HIPAA Notice of Privacy Practices

Effective Date: February 6, 2026

This Notice describes how health information about you may be used and disclosed and how you can access this information. Please review it carefully.

Lost Sierra Dental is required by law to maintain the privacy of your protected health information (PHI), provide you with this Notice of our legal duties and privacy practices, and notify you following a breach of unsecured PHI if one occurs.

We are required to follow the terms of this Notice while it is in effect. We reserve the right to change our privacy practices and update this Notice at any time, as permitted by law. When we make significant changes, we will update this page and post the revised Notice at our office. Copies are available upon request.

How We May Use and Disclose Your Health Information

We may use and disclose your health information for the following purposes:

Treatment

We may use or share your information to provide, coordinate, or manage your dental care. For example, we may share information with a specialist involved in your treatment.

Payment

We may use or disclose your information to obtain payment for services. This includes billing, claims submission, eligibility verification, and insurance processing.
If you choose to pay out of pocket in full, you may request that we not disclose related information to your dental plan.

Healthcare Operations

We may use your information for administrative purposes such as quality improvement, staff training, licensing, accreditation, and compliance.

Special Protections

Certain records, including HIV-related information, genetic information, mental health records, alcohol or substance use disorder records, may be protected under additional state or federal laws. We comply fully with those protections.

If we receive substance use disorder treatment records covered under federal regulation (42 CFR Part 2), we will use or disclose them only as permitted by law or your written consent.

Other Situations Where We May Disclose Information

We may disclose your health information when required or permitted by law, including:

  • Public health reporting

  • Reporting abuse, neglect, or domestic violence

  • Health oversight activities (audits, inspections, licensure)

  • Law enforcement purposes

  • Judicial or administrative proceedings

  • Worker’s compensation claims

  • National security and military purposes

  • Disaster relief efforts

  • Research approved by a privacy board

  • Coroners, medical examiners, or funeral directors

We will disclose your information to the U.S. Department of Health and Human Services when required to demonstrate HIPAA compliance.

Individuals Involved in Your Care

We may share relevant health information with family members, friends, or others involved in your care or payment, unless you object. If someone is legally authorized to make healthcare decisions for you, we will treat that person as your representative.

Uses That Require Your Authorization

We will obtain your written authorization before:

  • Disclosing psychotherapy notes

  • Using or disclosing PHI for marketing

  • Selling PHI

  • Any other use not described in this Notice

You may revoke your authorization in writing at any time.

Your Rights Regarding Your Health Information

You have the following rights:

Right to Access

You may request copies of your health records. Requests must be submitted in writing. We may charge a reasonable cost-based fee for copies.

Right to an Accounting of Disclosures

You may request a list of certain disclosures we have made of your PHI.

Right to Request Restrictions

You may request limits on how we use or disclose your information. We are not required to agree, except when you pay in full out-of-pocket and request that information not be shared with your health plan.

Right to Request Alternative Communication

You may request that we contact you in a specific way or at a specific location.

Right to Notification of a Breach

You will be notified if a breach of your unsecured PHI occurs as required by law.

Questions or Complaints

If you have questions about this Notice or believe your privacy rights have been violated, please contact us:

Privacy Officer: Emily S. Luscri, DDS
Address: 431 Main St., Quincy, CA 95971
Phone: 530.283.1119
Fax: 530.283.2319

You may also file a complaint with the U.S. Department of Health and Human Services. We will provide contact information upon request.

We will not retaliate against you for filing a complaint.