Notice of Privacy Practices

Effective Date: February 12, 2026

THIS NOTICE DESCRIBES HOW MEDICAL/DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Commitment to Your Privacy

Philadelphia Dental Associates is committed to protecting the privacy and confidentiality of your protected health information (PHI). We are required by law to maintain the privacy of your PHI, to provide you with this Notice of Privacy Practices, and to follow the terms of this Notice currently in effect.

Practice Information

• Practice Name: Philadelphia Dental Associates
• Address: 2000 Market Street, Suite BSA 2 Philadelphia, PA 19103
• Phone: (215) 564 9010
• Privacy Officer: Dr. John J. Kang
• Privacy Officer Contact: (215) 564 9010

What Is Protected Health Information (PHI)?

Protected Health Information is individually identifiable health information that relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or payment for that care. PHI may be created, received, maintained, or transmitted in any form, including electronic, paper, or oral communications.

Examples of PHI include your name, address, phone number, email address, and date of birth; dental and medical histories; diagnostic images, X-rays, charts, and clinical notes; treatment plans and progress notes; insurance and billing information; and appointment and scheduling records.

How We May Use and Disclose Your PHI Without Your Authorization

Federal privacy laws allow us to use and disclose your PHI without your written authorization for certain purposes, including treatment, payment, and health care operations.

• Treatment. We may use and disclose your PHI to provide, coordinate, or manage your dental care. This includes sharing information with other health care providers, specialists, laboratories, pharmacies, or other entities involved in your treatment. Example: If you are referred to a specialist, we may share your dental records and X-rays with that provider to coordinate your care.
• Payment. We may use and disclose your PHI to obtain payment for services provided to you. This may include billing insurance companies, processing claims, determining eligibility or coverage, and collecting copayments or balances. Example: We may send a claim to your dental insurance company that includes your diagnosis and procedure codes.
• Health Care Operations. We may use and disclose your PHI for activities necessary to operate our practice. These activities may include quality assessment and improvement, staff training, accreditation, licensing, compliance reviews, audits, business planning, and administrative functions. Example: We may use your information to conduct internal quality reviews of the care provided to you.

Other Permitted or Required Uses and Disclosures

We may also use or disclose your PHI without your authorization in the following circumstances, as permitted or required by law:

• To comply with federal, state, or local laws
• For public health activities (e.g., disease prevention, reporting adverse events)
• For health oversight activities (e.g., audits, investigations, inspections)
• In response to court orders, subpoenas, or lawful processes
• For law enforcement purposes, as required by law
• To avert a serious threat to health or safety
• For workers' compensation or similar programs
• To coroners, medical examiners, and funeral directors, as necessary
• For organ and tissue donation purposes, if applicable
• For certain research purposes, subject to applicable safeguards
• For specialized government functions (e.g., military, national security)
• To comply with the requirements of the U.S. Department of Health and Human Services for enforcement of HIPAA

Special Protections for Certain Records (Including Substance Use Disorder Records)

Some health information may be subject to additional protections under federal or state law, including records related to substance use disorder (SUD) treatment governed by 42 CFR Part 2.

When applicable: such records may not be used or disclosed without your written consent, except as specifically permitted or required by law; redisclosure of this information may be prohibited; and these records generally may not be used in civil, criminal, administrative, or legislative proceedings without specific authorization or a court order.

If your information is subject to these additional protections, we will comply with all applicable requirements.

Your Rights Regarding Your PHI

• Right to Access. You have the right to inspect and obtain a copy of your PHI, with limited exceptions. Requests must be submitted in writing. We will respond within 30 days (or as otherwise required by law) and may charge a reasonable, cost-based fee for copies.
• Right to Request Amendment. If you believe your PHI is incorrect or incomplete, you may request an amendment in writing. We may deny your request under certain circumstances, in which case you may submit a written statement of disagreement.
• Right to Request Restrictions. You may request restrictions on how we use or disclose your PHI for treatment, payment, or health care operations. We are not required to agree to all requests, except that we must agree to restrict disclosures to a health plan for services you have paid for in full out of pocket.
• Right to Confidential Communications. You may request that we communicate with you in a specific manner or at a specific location (for example, at an alternate phone number or address).
• Right to an Accounting of Disclosures. You may request a list of certain disclosures of your PHI made by us, as permitted by law.
• Right to a Paper Copy. You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive it electronically.
• Right to Be Notified of a Breach. You have the right to be notified if a breach of your unsecured PHI occurs.

Contact Us

If you believe your privacy rights have been violated, you may file a complaint with: