Your Privacy. Our Priority.
Updated August 5, 2026
NOTICE OF PRIVACY PRACTICES
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: January 1, 2026
Our Legal Duty
Mandarin South Dentistry is required by applicable federal and state law to maintain the privacy of your Protected Health Information (PHI). We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices described in this Notice while it is in effect. We are required to notify you following a breach of unsecured PHI.
How We May Use and Disclose Your Health Information
We use and share your PHI for treatment, payment, and healthcare operations. Examples include:
Treatment: We may use your PHI to provide, coordinate, or manage your dental care and related services. This includes sharing information with specialists, laboratories, or pharmacy providers.
Payment: We may use and disclose your PHI to bill and collect payment from you, an insurance company, or a third party for the services you receive.
Healthcare Operations: We may use and disclose your PHI in connection with our healthcare operations, including quality assessment, employee review activities, licensing, and staff training.
Business Associates: We may share PHI with third-party vendors (Business Associates) who perform functions on our behalf. All Business Associates are legally required to sign contracts agreeing to safeguard your information.
As Required by Law: We will disclose PHI when required to do so by federal, state, or local law, including public health reporting, audit functions, or court orders.
Uses and Disclosures Requiring Your Written Authorization
Other uses and disclosures will be made only with your explicit written authorization, which you may revoke at any time in writing:
Marketing: We will not use or disclose your PHI for third-party marketing purposes or sell your information without your prior written authorization.
Psychotherapy or Highly Sensitive Notes: Any specialized notes requiring separate authorization under federal or state rules.
Your Privacy Rights
Under HIPAA, you have the following rights regarding your PHI:
Right to Inspect and Copy: You have the right to inspect and obtain a copy of your health and billing records (electronic or paper format).
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures.
Right to Restrict Disclosures for Out-of-Pocket Payments: If you pay for a service or dental procedure completely out-of-pocket, you have the right to request that PHI regarding that service not be disclosed to your health plan, and we are legally required to honor that request.
Right to Alternative Communications: You may request that we communicate with you by alternative means or at alternative locations (e.g., restricting voicemails or specifying an email address).
Right to Amend: You may request an amendment to your records if you feel information is incorrect or incomplete.
Right to an Accounting of Disclosures: You have the right to request a list of certain non-routine disclosures we have made of your PHI.
Right to a Paper Copy: You have the right to receive a physical paper copy of this Notice upon request at any time.
Questions and Complaints
If you believe your privacy rights have been violated, or if you disagree with a decision we made about access to your records, you may file a complaint with our office or directly with the U.S. Department of Health and Human Services.
Mandarin South Dentistry Privacy Officer
Phone: [Insert Office Phone Number]
Email/Address: [Insert Office Contact Info]
U.S. Department of Health and Human Services (OCR)
200 Independence Avenue, S.W., Washington, D.C. 20201
We will not retaliate against you in any way for filing a privacy complaint.
Questions or Concerns?
Your peace of mind is important to us. If you have any questions about this policy or wish to exercise your rights, please contact our Privacy Officer:
Mandarin South Dentistry
Phone: 904-268-7552
Address: 12421 San Jose Blvd 200A, Jacksonville, FL 32223
Click here to download our full, formal 2026 Notice of Privacy Practices (PDF)