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Effective Date: November 2026

Peter Kaufman OMS

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.

At Peter Kaufman OMS, we are committed to protecting the privacy and confidentiality of your personal health information. This Notice of Privacy Practices explains how we may use and disclose your protected health information (PHI), your rights regarding that information, and our legal responsibilities under the Health Insurance Portability and Accountability Act (HIPAA).

1. Our Commitment to Your Privacy

We understand that information about your health and medical care is personal. We are required by law to maintain the privacy and security of your protected health information, provide you with this notice, and follow the privacy practices described in it.

We will notify affected individuals when required by law if a breach compromises the privacy or security of their protected health information.

2. How We May Use and Disclose Your Health Information

We may use or disclose your protected health information without your written authorization for purposes permitted or required by law, including:

Treatment

We may use and share your health information with dentists, oral surgeons, physicians, specialists, and other healthcare professionals involved in your treatment.

For example, we may share relevant medical records, diagnostic images, or treatment plans with another healthcare provider coordinating your care.

Payment

We may use and disclose health information to obtain payment for services provided, verify insurance coverage, submit claims, and process billing.

Healthcare Operations

We may use health information to manage our practice, evaluate the quality of our services, train authorized staff, and improve patient care.

Other Uses Permitted or Required by Law

We may disclose health information when permitted or required for public health activities, health oversight, reporting certain injuries or conditions, responding to lawful government requests, workers' compensation matters, or legal proceedings.

Disclosures for research, law enforcement, and other legally authorized purposes will be made only when applicable legal requirements are satisfied.

3. Your Rights Regarding Your Health Information

Under HIPAA, you have certain rights concerning your protected health information.

Right to Access Your Records

You may request to inspect or obtain an electronic or paper copy of your medical and billing records, subject to applicable legal exceptions.

We will generally respond within 30 days and may charge a reasonable, cost-based fee when permitted by law.

Right to Request Corrections

If you believe your health information is incorrect or incomplete, you may request an amendment.

We may deny certain requests, but we will explain the reason in writing within the time required by law.

Right to Request Restrictions

You may request limitations on how we use or disclose your information for treatment, payment, or healthcare operations.

We are not required to agree to every request. However, when you pay in full out of pocket for a service, you may request that information about that service not be disclosed to your health plan for payment or healthcare operations, unless disclosure is required by law.

Right to Confidential Communications

You may request that we contact you using a specific method or at an alternative address.

We will accommodate reasonable requests.

Right to an Accounting of Disclosures

You may request a list of certain disclosures of your protected health information made during the previous six years, subject to applicable exceptions.

Right to a Paper Copy

You may request a paper copy of this Notice of Privacy Practices at any time, even if you have agreed to receive it electronically.

Right to Choose a Personal Representative

If someone has legal authority to act on your behalf, such as a legal guardian or an individual holding an appropriate healthcare power of attorney, that person may exercise your privacy rights as permitted by law.

4. Your Choices About Sharing Information

In certain circumstances, you may tell us how you would like your health information shared.

These circumstances may include:

• Sharing information with family members or friends involved in your care

• Sharing information with individuals involved in payment for your treatment

• Providing information during disaster relief situations

If you cannot communicate your preferences, we may share relevant information when permitted by law and when we believe doing so is in your best interest.

5. Uses and Disclosures Requiring Written Authorization

Certain uses and disclosures of protected health information require your written authorization.

These generally include:

• Uses or disclosures for marketing when authorization is required by law

• Sale of protected health information

• Most uses and disclosures of psychotherapy notes, if applicable

• Other uses or disclosures not otherwise permitted or required by law

You may revoke your authorization in writing at any time, except to the extent that we have already acted in reliance on it.

6. Substance Use Disorder Records

Certain substance use disorder treatment records may receive additional privacy protections under federal law, including 42 CFR Part 2.

To the extent that Peter Kaufman OMS maintains records subject to these requirements, their use and disclosure will be governed by applicable federal protections.

Such records generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your specific written consent or an appropriate court order accompanied by the required legal process.

If applicable, additional consent and redisclosure requirements will be followed.

7. Our Responsibilities

Peter Kaufman OMS is required to:

• Maintain the privacy and security of protected health information

• Implement appropriate safeguards against unauthorized access or disclosure

• Notify affected individuals of breaches when required by law

• Follow the privacy practices described in this notice

• Provide patients with access to this notice

• Comply with applicable federal and state privacy requirements

We will not use or disclose your protected health information in ways not described in this notice unless you provide written authorization or applicable law otherwise permits or requires the disclosure.

8. Changes to This Notice

We reserve the right to revise this Notice of Privacy Practices as permitted by law.

Any revised notice may apply to protected health information we already maintain, as well as information received in the future.

The updated notice will be available upon request, at our office, and on our website.

9. Filing a Privacy Complaint

If you believe your privacy rights have been violated, you may file a complaint directly with Peter Kaufman OMS or with the U.S. Department of Health and Human Services Office for Civil Rights.

You will not be retaliated against for filing a complaint.

Complaints to the U.S. Department of Health and Human Services may be submitted through:

U.S. Department of Health and Human Services

Office for Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

Phone: 1-877-696-6775

Website: https://www.hhs.gov/hipaa/filing-a-complaint/

10. Contact Information

If you have questions about this Notice of Privacy Practices, wish to exercise your privacy rights, or would like to submit a privacy complaint, please contact:

Peter Kaufman OMS

Website: https://www.peterkaufmanoms.com/

Phone: (941) 491-1582 / (941) 294-5537