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.
About this notice
Jacqueline Younesi Dentistry ("we", "our", "us") is a general, cosmetic, and family dental practice located at 2121 East Coast Hwy, Suite 230, Corona Del Mar, CA 92625. We are a covered entity under the federal Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, which we refer to together as HIPAA. We understand that information about you and your health is personal, and we are committed to protecting it.
This notice explains how we may use and disclose your protected health information, which means individually identifiable information about your health, your dental care, and the payment for that care. Protected health information includes your chart and treatment notes, radiographs and photographs, digital scans and models, diagnoses and treatment plans, prescriptions, insurance and claims records, and billing and payment records. This notice also describes the rights you hold over that information and the legal duties we owe you.
This notice applies to Dr. Jacqueline Younesi, to every dentist, hygienist, assistant, administrative team member, student, and volunteer who works in this office, and to every business associate that handles protected health information on our behalf. We follow the practices described here in this office and wherever we hold your information, and we are required to abide by the terms of the notice that is currently in effect.
Whenever we use or disclose your protected health information, we limit ourselves to the minimum amount of information reasonably necessary to accomplish the purpose, except for disclosures to you, disclosures for treatment, disclosures you have authorized in writing, and the limited other categories where federal law does not apply the minimum necessary standard.
How we may use and disclose your health information for treatment, payment, and health care operations
Federal law permits us to use and disclose your protected health information for the three purposes below without a separate written authorization from you.
Treatment
We use your health information to provide, coordinate, and manage your dental care, and we disclose it to other providers who are involved in that care. For example, if Dr. Younesi refers you to an oral surgeon for an extraction or to an endodontist for a root canal, we send that specialist your radiographs, your chart notes, and the relevant portions of your medical and dental history so the specialist can treat you safely. We send digital scans, impressions, shade selections, and design specifications to the dental laboratory that fabricates your crown, veneer, or night guard. We contact your physician when a medical condition, a medication, or an allergy affects your dental treatment, for example before prescribing an antibiotic or an analgesic, and we transmit prescriptions to the pharmacy you choose.
Payment
We use and disclose your health information so that we can be paid for the care we provide and so that you and your dental plan know what is owed. For example, we send your dental plan the tooth numbers, procedure codes, narrative, and radiographs it requires in order to preauthorize a crown or to pay a claim for a filling. We verify your eligibility and benefits before your visit, we prepare and send you statements, and we determine what your plan covers and what portion is your responsibility. If you finance treatment through a third party lender, we disclose the limited information that lender requires to process the application. If an account remains unpaid after we have tried to resolve it with you, we may disclose the minimum necessary information to a billing or collection service.
Health care operations
We use and disclose your health information to run the practice and to keep the quality of care high. For example, Dr. Younesi may review a series of completed restorative cases to evaluate the outcome of a particular technique, a supervising clinician may review a hygienist's periodontal charting for accuracy and completeness, and we may use your record to train dental assistants, hygienists, and dental students. Operations also include credentialing and evaluating the qualifications and performance of our clinicians, responding to a dental plan audit, arranging for legal and accounting services, obtaining professional liability coverage, business planning and management, and our compliance, fraud detection, and abuse detection activities.
Business associates
Some services in this office are performed by outside companies, which HIPAA calls business associates. We use Dentrix Ascend, operated by Henry Schein One, for scheduling, charting, claims, and practice management, and we work with billing, information technology, secure records destruction, and similar vendors. Each of them signs a written business associate agreement requiring it to safeguard your protected health information, to use it only for the purposes we specify, to report breaches to us, and to hold its own subcontractors to the same terms.
Other uses and disclosures we may make without your authorization
Federal and California law also permit or require the uses and disclosures described below. We make them only when the law allows and only to the extent the law allows.
