Shine Dental

Effective Date: February 13, 2026

This notice explains how we may use and protect your health information and your rights regarding that information.

We may use and disclose your protected health information (PHI) for:

Treatment – To provide, coordinate, or manage your dental care (including sharing information with specialists, labs, or other healthcare providers).

Payment – To bill and receive payment from insurance companies or other payers.

Healthcare Operations – For practice management, quality improvement, staff training, licensing, and administrative purposes.

Appointment Reminders & Communication – To contact you by phone, text, email, or mail regarding appointments, treatment, or office updates.

Individuals Involved in Your Care – We may share relevant information with family or others involved in your care unless you object.

Legal & Public Health Requirements – When required by law, court order, or for public health and safety purposes.

Certain records related to substance use disorder diagnosis, treatment, or referral are protected under federal law (42 CFR Part 2) in addition to HIPAA.

If we receive or maintain these records:

• We will use or disclose them only as permitted by law.
• Your written consent may be required before disclosure.
• These records generally may not be used in legal proceedings without your specific written consent or a court order.
• Recipients are restricted from redisclosing this information.

You may revoke consent for disclosure as permitted by law.

You have the right to:

• Inspect and obtain a copy of your records
• Request corrections to your records
• Request restrictions on certain uses or disclosures
• Request confidential communications
• Receive an accounting of certain disclosures
• Obtain a paper copy of this notice at any time

We are required by law to:

• Maintain the privacy and security of your health information
• Provide this notice of our legal duties and privacy practices
• Notify you if a breach of unsecured PHI occurs
• Follow the terms of the notice currently in effect

We reserve the right to update this notice at any time. Updates will be posted in our office and on our website.

If you have questions or believe your privacy rights have been violated, contact:

Privacy Officer: Nancy Salgado

Phone: 224-999-9000

Email: office@shinedentalpractice.com

Address: 701 W. Golf Road Mount Prospect IL 60056

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.