Effective Date: January 1, 2026
This notice describes how health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
Please review this Notice carefully.
Surf City Endodontics is required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices that are described in this Notice while it is in effect.
This Notice takes effect on the date listed above and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make new Notice provisions effective for all protected health information that we maintain. When we make a significant change in our privacy practices, we will update this Notice and make the revised version available at our office and on our website.
At Surf City Endodontics, we may use and disclose your health information for different purposes, including treatment, payment, and health care operations. For each of these categories, we have provided a description and an example below. Some information, such as HIV-related information, genetic information, alcohol and substance use disorder treatment records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law.
We may use and disclose your health information to provide, coordinate, or manage your endodontic care. For example, we may share relevant records with a referring dentist, a specialist involved in your care, or a laboratory performing diagnostic tests. We may also share information with other health care providers who are treating or consulting on your case.
We may use and disclose your health information so that we can bill for the treatment and services you receive and collect payment from you, your insurance company, or a third-party payer. For example, we may need to provide information to your dental insurance carrier to receive pre-authorization for a planned procedure such as a root canal or apicoectomy, or to verify your coverage and benefits.
We may use and disclose your health information to support the day-to-day operations of Surf City Endodontics. These activities include quality assessment, staff training, licensing, and conducting or arranging other business activities. For example, we may review treatment records to evaluate the performance of our clinical team and ensure the highest standard of endodontic care.
We may use or disclose your health information when we are required to do so by federal, state, or local law. For example, we may disclose health information when required by a court order in a legal proceeding, or to report certain conditions as required by California public health authorities.
We may disclose your health information for public health activities, including reporting disease, injury, vital events such as births, and conducting public health surveillance and investigations. We may also disclose information to a person who may have been exposed to a communicable disease or who may otherwise be at risk of contracting or spreading a condition, when authorized by law.
As a patient of Surf City Endodontics, you have certain rights under federal privacy law regarding your protected health information. Below is a summary of those rights and how you may exercise them. To make a request or learn more, please contact our office at (714) 596-0818 or visit us at 17762 Beach Blvd STE 200, Huntington Beach, CA 92647.
You have the right to inspect and obtain a copy of the protected health information that Surf City Endodontics maintains about you, including medical and billing records. We may charge a reasonable fee for copies. You may request records in electronic format when the information is maintained electronically.
You have the right to request that we amend your protected health information if you believe it is incorrect or incomplete. We may deny the request in certain circumstances, but we will provide a written explanation if we do so.
You have the right to request a list of disclosures we have made of your protected health information. This accounting will not include disclosures made for treatment, payment, or health care operations, or disclosures you authorized in writing.
You have the right to request that we restrict how we use or disclose your health information for treatment, payment, or health care operations. We are not required to agree to your request, but if we do, we will abide by the agreed-upon restrictions except in emergency situations.
You have the right to request that we communicate with you about your health information in a specific way or at a specific location. For example, you may ask that we send correspondence to a particular address or contact you only by phone. We will accommodate all reasonable requests.
You have the right to obtain a paper copy of this Notice upon request, even if you have previously agreed to receive it electronically. You may request a copy at any time by contacting our office at (714) 596-0818 or stopping by 17762 Beach Blvd STE 200, Huntington Beach, CA 92647.
If you have questions about this Notice or our privacy practices, or if you believe your privacy rights have been violated, you have the right to file a complaint with our practice or with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
(714) 596-0818
surfcityendo.com
17762 Beach Blvd, Suite 200
Huntington Beach, CA 92647
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:
www.hhs.gov/ocr/privacy/hipaa/complaints
(800) 368-1019
200 Independence Avenue, S.W.
Washington, D.C. 20201
Our team at Surf City Endodontics is here to help. Whether you are dealing with tooth pain, a dental emergency, or a referral from your dentist, we make it easy to get the expert care you need. Call us at (714) 596-0818 or book online today.
Book Appointment17762 Beach Blvd STE 200, Huntington Beach, CA 92647, United States
