HIPAA Notice of Privacy Practices - Elite Smiles and Dental Spa

Effective date: September 1, 2026

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.

This Notice of Privacy Practices describes how Elite Smiles and Dental Spa (operated by Gabriel's Dentistry, PLLC) may use and disclose your protected health information ("PHI") to carry out treatment, payment, and health care operations, and for other purposes that are permitted or required by law. It also describes your rights regarding your health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services.

Who we are

Elite Smiles and Dental Spa is a dental practice located at 1574 Bloomingdale Ave, Valrico, FL 33596, phone (813) 793-2016. We are required by the Health Insurance Portability and Accountability Act (HIPAA) and by applicable Florida law to protect the privacy of your health information.

Our legal duties

We are required by law to:

Maintain the privacy of your protected health information;
Give you this Notice of our legal duties and privacy practices with respect to your health information;
Follow the terms of the Notice that is currently in effect; and
Notify you following a breach of your unsecured protected health information.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided the changes are permitted by law, and to make the changes effective for all protected health information that we maintain.

How we may use and disclose your health information

The following describes the ways we may use and disclose your protected health information. Not every use or disclosure is listed, but every permitted use and disclosure will fall within one of the categories below.

Treatment. We may use and disclose your PHI to provide, coordinate, or manage your dental care. For example, we may share information with the dentist, hygienists, and assistants involved in your care, with a specialist (such as an oral surgeon or orthodontist) to whom we refer you, or with a dental laboratory that fabricates a crown, bridge, or denture for you.
Payment. We may use and disclose your PHI to obtain payment for the treatment and services you receive. For example, we may send a claim to your dental or medical insurance plan, verify coverage and benefits, or bill you or a responsible party.
Health care operations. We may use and disclose your PHI to run the practice and ensure quality care — for example, for scheduling, quality review, staff and student training, licensing, business management, and general administrative activities.
Appointment reminders, treatment alternatives, and health-related benefits. We may contact you by phone, text message, email, or mail to remind you of an appointment, to tell you about or recommend possible treatment options, or to inform you of health-related benefits or services that may interest you. Unless you ask us not to, we may leave a message on the voicemail of any phone number you give us, and may send reminders by text or email to the number or address you provide. You can change how we contact you at any time (see “Right to request confidential communications” below).
Individuals involved in your care or payment. We may share PHI with a family member, relative, friend, or other person you identify who is involved in your dental care or in paying for your care, when you are present and do not object, or when it is in your best interest and you are unable to agree.
Business associates. We may disclose your PHI to third parties ("business associates") that perform services for us — for example, billing, IT, website hosting, or a dental laboratory. We require our business associates to appropriately safeguard your information.
As required by law. We will disclose your PHI when federal, state, or local law requires it.
Public health and safety. We may disclose your PHI for public health activities, such as reporting disease, injury, or vital events, or to a person who may have been exposed to a communicable disease.
Health oversight activities. We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.
Legal proceedings and law enforcement. We may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process, and for certain law enforcement purposes.
To avert a serious threat to health or safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person.
Research. Under limited circumstances, and with appropriate approvals and safeguards, we may use or disclose PHI for research purposes.
De-identified information. We may use or disclose information that has been de-identified so that it no longer identifies you.
Workers' compensation. We may disclose PHI as authorized by, and to the extent necessary to comply with, workers' compensation laws.
Breach notification. We may use your contact information to provide you with any legally required notice of an unauthorized acquisition, access, use, or disclosure of your PHI.
Other uses — with your written authorization. Uses and disclosures not described in this Notice will be made only with your written authorization. In particular, most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes, and disclosures that would be a sale of PHI require your authorization. You may revoke an authorization in writing at any time, except to the extent we have already relied on it.

Highly confidential information

Certain federal and Florida laws give extra protection to specific categories of health information, including information about HIV/AIDS, mental health, alcohol and substance use disorder treatment (42 CFR Part 2), genetic testing (GINA), sexually transmitted diseases and reproductive health, and child or adult abuse or neglect. Where one of those laws is stricter than HIPAA, we follow the stricter law, and in most cases we will not disclose that information without your specific written authorization.

Your rights regarding your health information

Right to inspect and copy. You have the right to inspect and obtain a copy of the PHI we maintain about you, in the form and format you request if it is readily producible. We may charge a reasonable, cost-based fee.
Right to amend. If you believe information we have about you is incorrect or incomplete, you may ask us to amend it. We may deny your request in certain cases, and you may then submit a statement of disagreement.
Right to an accounting of disclosures. You have the right to request a list of certain disclosures we made of your PHI, other than those for treatment, payment, and health care operations and certain other exceptions.
Right to request restrictions. You may request a restriction on how we use or disclose your PHI. We are not required to agree, except that we must agree to restrict disclosure to a health plan for payment or operations if you paid out of pocket in full for the service.
Right to request confidential communications. You may ask that we communicate with you about your health matters in a certain way or at a certain location (for example, only by mail, or only at a specific phone number).
Right to a paper copy of this Notice. You have the right to a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
Right to be notified of a breach. You have the right to be notified if there is a breach of your unsecured PHI, as required by law.
Right to choose a personal representative. A person with legal authority to act on your behalf (such as a parent, guardian, or person with power of attorney) may exercise your rights and make choices about your health information; we may ask for documentation of that authority.

How to exercise your rights

To exercise any of these rights, please submit your request in writing to our Privacy Officer at the address below. We can provide forms to help you make your request.

Changes to this Notice

We reserve the right to change this Notice and to make the revised Notice effective for protected health information we already have as well as any information we receive in the future. The current Notice will be posted at esdentalspa.com, and a copy will be available at our office. Each Notice will show its effective date.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by contacting our Privacy Officer, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.

U.S. Department of Health and Human Services, Office for Civil Rights — 200 Independence Avenue, S.W., Washington, D.C. 20201 — 1-800-368-1019 — hhs.gov/ocr/privacy/hipaa/complaints

Contact — Privacy Officer

If you have questions about this Notice or wish to exercise any of your rights, please contact:

Privacy Officer — Elite Smiles and Dental Spa
1574 Bloomingdale Ave, Valrico, FL 33596
(813) 793-2016 · info@esdentalspa.com

Read our Privacy Policy