Notice of Privacy Practices
Coliseum Dental Walnut Creek
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information.
We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect February 16, 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, provided such changes are permitted by applicable law, and to make new Notice provisions effective for all protected health information that we maintain.
When we make a significant change, we will update and post the Notice clearly and prominently at our practice location, and provide copies upon request.
You may request a copy of our Notice at any time. For more information, please contact us using the information listed at the end of this Notice.
How We May Use and Disclose Health Information About You
We may use and disclose your health information for purposes including treatment, payment, and healthcare operations.
Treatment
We may disclose your health information to healthcare providers involved in your treatment.
Payment
We may use and disclose your health information to obtain reimbursement for services. This includes billing, claims management, and eligibility verification.
Healthcare Operations
Includes quality assessment, training, licensing, and operational improvements.
Individuals Involved in Your Care
We may disclose information to family, friends, or representatives involved in your care or payment.
Disaster Relief
We may use or disclose information to assist disaster relief efforts.
Required by Law
We may disclose information when required by law.
Public Health Activities
- Prevent or control disease, injury, or disability
- Report abuse or neglect
- Report reactions to medications
- Notify recalls
- Notify exposure to disease
- Report domestic violence
National Security
We may disclose information for military, intelligence, or correctional purposes.
Secretary of HHS
We may disclose information for HIPAA compliance investigations.
Worker’s Compensation
We may disclose information to comply with worker’s compensation laws.
Law Enforcement
We may disclose information as required by law or court orders.
Health Oversight Activities
Includes audits, inspections, and licensing.
Judicial Proceedings
We may disclose information in response to legal proceedings.
Research
We may disclose information for approved research purposes.
Coroners and Funeral Directors
We may release information to identify deceased persons or determine cause of death.
Fundraising
You may opt out of fundraising communications.
SUD Treatment Information
Special protections apply to substance use disorder records under federal law.
Other Uses and Disclosures
Your written authorization is required for:
- Psychotherapy notes
- Marketing
- Sale of PHI
You may revoke authorization at any time in writing.
Your Health Information Rights
Access
You may request copies of your health information in writing. Fees may apply.
Disclosure Accounting
You may request a list of disclosures.
Restriction Requests
You may request limits on use or disclosure.
Alternative Communication
You may request contact through alternative methods or locations.
Amendment
You may request corrections to your records.
Breach Notification
You will be notified of breaches as required by law.
Electronic Notice
You may request a paper copy even if you receive it electronically.
Questions and Complaints
If you have questions or concerns, contact us. You may also file a complaint with the U.S. Department of Health and Human Services.
We will not retaliate against you for filing a complaint.
Privacy Official Contact Information
Privacy Official Name: Drs Pope and Erickson
Telephone: (925) 939-4989
Address: 1270 Arroyo Way, Walnut Creek CA 94596
Email: office@coliseumdentalwc.com
