Notice of Privacy Practices (HIPAA)
Effective Date: December, 15, 2025
This Notice of Privacy Practices describes how Sophia Rozov, D.D.S., Inc., doing business as Smile Avenue Dental Group may use and disclose your protected health information (PHI) and how you can access this information.
Our Commitment to Your Privacy
We are committed to protecting the privacy of your health information.
We are required by law to maintain the confidentiality of your protected health information and to provide you with this notice explaining our legal duties and privacy practices.
How We May Use and Disclose Your Health Information
We may use or share your protected health information for the following purposes:
Treatment
To provide, coordinate, or manage your dental care.
This may include sharing information with other healthcare providers involved in your treatment.
Payment
To bill and collect payment from insurance companies, dental plans, or other responsible parties.
Healthcare Operations
To support our business operations, such as quality assessment, staff training, licensing, and compliance activities.
Other Permitted Uses and Disclosures
We may also use or disclose your health information when required or permitted by law, including:
Public health activities
Health oversight activities
Law enforcement purposes
To prevent a serious threat to health or safety
As required by workers’ compensation laws
Authorization requirement
Uses Requiring Your Written Authorization For any use or disclosure of your health information not described above — such as for marketing purposes — we will obtain your written authorization. You may revoke this authorization at any time by notifying us in writing, except to the extent we have already acted in reliance on it.
Your Rights Regarding Your Health Information
You have the right to:
Access your health records
Request corrections to your records
Request restrictions on certain uses or disclosures
Request confidential communications
Receive a paper copy of this Notice at any time
Receive an accounting of certain disclosures of your health information made by us in the six years prior to your request (excluding disclosures for treatment, payment, healthcare operations, and certain other exceptions)
To exercise any of these rights, please contact our office.
Our Responsibilities
We are required by law to:
Maintain the privacy of your protected health information
Provide you with this Notice of Privacy Practices
Follow the terms of this notice
Privacy Officer - Designate a Privacy Officer responsible for ensuring compliance with this Notice and applicable privacy laws
We will notify you if a breach occurs that may compromise the privacy or security of your information.
Changes to This Notice
We reserve the right to change this Notice of Privacy Practices at any time.
Any changes will apply to all health information we maintain and will be posted on our website and available in our office.
Questions or Complaints
If you have questions about this Notice or believe your privacy rights have been violated, please contact:
Sophia Rozov, D.D.S., Inc.
DBA Smile Avenue Dental Group
📍 8543 Rosemead Blvd # D, Pico Rivera, CA, USA
📞 +1 562 904 0400
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at www.hhs.gov/hipaa/filing-a-complaint or by mail, fax, or email as described on that page. You will not be penalized for filing a complaint.
