Notice of Privacy Practices (HIPAA)

NOTICE OF PRIVACY PRACTICES Effective Date: Feburary 18, 2026

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.

Ragini Singla DMD is required by law to maintain the privacy of your protected health information (“PHI”), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of this Notice currently in effect.

I. How We May Use and Disclose Your Protected Health Information

For Treatment We may use and disclose your PHI to provide, coordinate, or manage your dental care and related services. This includes consultation with other healthcare providers involved in your care.

For Payment We may use and disclose your PHI to obtain payment for services we provide. This may include billing your insurance company, verifying coverage, or collecting outstanding balances.

For Healthcare Operations We may use and disclose your PHI for practice operations, including quality assessment, staff training, licensing, auditing, compliance, and administrative activities necessary to run our dental practice.

II. Other Uses and Disclosures Permitted or Required by Law

We may disclose your PHI without your written authorization in the following circumstances:

• Public health activities
• Health oversight activities
• Judicial and administrative proceedings
• Law enforcement purposes
• As required by federal, state, or local law
• To avert a serious threat to health or safety

Reproductive Health Information Federal law restricts the use and disclosure of protected health information related to lawful reproductive healthcare services. We will not use or disclose PHI for purposes of investigating or imposing liability on individuals or providers for seeking, obtaining, providing, or facilitating lawful reproductive healthcare.

Where required under federal law, we will obtain a signed attestation before disclosing PHI potentially related to reproductive healthcare for certain law enforcement, judicial, or oversight requests.

III. Uses and Disclosures Requiring Your Written Authorization

We will obtain your written authorization for:

• Uses and disclosures not described in this Notice
• Marketing communications, where required by law
• Sale of protected health information
• Use or disclosure of psychotherapy notes (if applicable)

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

IV. Your Rights Regarding Your Health Information

You have the following rights:

Right to Inspect and Copy You have the right to inspect and obtain a copy of your PHI maintained in a designated record set, subject to limited exceptions. We may charge a reasonable, cost-based fee.

Right to Request Amendment If you believe your health information is incorrect or incomplete, you may request an amendment in writing. We may deny certain requests as permitted by law.

Right to Request Restrictions You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to most requested restrictions. However, if you pay out-of-pocket in full for a service, you may request that we not disclose information about that service to your health plan, and we will comply unless disclosure is otherwise required by law.

Right to Confidential Communications You may request that we communicate with you by alternative means or at alternative locations. We will accommodate reasonable requests.

Right to an Accounting of Disclosures You have the right to receive a list of certain disclosures we have made of your PHI, as required by law.

Right to a Paper Copy of This Notice You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

Right to File a Complaint If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

V. Our Legal Duties

We are required by law to:

• Maintain the privacy and security of your protected health information
• Provide you with this Notice
• Abide by the terms of this Notice
• Notify you following a breach of unsecured PHI, as required by law

VI. Changes to This Notice

We reserve the right to change this Notice. Any revised Notice will apply to all PHI we maintain and will be made available in our office and on our website. The revised Notice will contain a new effective date.

VII. Contact Information

If you have questions about this Notice or wish to exercise your rights, please contact:

Ragini Singla DMD 30 Central Park South, Suite 7D New York, NY 10019 Email: [email protected]

Phone: (212) 486-7574