Notice of Privacy Practices

01About this notice

This notice applies to Artistic Dentistry, the dental practice of Dr. Kami Hazaveh, DMD, at 501 Carsonia Avenue, Reading, PA 19606. It explains how we may use and share your health information, your rights regarding that information, and our responsibilities to protect it. This notice is effective October 11, 2026.

We post this copy on our website for your convenience. It does not replace the paper notice we give you in our office. You can ask for a paper copy at any time, in our office or by contacting our Privacy Officer.

To use any of the rights described below, contact our Privacy Officer using the information at the end of this notice. We may ask you to make certain requests in writing.

02Your rights: copies and corrections

Get a copy of your health records. You can ask to see or get an electronic or paper copy of your dental records and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your records. You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say no to your request, but we will tell you why in writing within 60 days.

03Your rights: how we contact you and what we share

Request confidential communications. You can ask us to contact you in a specific way (for example, by home or office phone) or to send mail to a different address. We will say yes to all reasonable requests.

Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say no if it would affect your care.

Services you pay for yourself. If you pay for a service or health care item out of pocket in full, you can ask us not to share that information with your health insurer for the purpose of payment or our operations. We will say yes unless a law requires us to share that information.

04Your rights: list of disclosures and copy of notice

Get a list of those with whom we have shared information. You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all disclosures except those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one list a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

05Your rights: choose someone to act for you

If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. A parent or guardian can generally do the same for a minor child, subject to applicable law. We will make sure the person has this authority and can act for you before we take any action.

06Your rights: file a complaint

If you feel we have violated your rights, you can file a complaint with us by contacting our Privacy Officer by phone at (610) 779-0911 or by mail at Artistic Dentistry, Attn: Privacy Officer, 501 Carsonia Avenue, Reading, PA 19606.

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

07Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and the choice to tell us to:

• Share information with your family, close friends, or others involved in your care.
• Share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes.
• Sale of your information.

08How we use and share your information

We typically use or share your health information in the following ways:

• To treat you. We can use your health information and share it with other professionals who are treating you. For example, we may share information with a dental specialist, such as an oral surgeon, or with your physician when they are involved in your care.
• To run our practice. We can use and share your health information to run our practice, improve your care, and contact you when necessary, for example to manage your treatment and to remind you of appointments.
• To bill for your services. We can use and share your health information to bill and get payment from health plans or other entities. For example, we give information about you to your dental insurance plan so it will pay for your services.

09Other ways we may use or share your information

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

• Public health. We can share health information about you for certain situations, such as preventing disease, helping with product recalls, and reporting adverse reactions to medications.
• Safety. We can share health information about you to report suspected abuse, neglect, or domestic violence, or to prevent or reduce a serious threat to anyone’s health or safety.
• Research. We can use or share your information for health research, as the law allows.
• Complying with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
• Organ and tissue donation. We can share health information about you with organ procurement organizations.
• Medical examiners and funeral directors. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

10Government requests and legal actions

We can use or share health information about you:

• For workers’ compensation claims.
• For law enforcement purposes or with a law enforcement official.
• With health oversight agencies for activities authorized by law.
• For special government functions, such as military, national security, and presidential protective services.
• In response to a court or administrative order, or in response to a subpoena.

11Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Where Pennsylvania or other applicable law gives certain health information more protection than federal law, we follow the more protective law.

12Changes to this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

13Contact our Privacy Officer

For questions about this notice, to use any of your rights, or to file a complaint with us, contact our Privacy Officer. Our office is open Monday to Friday, 8am to 7pm, and Saturday, 8am to 2pm.

• Phone: (610) 779-0911
• Mail: Artistic Dentistry, Attn: Privacy Officer, 501 Carsonia Avenue, Reading, PA 19606

Effective date of this notice: October 11, 2026.