Call Us (310) 375-1200

Notice of Privacy Practices

South Bay Endodontics Dental Practice
3771 W. 242nd Street, Suite 103
Torrance, CA 90505

T:(310) 375-1200
F:(310) 375-1299
southbayendo@gmail.com

Your Information. Your Rights. Our Responsibilities.

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: FEBRUARY 16, 2026

South Bay Endodontics complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

English: Our dental practice will provide language assistance services free-of-charge to individuals who do not speak En- glish well enough to discuss the dental care we are providing.

Spanish: Nuestro consultorio dental les proporcionará servicios de asistencia lingüística gratuitos a los individuos que no hablen inglés con suficiente fluidez para discutir la atención dental que proporcionamos.

Chinese: 我们的牙科业务将为英语不太流利的人士提供免费的语言协助服务，以方便讨论我们提供的牙齿护理服务。

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your record

  • You can ask to see or get an electronic or paper copy of your record. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 15 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will verify the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information below.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/ privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care.
  • Share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes.
  • Sale of your information, except as part of a practice sale or merger.
  • Substance use disorder treatment information in your record.

In the case of fundraising for our nonprofit organization, we may contact you for fundraising efforts, but you can tell us not to contact you again. (Delete if statement is not applicable.)

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways:

Treat you: We can use your health information and share it with other professionals who are treating you. The dentist may refer you to another dentist who specializes in treating certain types of cases, or may consult with your physician when you are scheduled for dental surgery.

Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary. For example, we may use a third-party service or artificial intelligence system to manage appointment reminders, patient communications and our schedule, and to assist with documentation. When we do so, we have agreements that reinforce that they are required to comply with privacy and security laws.

Bill for your services: We can use and share your health information to bill and get payment from health plans or other entities. Example: We give necessary information about you to your health insurance plan so it will pay for the services we provide you.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet specified conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease.
  • Helping with product recalls.
  • Reporting adverse reactions to medications.
  • Reporting suspected abuse, neglect, or domestic violence.
  • Preventing or reducing a serious threat to anyone’s health or safety.

Do research: We can use or share your information for health research

Comply with the law: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

Work with a medical examiner or funeral director: We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers’ compensation claims.
  • For law enforcement purposes or with a law enforcement official.
  • With health oversight agencies for activities authorized by law.
  • For special government functions such as military and national security.

Respond to lawsuits and legal actions: We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will not send you unsecured emails containing your protected health information without obtaining your informed consent.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
  • We are required to comply with California law which places further restrictions on the use and disclosure of your information. For example, we may not share without your written consent any information we hold regarding treatment for mental health or substance abuse, abortion, contraception or gender-affirming care.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office and on our web site.

Other Instructions for Notice

  • Insert any special notes that apply to your entity’s practices such as “we never market or sell personal information.”
  • If your dental practice is part of an OHCA (organized health care arrangement) that has agreed to a joint notice, use this space to inform your patients of how you share information within the OHCA (such as for treatment, payment, and operations related to the OHCA). Also, describe the other entities covered by this notice and their service locations. For example, “This notice applies to Grace Community Hospitals and Emergency Services Incorporated which operate the emergency services within all Grace hospitals in the greater Dayton area.”

Questions and Complaints

If you want more information about our privacy practices or have questions or concerns, please contact us at:

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may send a written complaint to our office or to the U.S. Department of Health and Human Services, Office of Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/ complaints/. We will not retaliate against you for filing a complaint.

South Bay Endodontics complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

CALIFORNIA

English:
Our dental practice will provide language assistance services free-of-charge to individuals who do not speak English well enough to discuss the dental care we are providing.

Spanish:
Nuestro consultorio dental les proporcionará servicios de asistencia lingüística gratuitos a los individuos que no hablen inglés con suficiente fluidez para discutir la atención dental que proporcionamos.

Chinese:
我们的牙科业务将为英语不太流利的人士提供免费的语言协助服务，以方便讨论我们提供的牙齿护理服务。

Vietnamese:
Thực hành nha khoa của chúng tôi sẽ cung cấp các dịch vụ hỗ trợ ngôn ngữ miễn phí cho những người không có khả năng nói tiếng Anh đủ tốt để thảo luận việc chăm sóc răng miệng mà chúng tôi đang cung cấp.

Tagalog:
Ang aming dental na kasanayan ay magbibigay ng walang bayad na mga serbisyong tulong na wika sa mga indibidwal na hindi nakakapagsalita ng maayos na Ingles upang talakayin ang ibinibigay naming dental na pangangalaga.

