HIPAA Notice of Privacy Practices

Illahee Dental

Effective date: February 16, 2026

This notice explains how your health information may be used and disclosed, how you can access it, and your rights. Please review it carefully.

Privacy contact: Privacy Officer — Illahee Dental
Phone: 360-782-1000
Practice address: 1344 NE McWilliams Rd, Bremerton, WA 98311
Website: www.illaheedental.com

Your Rights

Access your records. You may request an electronic or paper copy of your dental record and other health information we maintain. We generally respond within 30 days and may charge a permitted reasonable, cost-based fee.

Ask for corrections. You may request an amendment to information you believe is inaccurate or incomplete. If we deny your request, we will explain why in writing, generally within 60 days.

Confidential communications. You may ask us to contact you in a particular way or at another address. We will accommodate reasonable requests.

Request restrictions. You may ask us to limit uses or disclosures for treatment, payment, or health care operations. We need not agree except that, when you pay out of pocket in full for a service, you may request that we not disclose that service to your health plan for payment or operations unless law requires disclosure.

Accounting of disclosures. You may request a list of certain disclosures made during the six years before your request. Some disclosures, including many for treatment, payment, and operations, are excluded. One accounting per 12-month period is free; permitted fees may apply to additional requests.

Copy of this notice. You may request a paper copy at any time, even if you agreed to receive it electronically.

Personal representative. A legally authorized representative may exercise your rights when permitted by law and after we verify authority.

Complaints. You may complain to our privacy contact or to the U.S. Department of Health and Human Services Office for Civil Rights at www.hhs.gov/hipaa/filing-a-complaint, 1-877-696-6775, or 200 Independence Avenue SW, Washington, DC 20201. We will not retaliate against you for filing a complaint.

Your Choices and Authorizations

You may tell us your preferences about sharing relevant information with family, friends, or others involved in your care or payment. In some circumstances we may use professional judgment to share information in your best interest.

We will obtain your written authorization for uses or disclosures that require it, including most marketing uses, sales of protected health information, and most uses of psychotherapy notes if applicable. You may revoke an authorization in writing, except to the extent we have already relied on it.

Fundraising communications, if any, will provide a way to opt out.

How We Use and Disclose Health Information

Treatment. We may share information with dentists, specialists, laboratories, pharmacies, and other professionals involved in your care.

Payment. We may use or disclose information to obtain payment from you, dental benefit plans, and other payers.

Health care operations. We may use information to manage our practice, assess quality, train personnel, and improve care.

Other legally permitted or required purposes. Subject to applicable conditions, we may disclose information for public health and safety, required reporting, health oversight, research, organ and tissue donation, medical examiners or funeral directors, workers’ compensation, law enforcement or government requests, and judicial or administrative proceedings. We may disclose information when required by law. Special restrictions may apply under state or federal law.

Special Protections for Substance Use Disorder Treatment Records (42 CFR Part 2)

If we receive or maintain records protected by 42 CFR Part 2 from a federally assisted substance use disorder treatment program, additional federal confidentiality protections apply.

When those records are disclosed to us pursuant to a valid general consent for treatment, payment, and health care operations, we may use and disclose them for those purposes as permitted by applicable law and that consent.

We will not use or disclose Part 2 records, or testify about them, in civil, criminal, administrative, or legislative proceedings against you without your specific written consent or a qualifying Part 2 court order accompanied by a subpoena or other legal mandate, as applicable.

Part 2 records may have additional consent and redisclosure restrictions. Where applicable, we will honor requirements concerning separate consent for certain records and uses. If we use Part 2 records for fundraising, we will provide advance notice and a choice about receiving such communications.

Our Responsibilities

• We must protect the privacy and security of your protected health information, follow the practices described in this notice, and provide a copy upon request.
• We will notify affected individuals when required if a breach of unsecured protected health information occurs.
• We will not use or disclose your information other than as described here unless you authorize it in writing or law permits or requires it. You may revoke your authorization in writing, subject to actions already taken in reliance on it.
• We may change this notice. Changes may apply to all information we maintain. The current notice will be available at our office, on our website, and upon request.

Washington Law and Additional Privacy Protections

We comply with applicable Washington State privacy and confidentiality laws when they provide additional protections for particular health information or restrict disclosure beyond federal HIPAA requirements.