Pendleton Neighborhood Dental
HIPAA Notice of Privacy Practices
Effective Date: August 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.
Pendleton Neighborhood Dental is required by federal law to maintain the privacy of your protected
health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to
notify you following a breach of unsecured PHI. We are required to follow the privacy practices
described in this Notice while it is in effect. We reserve the right to change this Notice and our privacy
practices at any time, as permitted by applicable law. Any changes will apply to all PHI we maintain.
When we make a significant change, we will post the updated Notice in our office and on our website,
and provide copies upon request.
How We May Use and Disclose Your Health Information
For Treatment
We may use and disclose your PHI to provide, coordinate, or manage your dental care. For example, we
may share your information with a specialist, such as an oral surgeon, endodontist, or orthodontist, to
whom we refer you, or with your physician or pharmacist when relevant to your care.
For Payment
We may use and disclose your PHI to obtain payment for services. For example, we may submit claims
to your dental insurance plan, verify benefits, or share information with billing services and collection
agencies as permitted by law.
For Healthcare Operations
We may use and disclose your PHI to operate our practice. This includes activities such as quality
improvement, staff training, credentialing, scheduling, and general business management.
Appointment Reminders and Treatment Information
We may contact you by phone, text message, email, or postal mail to remind you of appointments,
share treatment information, or recommend health-related services that may interest you.
Individuals Involved in Your Care
With your permission, we may share your PHI with family members, friends, or others you identify as
involved in your care or payment for your care.
Special Situations
Federal and state law allow or require us to use or disclose your PHI without your authorization in
certain situations, including:
• Public health activities, such as reporting communicable diseases or product recalls
• Reporting suspected abuse, neglect, or domestic violence
• Health oversight activities such as audits, investigations, and licensing inspections
• Judicial and administrative proceedings, including subpoenas and court orders
• Law enforcement purposes as permitted or required by law
• Coroners, medical examiners, and funeral directors
• Organ and tissue donation
• Workers’ compensation claims
• Serious threats to health or safety
• Specialized government functions, including military, national security, and protective services
• Research, when approved through an established review process
• Disclosures required by the U.S. Department of Health and Human Services to investigate
compliance with HIPAA
Special Protections for Sensitive Information
Some types of information receive additional legal protection under federal or state law and may
require your specific written authorization before disclosure. These include:
• HIV/AIDS-related information
• Genetic information
• Mental health and psychotherapy records
• Alcohol and substance use disorder treatment records
Substance Use Disorder Records (42 CFR Part 2)
In limited situations, our practice may receive substance use disorder (SUD) treatment records from a
federally assisted treatment program subject to 42 CFR Part 2. When Part 2 applies, those records
receive heightened confidentiality protection beyond what HIPAA requires. We will not redisclose Part 2
records except as permitted by Part 2, generally, only with your specific written consent or under one of
the limited exceptions allowed by law, such as medical emergencies, reports of child abuse, or court
orders meeting Part 2 requirements. This applies regardless of whether the same information appears
elsewhere in your dental record.
Uses and Disclosures Requiring Your Written Authorization
Other uses and disclosures of your PHI not described in this Notice will be made only with your written
authorization. Specifically, we will obtain your written authorization before:
• Using or disclosing your PHI for marketing purposes, with limited exceptions allowed by law
• Selling your PHI
• Using or disclosing psychotherapy notes, if applicable
You may revoke your authorization in writing at any time, except to the extent we have already acted in
reliance on it.
Your Rights Regarding Your Health Information
Right to Inspect and Copy
You have the right to inspect and request a copy of your PHI maintained in our records. Requests must
be made in writing. We may charge a reasonable, cost-based fee for copies as permitted by law. We
may deny access in certain limited circumstances, and you may have the right to have the denial
reviewed.
Right to an Electronic Copy
If we maintain your PHI electronically, you have the right to request an electronic copy in the form and
format you request, if readily producible.
Right to Request an Amendment
If you believe your PHI is incorrect or incomplete, you may request a written amendment. We may deny
your request under certain circumstances and will explain our reason in writing.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your PHI, other than
disclosures made for treatment, payment, healthcare operations, or those you authorized.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your PHI. We are not required to
agree to your request, except that we must agree to a restriction on disclosures to a health plan for
payment or healthcare operations if you have paid for the service in full out of pocket and the disclosure
is not otherwise required by law.
Right to Confidential Communications
You have the right to request that we communicate with you about your PHI in a particular way or at a
particular location, for example, by mail to a specific address or by phone at a specific number. We will
accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive
it electronically. To request a copy, ask any staff member or contact our Privacy Officer.
Right to Be Notified of a Breach
You have the right to be notified following a breach of your unsecured PHI.
Our Legal Duties
We are required by law to:
• Maintain the privacy and security of your PHI
• Provide you with this Notice of our legal duties and privacy practices
• Follow the terms of the Notice currently in effect
• Notify you following a breach of your unsecured PHI
Changes to This Notice
We reserve the right to change this Notice at any time. Changes will apply to PHI we already have as well
as information we receive in the future. The current Notice is posted in our office and on our website,
and includes the effective date. You may request a copy of the current Notice at any time.
Complaints
If you believe your privacy rights have been violated, you may file a written complaint with our Privacy
Officer or with the U.S. Department of Health and Human Services. You will not be retaliated against for
filing a complaint.
To file a complaint with our practice, contact:
Privacy Officer: Dr. Kerills Habashi
Pendleton Neighborhood Dental
137 Cotesworth St., Unit E
Pendleton, SC 29670
Phone: (864) 502-8299
Email: info@pendletondentalsc.com
To file a complaint with the federal government, contact:
U.S. Department of Health and Human Services
Office for Civil Rights
Online: www.hhs.gov/ocr/privacy/hipaa/complaints/
Phone: 1-800-368-1019
TDD: 1-800-537-7697