Korean:
저희 치과는 저희가 제공하는 치과 치료에 대해 영어로 논의하기가 불편하신 분들을 위해 무료 언어 지원 서비스를 제공할 것입니다.

Armenian:
Մեր ատամնաբուժական պրակտիկան կտրամադրի անվճար լեզվական ծառայություններ բոլոր այն անձանց ովքեր անգլերենին բավարար չեն տիրապետում մեր կողմից տրամադրվող ատամնաբուժական խնամքի շուրջ հարցեր քննարկելու:

Persian (Farsi):
رمکزخدمات دندانپزشکیماخدمات کمک زبانی را بھ صورت را ان ای افرادی فراھممیآ دکھانگلیسی را با تسلط صحبت نمیکند تا در مورد مراقبت ھای د انی کھ ارائھ ن میک یم گفتگو کنند .

Russian:
Наша стоматологическая клиника бесплатно предоставляет клиентам, которые не достаточно хорошо говорят на английском языке, услуги переводчика, чтобы помочь им обсудить предоставляемую нами стоматологическую помощь.

Japanese:
当社の⻭科治療では提供している⻭科ケアに関して話し合える程度の英語⼒のない方に無料で言語サポートサービスを提供していま。

Arabic:
ا . مھ
سوف تقدم عیادة طب الأسنان مساعدة لغویة مجانیة لأولئك الذین لا یجیدون الإنكلیزیة من أجل مناقشة خدمات العنایة بالأسنان التي نقد

Punjabi:
ਉਰ ਡ%ਟਲ ਪ)ੈ ਕਿਟਸ ਕੈਵਲ ਪੋ)ਵੀਦੇ ਲ%ਗੂਏਜ ਅੱਸੀਸਟ%ਸ ਸਕਰਵਸਜ਼ ਫ)ੈੀ-ਓਫ-ਚਾਰਜ ਤ@ ਇੰਕੈਕਡਵਦੁਲਸ ਹੂ ਦੋ ਨ ਸਪ Fਿ ਇੰਕਗਲਸ਼ ਵ Fਲ ਏਨੌਘ ਤ@ ਕੈਡਸਿਸ ਥੇ ਡ%ਟਲ ਚਾਰੇ ਵੀ ਰੇ
ਪ)ੈੋਵੀਡੀਨਗ.

Mon-Khmer:
គី” និកេធ)កេយ,ងខ/ 0ំ នឹងផ4ល់នូកេស:ជ នួយែំផ>េ?@កំAយឥតគិតៃំថ”ជូនដល់អតិថិជនH> េ់ៗែំដលមិកនចះនិMយ?@អង់ចNស់Oស់
កំដ,មPំីពិកំRSំះពិ?េTS> អ ពីបVW កំស:ត ែំហYំ កំធ)ែេដកលយ,ងខ/ 0ំ េ ពុងផ4ល់ជូន។

Hmong:
Ang aming pagsasanay ukol sa ngipin o dental practice ay magbibigay ng libreng mga serbisyong tulong sa mga indibiduwal na hindi masyadong nakakapagsalita ng Ingles upang talakayin ang pangangalaga sa ngipin na aming ibinibigay.

Hindi:
हमारे दंत )च+क-छालय के 1भार3, जो 6य7ती अ-छ: तरह ;<ल3श बोल नह3 सकते है उनको, हम जो दंत )च+क-छा देखभाल 1दान कर रहे है उसके बारेमD बात करनेके Eलये बीना कोई फ़Hस भाषा सहायता सेवाएं 1दान करDगे |

Thai:
แนวปฏิบัติด้านทันตกรรมของเราจะให้บริการช่วยเหลือด้านภาษาฟรีแก่บุคคลทีDพูดภาษาอังกฤษไม่ชำนาญเพียงพอทีDจะหารือเกีDยวกับบริการทันตกรรมของเรา

    Acknowledgement of Receipt of Notice of Privacy Practices

    You May Refuse to Sign This Acknowledgement

    I,, have received a copy of the Privacy Practices.

    Print Name:

    Signature:

    Date:

    If this acknowledgement is signed by a personal representative on behalf of the patient, complete the following:

    Personal Representative's Name:

    Relationship to Patient:

    For Program Use Only

    We attempted to obtain written acknowledgement of receipt of our Notice of Privacy Practices, but acknowledgement could not be obtained because:

    Individual refused to signCommunications barriers prohibited obtaining the acknowledgementAn emergency situation prevented us from obtaining acknowledgementOther

    If other, please specify:

    Notice of Privacy Practices

    South Bay Endodontics Dental Practice
    3771 W. 242nd Street, Suite 103
    Torrance, CA 90505

    T:(310) 375-1200
    F:(310) 375-1299
    southbayendo@gmail.com

    Your Information. Your Rights. Our Responsibilities.

