Notice of Privacy Practices — Dentistri PLLC (SmilexPro Dentistry, Houston) and SmilexPro of Cypress PLLC (SmilexPro Dentistry of Cypress)

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.

Who this notice covers. This notice is followed by Dentistri PLLC d/b/a SmilexPro Dentistry, at our Houston (FM 1960) office, 11049 FM 1960 Rd W, Suite A, Houston, TX 77065, and SmilexPro of Cypress PLLC d/b/a SmilexPro Dentistry of Cypress, at our Cypress office, 10730 Barker Cypress Rd, Suite A, Cypress, TX 77433. Both companies are under common ownership and have designated themselves, in writing, as a single affiliated covered entity under HIPAA. They follow this one notice and share your information as described below. It covers all of our dentists, staff, and anyone else who works with your information on our behalf at either office.

Language help and accessibility. We provide free language assistance services and free aids and services for people with disabilities, such as qualified interpreters and written information in other formats. Call (281) 469-4500 or ask at either office. Ask at either office for help in Spanish or Vietnamese.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (281) 469-4500. CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (281) 469-4500.

1. 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. To use any of these rights, contact our Privacy Officer (§8) or ask at either office.

Get a copy of your dental and billing records.

You can ask to see or get a copy of your dental records and other health information we have about you, including X-rays. Ask in writing: use our form, write a letter, or email privacy@smilexprodentistry.com (our only official email). Regular email isn’t encrypted, so please don’t attach photos of your ID or insurance card; we’ll confirm who you are by phone.
If you ask for an electronic copy of records we keep electronically, we will send it within 15 business days of your written request (Texas law). Our goal is 15 business days for every request. Federal law sets an outer limit of 30 days, with one 30-day extension only if we tell you in writing why and when you’ll get it. Texas dental rules require copies, including X-rays, within 30 days.
Fees: looking at your records in our office is free. A standard electronic copy (for example on a secure link, or by email if you ask for it) is free. Electronic copies on a USB drive or other media cost only the media and postage, up to $6.50 total. Paper copies: only our actual cost for copying labor, supplies and postage, never more than the Texas dental board’s limit ($25 for the first 20 pages, then $0.15 a page; set limits for X-ray copies). We don’t charge a search or retrieval fee for your own copy. We’ll tell you the fee before we copy anything.
We never hold back your records because of an unpaid dental bill, and we won’t let an unpaid copy fee delay your copies past these deadlines.
Sending copies to someone else: you can tell us in a signed, written request to send an electronic copy of records we keep electronically to another person. To send paper copies or other records to someone else, we need your written authorization. You can also have copies sent to another Texas dentist who will treat you; we’ll send them within 30 days.
We may deny parts of a request only for reasons the law allows. If we do, we’ll explain in writing, and in some cases you can have the decision reviewed by another licensed dentist.

Ask us to correct (amend) your records.

You can ask us to correct health information that you think is wrong or incomplete. Ask in writing and tell us why.
We may say “no,” but we’ll tell you why in writing within 60 days (we may extend once by up to 30 days with written notice). You can then send a statement of disagreement to be included with your records.

Request confidential communications.

You can ask us to contact you in a specific way (for example, your cell phone instead of home, or a different address or email).
We will say “yes” to all reasonable requests, and we won’t ask you why.

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 don’t have to agree, and we may say “no” if it would affect your care.
If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or our operations. We will say “yes” unless a law requires us to share it.

Get a list of those we’ve shared information with (an accounting).

You can ask for a list of the times we’ve shared your health information in the 6 years before the date you ask, who we shared it with, and why.
The list won’t include disclosures for treatment, payment and health care operations, disclosures to you, disclosures you authorized, and certain others the law excludes. We’ll answer within 60 days (one 30-day extension with written notice).
We provide one list a year free. If you ask for another within 12 months, we may charge a reasonable, cost-based fee, and we’ll tell you the fee first so you can change or withdraw your request.

Get a paper copy of this notice.

You can ask for a paper copy at any time, even if you agreed to get it electronically. We’ll give it to you promptly.

Choose someone to act for you.

If you’ve given someone medical power of attorney, or someone is your legal guardian, that person can use your rights and make choices about your health information.
In most cases a parent or legal guardian can act for a child under 18. Texas law has some exceptions, for example when a minor can legally consent to their own care.
We’ll make sure the person has this authority before we act.

File a complaint if you feel your rights are violated: see §7.

2. 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 below, tell us what you want, and we’ll follow your instructions.

Family and friends: in these cases, you have both the right and the choice to tell us whether to share information with your family, close friends, or others involved in your care or paying for your care. If you can’t tell us, for example if you’re unconscious, we may share it if we believe it will help you. We may also share information when needed to lessen a serious and imminent threat to health or safety.
Disaster relief: you can tell us whether to share information in a disaster relief situation.
We never share your information unless you give us written permission for:
marketing purposes;
sale of your information.
Fundraising: we do not fundraise. If that ever changes, we’ll update this notice, and you’ll be able to tell us not to contact you for fundraising.

