HIPAA Notice.

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.

Effective date: April 25, 2026

Our duties

Mid-Florida Endodontics is required by federal and state law to:

• Maintain the privacy of your protected health information (PHI).
• Provide you with this notice of our legal duties and privacy practices regarding your PHI.
• Follow the terms of the notice that is currently in effect.
• Notify you in the event of a breach involving your unsecured PHI, as required by law.

How we may use and share your health information without your authorization

We may use and share your PHI for the following purposes without separate written authorization from you:

Treatment

We share information with your referring general dentist, restorative dentist, oral surgeon, anesthesiologist, and other treating providers so your care is coordinated. For example, after a root canal we send a treatment summary back to your referring dentist so they can plan your final restoration.

Payment

We use your PHI to bill and collect payment from you, your insurance company, or another payer. This includes verifying eligibility, obtaining prior authorization, submitting claims, and following up on outstanding balances.

Healthcare operations

We use PHI to run our practice: quality improvement, staff training, accreditation, compliance review, business management, and similar activities that allow us to keep delivering high-quality endodontic care.

When required by law

We will disclose PHI when required to by federal, state, or local law: including in response to a court order, subpoena, or valid government request.

Public health and safety

We may share PHI with public health authorities for disease prevention or control, with the FDA for adverse-event reporting on regulated products, and to prevent or lessen a serious threat to a person’s health or safety.

Health oversight, legal, and government functions

We may disclose PHI for audits, investigations, and licensure activities by health oversight agencies; for specialized government functions including military, national security, and correctional institutions; and as authorized by state law for workers’ compensation claims.

Uses and disclosures that require your written authorization

We will obtain your written authorization before using or sharing your PHI for any of the following:

• Most marketing communications.
• Any sale of PHI (we do not sell PHI).
• Most uses or disclosures of psychotherapy notes (this category is rare in endodontic care, but is included for completeness).
• Any other use or disclosure not described in this notice.

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

Your rights regarding your health information

• Right to request restrictions. You may ask us to limit how we use or share your PHI for treatment, payment, or healthcare operations. We will consider your request but are not required to agree, except that we must agree to restrict disclosures to a health plan when you have paid for the service in full out of pocket.
• Right to request confidential communications. You may ask us to contact you in a particular way (for example, only at a specific phone number or mailing address). We will accommodate reasonable requests.
• Right to inspect and copy. You have the right to inspect and obtain a copy of your records. We may charge a reasonable cost-based fee for copies.
• Right to amend. If you believe information in your record is incorrect or incomplete, you may request an amendment. We may deny the request in limited circumstances and will explain in writing if we do.
• Right to an accounting of disclosures. You have the right to receive a list of certain disclosures we have made of your PHI in the previous six years (excluding disclosures for treatment, payment, healthcare operations, and other categories permitted by law).
• Right to a paper copy of this notice. You have the right to a paper copy of this notice on request, even if you have agreed to receive it electronically.
• Right to file a complaint. You may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

How to exercise your rights or file a complaint

To exercise any of the rights above or to file a complaint with our practice, contact our Privacy Officer:

• Email: privacy@mymfe.com
• Mail: Mid-Florida Endodontics, Attn: Privacy Officer, 12301 Lake Underhill Rd., Suite 104, Orlando, FL 32828
• Phone: (407) 581-9515

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

• Mail: 200 Independence Avenue, S.W., Washington, D.C. 20201
• Phone: 1-877-696-6775
• Web: www.hhs.gov/ocr/privacy/hipaa/complaints/

Changes to this notice

We may change our privacy practices and the terms of this notice at any time, as permitted by law. Any updated notice will apply to all PHI we maintain at the time of the change. The current notice is posted in our offices, on this website, and provided to new patients at their first visit.

Effective date: April 25, 2026.