    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.

    We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices. This Notice describes how we protect your health information and what rights you have regarding it.

    TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

    The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; examining your teeth; prescribing medications and faxing them to be filled; referring you to another doctor or clinic for other health care or services; or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking you about your health or dental care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney). “Health care operations” mean those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.

    We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.

    USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION

    In some limited situations, the law allows or requires us to use or disclose your health information
    without your permission. Not all of these situations will apply to us; some may never come up at our
    office at all. Such uses or disclosures are:

    • when a state or federal law mandates that certain health information be reported for a specific purpose;
    • for public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or medical devices;
    • disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
    • uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws;
    • disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies;
    • disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else;
    • disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;
    • uses or disclosures for health related research;
    • uses and disclosures to prevent a serious threat to health or safety;
    • uses or disclosures for specialized government functions, such as for the protection of the president or high ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service;
    • disclosures of de-identified information;
    • disclosures relating to worker’s compensation programs;
    • disclosures of a “limited data set” for research, public health, or health care operations;
    • incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;
    • disclosures to “business associates” who perform health care operations for us and who commit to respect the privacy of your health information;

    Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your dental care.

    APPOINTMENT REMINDERS

    We may call or write to remind you of scheduled appointments, or that it is time to make a routine appointment. We may also call or write to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise, we will mail you an appointment reminder on a post card, and/or leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home.

    OTHER USES AND DISCLOSURES

    We will not make any other uses or disclosures of your health information unless you sign a written “authorization form.” The content of an “authorization form” is determined by federal law. Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the process if it’s your idea for us to send your information to someone else. Typically, in this situation you will give us a properly completed authorization form, or you can use one of ours. If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person named at the beginning of this Notice.

    YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

    The law gives you many rights regarding your health information. You can:

    • Ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want. To ask for a restriction, send a written request to the office contact person at the address, fax or E Mail shown at the beginning of this Notice.
    • ask us to communicate with you in a confidential way, such as by phoning you at work rather than at home, by mailing health information to a different address, or by using E mail to your personal E Mail address. We will accommodate these requests if they are reasonable, and if you pay us for any extra cost. If you want to ask for confidential communications, send a written request to the office contact person at the address, fax or E mail shown at the beginning of this Notice.
    • Ask to see or to get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or copying. For the most part, however, you will be able to review or have a copy of your health information within 30 days of asking us (or sixty days if the information is stored off-site). You may have to pay for photocopies in advance. If we deny your request, we will send you a written explanation, and instructions about how to get an impartial review of our denial if one is legally available. By law, we can have one 30 day extension of the time for us to give you access or photocopies if we send you a written notice of the extension. If you want to review or get photocopies of your health information, send a written request to the office contact person at the address, fax or E mail shown at the beginning of this Notice.
    • Ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask us. We will send the corrected information to persons who we know got the wrong information, and others that you specify. If we do not agree, you can write a statement of your position, and we will include it with your health information along with any rebuttal statement that we may write. Once your statement of position and/or our rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your health information. By law, we can have one 30 day extension of time to consider a request for amendment if we notify you in writing of the extension. If you want to ask us to amend your health information, send a written request, including your reasons for the amendment, to the office contact person at the address, fax or E mail shown at the beginning of this Notice.
    • Get a list of the disclosures that we have made of your health information within the past six years (or a shorter period if you want). By law, the list will not include: disclosures for purposes of treatment, payment or health care operations; disclosures with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30 day extension of time if we notify you of the extension in writing. If you want a list, send a written request to the office contact person at the address, fax or E mail shown at the beginning of this Notice.
    • Get additional paper copies of this Notice of Privacy Practices upon request. It does not matter whether you got one electronically or in paper form already. If you want additional paper copies, send a written request to the office contact person at the address, fax or E mail shown at the beginning of this Notice.

    OUR NOTICE OF PRIVACY PRACTICES

    By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our Web site.

    COMPLAINTS

    If you think that we have not properly respected the privacy of your health information, you are free to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the office contact person at the address, fax or E mail shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by phone.

    FOR MORE INFORMATION

    If you want more information about our privacy practices, call or visit the office contact person at the address or phone number shown at the beginning of this Notice.

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