information in the following ways.

Treat you. We can use your health information and share it with other professionals who are treating you. Example: we send X-rays and a summary of your child’s dental condition to a specialist we refer you to.

Run our practice. We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: we use health information about you to manage your treatment and services, and to remind you of an appointment.

Bill for your services. We can use and share your health information to bill and get payment from health plans or other entities. Example: we give information about your child’s treatment to your dental insurance plan so it will pay for the services.

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues. We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do research. We can use or share your information for health research.

Comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

Respond to organ and tissue donation requests. We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests. We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions. We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Substance use disorder treatment records. If we receive records from a substance use disorder treatment program covered by federal law (42 CFR Part 2), we will not use or share those records, or testimony about them, in a civil, criminal, administrative, or legislative proceeding against you unless you consent in writing or a court orders it after giving you notice and a chance to be heard.

California law. Where California law protects your health information more than federal law does, we follow California law.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know 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 give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the terms of this notice

We can 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.

Contact us

For more information about this notice or our privacy practices, contact our Privacy Officer: Dr. Nik’s Children’s Dentistry, 1464 S. Robertson Blvd., Los Angeles, CA 90035. Phone: (310) 855-9920 (TTY: 711).

Language assistance

ATTENTION: If you need help in your language call 1-310-855-9920 (TTY: 711). Aids and services for people with disabilities, like documents in braille and large print, are also available. Call 1-310-855-9920 (TTY: 711). These services are free of charge.

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ध्यान दें: अगर आपको अपनी भाषा में सहायता की आवश्यकता है तो 1-310-855-9920 (TTY: 711) पर कॉल करें। अशक्तता वाले लोगों के लिए सहायता और सेवाएं, जैसे ब्रेल और बड़े प्रिंट में भी दस्तावेज़ उपलब्ध हैं। 1-310-855-9920 (TTY: 711) पर कॉल करें। ये सेवाएं नि: शुल्क हैं।

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注意日本語での対応が必要な場合は 1-310-855-9920 (TTY: 711)へお電話ください。点字の資料や文字の拡大表示など、障がいをお持ちの方のためのサービスも用意しています。 1-310-855-9920 (TTY: 711)へお電話ください。これらのサービスは無料で提供しています。

유의사항: 귀하의 언어로 도움을 받고 싶으시면 1-310-855-9920 (TTY: 711) 번으로 문의하십시오. 점자나 큰 활자로 된 문서와 같이 장애가 있는 분들을 위한 도움과 서비스도 이용 가능합니다. 1-310-855-9920 (TTY: 711) 번으로 문의하십시오. 이러한 서비스는 무료로 제공됩니다.

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ВНИМАНИЕ! Если вам нужна помощь на вашем родном языке, звоните по номеру 1-310-855-9920 (линия TTY: 711). Также предоставляются средства и услуги для людей с ограниченными возможностями, например документы крупным шрифтом или шрифтом Брайля. Звоните по номеру 1-310-855-9920 (линия TTY: 711). Такие услуги предоставляются бесплатно.

ATENCIÓN: si necesita ayuda en su idioma, llame al 1-310-855-9920 (TTY: 711). También ofrecemos asistencia y servicios para personas con discapacidades, como documentos en braille y con letras grandes. Llame al 1-310-855-9920 (TTY: 711). Estos servicios son gratuitos.

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โปรดทราบ: หากคุณต้องการความช่วยเหลือเป็นภาษาของคุณ กรุณาโทรศัพท์ไปที่หมายเลข 1-310-855-9920 (TTY: 711) นอกจากนี้ ยังพร้อมให้ความช่วยเหลือและบริการต่าง ๆ สำหรับบุคคลที่มีความพิการ เช่น เอกสารต่าง ๆ ที่เป็นอักษรเบรลล์และเอกสารที่พิมพ์ด้วยตัวอักษรขนาดใหญ่ กรุณาโทรศัพท์ไปที่หมายเลข 1-310-855-9920 (TTY: 711) ไม่มีค่าใช้จ่ายสำหรับบริการเหล่านี้

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CHÚ Ý: Nếu quý vị cần trợ giúp bằng ngôn ngữ của mình, vui lòng gọi số 1-310-855-9920 (TTY: 711). Chúng tôi cũng hỗ trợ và cung cấp các dịch vụ dành cho người khuyết tật, như tài liệu bằng chữ nổi Braille và chữ khổ lớn (chữ hoa). Vui lòng gọi số 1-310-855-9920 (TTY: 711). Các dịch vụ này đều miễn phí.