HIPAA PRIVACY NOTICE
Renaissance Dental Clinic – Notice of Privacy Practices
Effective Date: 01/12/2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
WHO WILL FOLLOW THIS NOTICE?
This Notice of Privacy Practices describes the practices of Renaissance Dental Clinic (“Renaissance Dental Clinic”) and applies to all members of our workforce who create, receive, maintain, or access your medical information as part of their duties.
OUR PLEDGE REGARDING YOUR PROTECTED HEALTH INFORMATION
Renaissance Dental Clinic understands that medical and dental information about you and your health is personal. We are committed to protecting the privacy of your medical information.
We maintain medical records and conduct our dental practice with the goal of safeguarding your protected health information while providing high-quality dental care. This Notice applies to all records of your care created or received by Renaissance Dental Clinic.
Other healthcare providers (such as specialists, hospitals, or laboratories) may have different privacy practices regarding your medical information.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Protected health information (“PHI”) includes information that identifies you and relates to your past, present, or future physical or mental health condition and related healthcare services.
Uses and Disclosures for Treatment, Payment, and Healthcare Operations (TPO)
By becoming a patient at Renaissance Dental Clinic, you consent to the use and disclosure of your protected health information for treatment, payment, and healthcare operations.
- Treatment: We may use or disclose your health information to provide, coordinate, or manage your dental care. For example, we may share information with another dentist or specialist involved in your treatment.
- Payment: We may use or disclose your health information to bill and collect payment from insurance providers or other responsible parties.
- Healthcare Operations: We may use or disclose your health information to support business operations such as quality assessment, staff training, licensing, auditing, and administrative functions.
OTHER PERMITTED USES AND DISCLOSURES
The following uses and disclosures may be made without additional authorization, as permitted by law:
Appointment Reminders
We may contact you to remind you of scheduled appointments or to provide information about your care. If you request confidential communication methods, please submit your request in writing to:
Renaissance Dental Clinic
12002 SW 128th Ct., Suite 210
Miami, FL 33186
We will accommodate reasonable requests.
Individuals Involved in Your Care
We may disclose relevant health information to a family member, friend, or other individual you identify who is involved in your care or payment, unless you object.
Emergency Situations
We may use or disclose protected health information in emergency treatment situations. If possible, we will attempt to obtain your acknowledgment of this Notice after treatment.
Health-Related Benefits and Services
We may contact you regarding dental services, treatment options, or benefits that may be of interest to you.
Required by Law
We may disclose your protected health information when required by federal, state, or local law, or to the U.S. Department of Health and Human Services for compliance investigations.
Communicable Diseases
We may disclose health information, as authorized by law, to individuals or entities responsible for preventing or controlling disease.
Health Oversight Activities
We may disclose health information to health oversight agencies for audits, investigations, inspections, or licensing purposes.
Abuse or Neglect
We may disclose health information to appropriate authorities if required by law regarding suspected abuse, neglect, or domestic violence, in accordance with Florida law.
Food and Drug Administration (FDA)
We may disclose health information to the FDA or entities regulated by the FDA for product monitoring, reporting adverse events, or recalls.
Legal Proceedings
We may disclose protected health information in response to a court order, subpoena, or other lawful process, subject to applicable legal requirements.
Law Enforcement
We may disclose protected health information to law enforcement officials as required or permitted by law.
Coroners, Medical Examiners, Funeral Directors, and Organ Donation
We may disclose health information for identification, determination of cause of death, or organ donation purposes as permitted by law.
Research
We may disclose protected health information for approved research purposes, subject to legal privacy protections.
Serious Threats to Health or Safety
We may disclose protected health information if necessary to prevent or lessen a serious and imminent threat to health or safety, as permitted by law.
Workers’ Compensation
We may disclose health information as required for workers’ compensation or similar programs.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
Right to Inspect and Copy
You have the right to inspect and obtain copies of your medical and billing records. Requests must be made in writing. Fees may apply.
Right to Request Restrictions
You may request restrictions on the use or disclosure of your health information. We are not required to agree to all requests.
Right to Confidential Communications
You may request to receive communications by alternative means or locations. Requests must be submitted in writing.
Right to Amend
If you believe your health information is incorrect or incomplete, you may request an amendment. Requests must be submitted in writing.
Right to an Accounting of Disclosures
You may request a list of disclosures made for purposes other than treatment, payment, or healthcare operations, subject to legal limits.
Right to a Paper Copy
You have the right to receive a paper copy of this Notice at any time.
CHANGES TO THIS NOTICE
Renaissance Dental Clinic reserves the right to change this Notice and make the revised Notice effective for all protected health information we maintain. The current Notice will be available at our office and on our website.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with:
Renaissance Dental Clinic – Office Manager
12002 SW 128th Ct., Suite 210
Miami, FL 33186
Phone: +1 (786) 776-3328
You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
QUESTIONS
If you have questions about this Notice or your privacy rights, please contact the Office Manager at +1 (786) 776-3328.
