NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU (OR YOUR CHILD) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.

Our Legal Duty

We are required by applicable federal and state law to protect the privacy of your protected health information ("PHI"). We are also required to provide you with this Notice describing our privacy practices, our legal duties, and your rights regarding your PHI. We will follow the terms of this Notice while it remains in effect. This Notice takes effect January 1, 2026, and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this Notice at any time, as permitted by applicable law. Any such changes will apply to all PHI we maintain, including information created or received before the change was made.

You may request a copy of this Notice, or any future revised version, at any time by contacting us using the information at the end of this Notice.

Uses and Disclosures of Protected Health Information

We use and disclose PHI for treatment, payment, and healthcare operations. The examples below illustrate — but do not fully capture — the ways your information may be used or disclosed.

Treatment. We use and disclose PHI to provide, coordinate, and manage your child's dental care, including care coordinated with other providers. For example, we may share PHI with a specialist or anesthesiologist involved in your child's treatment, or with a provider to whom your child has been referred, so they have the information needed to diagnose or treat appropriately. We may also share PHI with another provider who becomes involved in your child's care at our request to assist with diagnosis or treatment.

Payment. We use PHI as needed to obtain payment for services provided. This may include activities your dental plan undertakes before approving or paying for recommended care, such as confirming eligibility, reviewing medical necessity, or conducting utilization review. For example, obtaining approval for a procedure may require disclosing relevant PHI to your insurance plan.

Healthcare Operations. We use and disclose PHI as needed to conduct routine business and operational activities, including quality assessment, staff training, licensing, and related business functions. For example, we may use a sign-in sheet at the front desk, call patients by name in the waiting area, or contact you by phone or mail to remind you of an appointment.

We share PHI with third-party "business associates" who perform services for our practice, such as billing or transcription. Any such arrangement is governed by a written contract requiring the business associate to protect the privacy of your PHI.

We may use or disclose PHI to inform you about treatment alternatives or other health-related services that may be of interest, and for other practice communications — for example, sending a newsletter about our practice. You may contact us at any time to opt out of receiving these materials.

Uses and Disclosures Requiring Your Written Authorization. Other than as described in this Notice, we will use or disclose your PHI only with your written authorization. You may revoke an authorization in writing at any time; the revocation will not affect uses or disclosures that already took place while the authorization was in effect.

Others Involved in Care. Unless you object, we may share PHI relevant to a family member, close friend, or other person's involvement in your child's care. If you are unavailable to agree or object, we may share such information if we determine, using our professional judgment, that doing so is in your child's best interest. We may also share PHI to notify a family member or other responsible person of your child's location or general condition.

Marketing. We may contact you with information about treatment alternatives that may interest you, and may involve a business associate in these communications. You may opt out of further marketing communications — other than general newsletters, in-person conversations, or communications about products or services of nominal value — by contacting us using the information at the end of this Notice.

Research; Death; Organ Donation. We may use or disclose PHI for research purposes in limited circumstances permitted by law. We may disclose the PHI of a deceased patient to a coroner, medical examiner, funeral director, or organ procurement organization for purposes related to their duties.

Public Health and Safety. We may disclose PHI to the extent necessary to prevent or lessen a serious and imminent threat to your child's health or safety, or to the health or safety of others. We may also disclose PHI to a government agency authorized to oversee the healthcare system, or to public health authorities for public health purposes.

Health Oversight. We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections, including agencies that oversee the healthcare system, government benefit programs, or civil rights compliance.

Abuse or Neglect. We may disclose PHI to a public health authority authorized by law to receive reports of child abuse or neglect, consistent with applicable federal and state law.

Food and Drug Administration. We may disclose PHI to a person or entity required by the FDA to report adverse events, product defects, or biologic product deviations; to track products; to enable recalls; to facilitate repairs or replacements; or to conduct post-marketing surveillance.

Criminal Activity. Consistent with applicable law, we may disclose PHI if we believe it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, or where necessary for law enforcement to identify or apprehend an individual.

Required by Law. We will use or disclose PHI when required to do so by law — for example, upon request by the U.S. Department of Health and Human Services to determine our compliance with federal privacy law, or as authorized by workers' compensation or similar laws.

Legal Process and Proceedings. We may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. In limited situations — such as a court order, warrant, or grand jury subpoena — we may disclose PHI to law enforcement.

Law Enforcement. We may disclose limited PHI to a law enforcement official regarding a suspect, fugitive, material witness, crime victim, or missing person, or regarding an inmate or person in lawful custody, under circumstances permitted by law.

Special Considerations for Pediatric Patients

Because most of our patients are minors, PHI is generally shared with and directed to the parent(s) or legal guardian(s) authorized to make healthcare decisions on the patient's behalf. Where parents share legal custody, both custodial parents generally retain equal rights to access their child's records unless we receive a court order stating otherwise. Please provide any custody-related restrictions on record access to us in writing.

Patient Rights

Access. You have the right to inspect or obtain copies of PHI, with limited exceptions. Requests must be made in writing to the contact listed at the end of this Notice. We may charge a reasonable, cost-based fee to cover the cost of locating, copying, and — if applicable — mailing records. If you prefer, we can instead prepare a summary or explanation of the records for a fee. Contact us for a full explanation of our fee structure.

Accounting of Disclosures. You have the right to receive a list of certain disclosures of PHI made for purposes other than treatment, payment, healthcare operations, and certain other activities, generally covering the six years prior to your request. This accounting will include the date of disclosure, the recipient, a description of the information disclosed, and the reason for disclosure. If you request this list more than once in a 12-month period, we may charge a reasonable, cost-based fee for additional requests.

Restriction Requests. You have the right to request additional restrictions on our use or disclosure of your PHI. We are not required to agree, but if we do, we will honor that agreement in writing (except in an emergency).

Confidential Communication. You have the right to request that we communicate with you about your PHI by alternative means or at an alternative location. Requests must be in writing, specify the alternative arrangement, and remain consistent with our ability to bill and collect payment.

Amendment. You have the right to request that we amend PHI you believe is incorrect or incomplete. Requests must be in writing and explain the reason for the request. We may deny the request under certain circumstances, and will provide a written explanation if so; you may then submit a statement of disagreement to be appended to the record. If we accept the amendment, we will make reasonable efforts to inform others you identify, and to include the change in future disclosures of that information.

Electronic Notice. If you receive this Notice through our website or by email, you are entitled to receive it in written form as well. Contact us using the information below to request a written copy.

Questions and Complaints

If you have questions about our privacy practices, or believe we may have violated your privacy rights — including disagreement with a decision we made about access to your PHI — you may contact us using the information below, or submit a written complaint to the U.S. Department of Health and Human Services, Office for Civil Rights. We will provide the appropriate address upon request.

We support your right to protect the privacy of your PHI and will not retaliate against you in any way for filing a complaint, whether with us or with HHS.

Contact Us

Life of Smiles, Inc.

Sebastopol Office: 8901 Barnett Valley Rd., Sebastopol, CA 95472 — sebastopol@lifeofsmiles.com

Windsor Office: 8911 Lakewood Dr., Suite #15, Windsor, CA 95492 — windsor@lifeofsmiles.com

This Notice describes the privacy practices of Life of Smiles, Inc. and how we may use and disclose protected health information about our patients. PHI is information about a patient — including their child's care — that may identify them and relates to their past, present, or future physical or mental health, condition, or related healthcare services. We are required by law to maintain the privacy of PHI and to provide patients with this Notice of our legal duties and privacy practices, as well as patients' rights to access and control their PHI.