Notice of Privacy Practices

Effective April 17, 2026 · Version 1.0

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.

Creekside Kids Dentistry respects your privacy and is required by federal law (HIPAA) and California law (CMIA) to protect your child's health information. This page summarizes how we use that information and your rights. For complete detail, download our full Notice of Privacy Practices (PDF link below).

How we use your health information

Without asking separately for your permission, we use and disclose your child's protected health information (PHI) for three purposes:

• Treatment — providing dental care, including sharing with specialists we refer you to (for example, an orthodontist or oral surgeon).
• Payment — submitting claims to your insurance, verifying benefits, and collecting payment for services.
• Health care operations — running the practice, including training staff, quality review, and sending appointment reminders.

We may also disclose information when required or permitted by law — for example, public health reporting (including child-abuse reporting), court orders or subpoenas, law enforcement requests, and workers’ compensation claims.

When we need your written permission

We will obtain your written authorization before any of the following:

• Marketing that involves payment to us from another party.
• Any sale of PHI.
• Disclosure of psychotherapy notes (rare in a dental practice).
• Sharing PHI with anyone not involved in your child’s care, unless permitted or required by law.

You can revoke any authorization in writing at any time. Revocation does not affect disclosures we already made.

Additional California protections

California law (CMIA) provides added protections. In particular:

• We do not sell or lease your medical information for money or other consideration.
• We do not disclose medical information for marketing without your specific written authorization.
• You may inspect your records within 5 working days of a written request, and obtain copies within 15 days.

Additional federal protections for substance-use-disorder records

Federal law (42 C.F.R. Part 2) provides heightened privacy protections for any record of substance use disorder diagnosis, treatment, or referral. If we maintain such records, we may be more limited in how we use or share them.

Your rights

You have the right to:

• Inspect and receive a copy of your PHI.
• Request that we amend your record.
• Request an accounting of certain disclosures.
• Request restrictions on how we use or share your PHI.
• Request confidential communications (for example, contact only by a specific phone number or mailing address).
• Receive a paper copy of this notice at any time.
• Be notified of any breach of your unsecured PHI.

Submit all requests in writing to our Privacy Officer (contact below).

Special protections for minors

Most of our patients are minors. Dental care is generally provided with parental or guardian consent. California law allows a minor of any age to consent to limited types of care independently (for example, certain mental-health, reproductive, or substance-use services). When a minor consents to care on their own under California law, that minor’s PHI about that care is protected from disclosure to the parent unless the minor authorizes disclosure or another legal exception applies.

Our duties

We are required to maintain the privacy and security of your PHI, follow the terms of this Notice, and notify you of any breach of unsecured PHI. We reserve the right to change this Notice; the most current version will always be available at our office and on this page.

Complaints

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

• With our practice — call (925) 504-1200 or email info@creeksidekidsdentistry.com.
• With the federal government — U.S. Department of Health and Human Services, Office for Civil Rights. Phone: 1-800-368-1019. Website: www.hhs.gov/ocr/privacy/hipaa/complaints/

Privacy Officer

Dr. Michael Sychrava, DMD
Creekside Kids Dentistry
1855 Olympic Blvd, Suite 360, Walnut Creek, CA 94596
(925) 504-1200 · info@creeksidekidsdentistry.com