Notice of Privacy Practices

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.

Effective date: September 30, 2026

This Notice applies to Cerritos Dental Surgery, the practice of Dr. Shawn Hofkes, and to our workforce members who handle your health information. We are required by law to maintain the privacy of your protected health information (“PHI”), to give you this Notice of our legal duties and privacy practices, and to notify you following a breach of unsecured PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or payment for that care.

How We May Use and Disclose Your PHI for Treatment, Payment, and Health Care Operations

We may use and disclose your PHI without your written authorization for the following purposes:

  • Treatment. We may use and share your PHI to provide, coordinate, or manage your care. For example, we may share information with your dentist, physician, anesthesia provider, or other specialist who is involved in your care, or with a pharmacy to fill a prescription.
  • Payment. We may use and share your PHI to bill and collect payment for services, such as sending information to your dental or medical insurance plan to determine coverage, obtain pre-authorization, or pay claims.
  • Health care operations. We may use and share your PHI for activities needed to run our practice, such as quality assessment and improvement, training, licensing and credentialing, auditing, legal services, business planning, and appointment reminders. We may also share PHI with business associates who perform services for us and who have agreed in writing to protect your information.

Other Uses and Disclosures Permitted Without Your Authorization

Federal and state law allow or require us to use or disclose your PHI without your authorization in certain situations, including:

  • Persons involved in your care or payment for your care, such as family members or friends, when you agree or do not object, or when we determine in our professional judgment that it is in your best interest, including in emergencies
  • Appointment reminders, treatment alternatives, and health-related benefits or services that may interest you
  • Public health activities, such as reporting disease, injury, or vital events, and reporting adverse reactions to medications or medical devices
  • Reporting suspected abuse, neglect, or domestic violence to authorities as required or permitted by law
  • Health oversight activities, such as audits, inspections, and licensure actions by government agencies
  • Judicial and administrative proceedings, in response to a court order, subpoena, or other lawful process
  • Law enforcement purposes, as permitted or required by law
  • Coroners, medical examiners, and funeral directors
  • Organ, eye, or tissue donation
  • Research, when approved through a process that protects the privacy of your information
  • Preventing or lessening a serious and imminent threat to health or safety
  • Specialized government functions, such as military and veterans activities, national security, and protective services
  • Workers’ compensation programs, as authorized by law
  • Disclosures required by law, including to the U.S. Department of Health and Human Services to determine our compliance with privacy rules

Uses and Disclosures That Require Your Written Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice. In particular, we will obtain your authorization for:

  • Psychotherapy notes. Most uses and disclosures of psychotherapy notes require your authorization, with limited exceptions permitted by law.
  • Marketing. Uses and disclosures of PHI for marketing purposes require your authorization, except for face-to-face communications made to you and promotional gifts of nominal value.
  • Sale of PHI. We will not sell your PHI without your authorization.

You may revoke an authorization at any time by giving us written notice, except to the extent we have already acted in reliance on it.

Your Rights Regarding Your PHI

  • Right to access. You have the right to inspect and obtain a copy of your PHI in our designated record set, including an electronic copy if the information is maintained electronically, and to direct that a copy be sent to another person you designate in writing. We may charge a reasonable, cost-based fee for copies. We may deny access in limited circumstances and, in some cases, you may request a review of the denial.
  • Right to request an amendment. If you believe your PHI is incorrect or incomplete, you may ask us in writing to amend it. We may deny the request in certain circumstances, and if we do, we will explain why in writing and describe your options, including submitting a statement of disagreement.
  • Right to an accounting of disclosures. You may request a list of certain disclosures of your PHI that we made in the six years before your request. The list does not include disclosures for treatment, payment, and health care operations, disclosures made to you or with your authorization, and certain other disclosures. One accounting per year is free; we may charge a reasonable fee for additional requests.
  • Right to request restrictions. You may ask us to restrict how we use or disclose your PHI for treatment, payment, or health care operations, or to persons involved in your care. We are not required to agree, except that we must agree to your request to restrict disclosure to a health plan for payment or operations purposes when the disclosure is not required by law and the PHI relates solely to an item or service for which you or someone other than the health plan has paid in full out of pocket.
  • Right to request confidential communications. You may ask that we contact you about your health information by alternative means or at an alternative location, such as a different phone number or mailing address. We will accommodate reasonable requests.
  • Right to a paper copy of this Notice. You may ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically.
  • Right to revoke an authorization. You may revoke a written authorization at any time, as described above.
  • Right to be notified of a breach. You have the right to be notified if we discover a breach of your unsecured PHI. We will notify you without unreasonable delay and no later than required by law.

To exercise any of these rights, please contact our Privacy Officer using the information at the end of this Notice. We may ask that requests be made in writing.

Our Duties

  • We are required by law to maintain the privacy and security of your PHI.
  • 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.

Changes to This Notice

We reserve the right to change the terms of this Notice and to make the new terms effective for all PHI we maintain, including PHI we created or received before the change. If we revise this Notice, we will post the revised Notice at our office and on our website at https://cerritosdentalsurgery.com/notice-of-privacy-practices/, and we will provide a copy upon request.

California-Specific Information

California law, including the Confidentiality of Medical Information Act (CMIA), provides additional protections for medical information. Where California law is more protective of your privacy or gives you greater rights than federal law, we will follow California law. For example, California law generally requires your authorization for disclosures of medical information that are not for treatment, payment, health care operations, or another use permitted or required by law, and places additional limits on the disclosure of certain sensitive information.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the federal government. You will not be retaliated against or penalized for filing a complaint.

  • With our practice: Contact our Privacy Officer by phone at 562-584-4082 or by mail at Privacy Officer, Cerritos Dental Surgery, 11480 South St #201, Cerritos, CA 90703.
  • With the U.S. Department of Health and Human Services, Office for Civil Rights: Visit https://www.hhs.gov/hipaa/filing-a-complaint/index.html, call 1-877-696-6775, or write to the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201.

Contact Person

For questions about this Notice or to exercise your rights, contact:

  • Privacy Officer, Cerritos Dental Surgery
  • 11480 South St #201, Cerritos, CA 90703
  • Phone: 562-584-4082

Effective date of this Notice: September 30, 2026.