3. Our uses and disclosures: treatment, payment and health care operations

Treat you. We use your health information and share it with other professionals who are treating you.

Example: a dentist reviews your X-rays and medical history before a filling; we send a prescription and scans to a dental lab that makes your crown; we send a referral and X-rays to another dental provider.
Our two offices: Your records are kept in one shared system. Your information is available to our dentists and staff at both our Houston and Cypress offices, because our two offices are a single affiliated covered entity, so you can get continuous care at whichever office you visit.
Appointment reminders and messages: we may contact you by phone, voicemail or email about appointments, recall visits, follow-up care or payment. We use text messages only for appointment reminders and confirmations and office updates. Tell us if you want us to contact you differently (see “Request confidential communications”). Standard message and data rates may apply.

Run our organization (health care operations). We can use and share your health information to run our practice, improve your care, and contact you when needed.

Example: we review records to check the quality of care, train staff, manage scheduling, and handle audits, legal and compliance work.

Bill for your services (payment). We can use and share your health information to bill and get payment from health plans or other entities.

Example: we give your dental insurance plan information about your treatment so it will pay for your services, or ask your plan to approve a treatment plan in advance.

Business associates. Some services are provided for us by other companies (for example, software, billing, IT and record-storage vendors). They may need your information to do that work. We require them by written agreement to protect it.

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 have to meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues: 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: under conditions the law sets (for example, approval by a review board).
Comply with the law: we share information if state or federal laws require it, including with the U.S. Department of Health and Human Services to show we’re complying with federal privacy law.
Respond to organ and tissue donation requests.
Work with a medical examiner or funeral director when a person dies.
Address workers’ compensation, law enforcement and other government requests: for workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies (including the Texas State Board of Dental Examiners) for activities authorized by law; for special government functions such as military, national security and presidential protective services.
Respond to lawsuits and legal actions: in response to a court or administrative order, or to a subpoena under the conditions the law sets.
Texas law: when Texas law is more protective than federal law, we follow Texas law.

Electronic disclosure of health information. Your health information is subject to electronic disclosure. We keep and send records electronically, for example to dental labs, specialists, your health plan, and our business associates. Under Texas law, we will not electronically disclose your health information to anyone without your separate authorization for each disclosure, except to another covered entity for treatment, payment, health care operations, or insurance functions, or as otherwise authorized or required by state or federal law. Your authorization can be written, electronic, or oral if we document it in writing.

5. Uses that need your written authorization

Psychotherapy notes: not applicable; we do not keep psychotherapy notes.
Marketing: we will not use or share your information for marketing without your written authorization. Texas law also requires your clear permission.
Sale of your information: we will not sell your information.
Everything else: we will not use or share your information in any way not described in this notice unless you tell us we can in writing. You can change your mind at any time by telling us in writing. That stops future uses and disclosures, but not ones we already made relying on your authorization.

6. Our responsibilities

We are required by law to maintain the privacy and security of your protected health information.
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.
Changes to 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 on request, in both offices, and on our website.

7. Complaints

If you feel we have violated your privacy rights, you can complain. We will not retaliate against you for filing a complaint.

To us: contact our Privacy Officer (§8), in writing or by phone, at either office.
To the U.S. Department of Health and Human Services, Office for Civil Rights: online at ocrportal.hhs.gov (Complaint Portal); by mail to Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201; by phone at 1-800-368-1019 (TDD 1-800-537-7697); or visit www.hhs.gov/ocr/privacy/hipaa/complaints/.
Complaints about a dentist, dental hygienist or dental assistant: Texas State Board of Dental Examiners, Attn: Investigations Division, 1801 Congress Ave., Suite 8.600, Austin, TX 78701 · complaints@tsbde.texas.gov · fax 512-649-2732 · help filing a complaint: 1-800-821-3205 · complaint form at www.tsbde.texas.gov. Complaints must be submitted on the Board’s Complaint Form, and the Board does not accept anonymous complaints.
Texas consumer health-privacy complaints: the Texas Attorney General’s office lists the state agencies that take health-privacy complaints and how to file: https://www.texasattorneygeneral.gov/consumer-protection/health-care/health-care-list-agencies.

8. Contact, effective date

Privacy Officer: Dr. Tri Trinh, DMD · Phone: (281) 469-4500 · Email: privacy@smilexprodentistry.com
Houston office: SmilexPro Dentistry, 11049 FM 1960 Rd W, Suite A, Houston, TX 77065 · (281) 469-4500
Cypress office: SmilexPro Dentistry of Cypress, 10730 Barker Cypress Rd, Suite A, Cypress, TX 77433 · (281) 845-2088
Effective date: October 20, 2026