Appointment reminders
We use Dentrix Ascend to remind you about scheduled visits by text message, email, automated or live telephone call, or postcard. A reminder identifies the practice and the date and time of your appointment and is limited to the minimum information necessary. Unless you tell us otherwise, we may leave a reminder on your voicemail or with the person who answers your phone. If you would prefer that we reach you a different way, see Right to request confidential communications below.
Treatment alternatives, and health related benefits and services
We may contact you to tell you about treatment options, to recommend a recall or hygiene visit, or to describe health related benefits and services that may be of interest to you. For example, we may let you know that a night guard or whitening tray is due to be replaced, that a watched area on a radiograph should be re-evaluated, or that a new restorative option is available for a tooth we have been monitoring.
Individuals involved in your care or in payment for your care
We may disclose to a family member, a relative, a close personal friend, or any other person you identify the health information directly relevant to that person's involvement in your care or in payment for your care. If you are present and able to make decisions, we will give you the opportunity to object first. If you are not present, or are incapacitated, or an emergency exists, we will use our professional judgment to decide whether the disclosure is in your best interest, and we will disclose only what is directly relevant. We may also use or disclose your information to notify or help notify a family member, a personal representative, or another person responsible for your care about your location or general condition, and we may disclose your information to a public or private disaster relief agency so that it can carry out a notification of that kind.
Uses and disclosures required by law
We will use and disclose your protected health information when federal, state, or local law requires it, and the disclosure will be limited to what that law requires. We are also required to disclose your information to the Secretary of the U.S. Department of Health and Human Services when the Secretary is investigating or determining our compliance with the privacy rules.
Public health activities
We may disclose your health information to public health authorities that are authorized to receive it, for purposes such as preventing or controlling disease, injury, or disability, reporting births and deaths, reporting reactions to medications or problems with products regulated by the U.S. Food and Drug Administration, notifying people of recalls of products they may be using, and notifying a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading it. We may also disclose information to an employer about a work related illness or injury where the law specifically allows it.
Victims of abuse, neglect, or domestic violence
Dentists in California are mandated reporters. We may and often must disclose your protected health information to a government authority authorized by law to receive reports of abuse, neglect, or domestic violence, including suspected child abuse or neglect and suspected abuse or neglect of an elder or a dependent adult. Where the law gives us discretion rather than a duty, we will tell you that we made the report unless we believe telling you would place you at risk of serious harm, or unless we would be telling a personal representative whom we believe to be responsible for the abuse.
Health oversight activities
We may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, licensure and disciplinary actions, and civil, administrative, or criminal proceedings. These agencies include the Dental Board of California, state and federal health and human services agencies, and licensing and accrediting bodies that oversee the health care system, government benefit programs, and compliance with civil rights laws.
Judicial and administrative proceedings
If you are involved in a lawsuit or a dispute, we may disclose your health information in response to a court order or an administrative order. We may also disclose it in response to a subpoena, a discovery request, or other lawful process that is not accompanied by a court order, but only after we receive satisfactory assurance that reasonable efforts have been made to notify you of the request, or to obtain a qualified protective order, so that you have an opportunity to object.
Law enforcement
We may disclose your health information to a law enforcement official in response to a court order, warrant, subpoena, or summons, or as otherwise required by law. Subject to the conditions the law imposes, we may also disclose it to identify or locate a suspect, fugitive, material witness, or missing person, to provide limited information about a person who is or is suspected to be a victim of a crime, to report a death we believe may have resulted from criminal conduct, to report criminal conduct that occurred on our premises, and, in an emergency, to report a crime, its location, its victims, and the identity, description, and location of the person who committed it.
Coroners, medical examiners, and funeral directors
We may disclose your health information to a coroner or medical examiner so that a decedent can be identified, a cause of death determined, or other duties authorized by law performed. Dental records are frequently the means by which an identification is made. We may also disclose information to a funeral director as necessary to carry out that person's duties.
Organ and tissue donation
If you are an organ donor, we may disclose your health information to an organ procurement organization or to an entity that handles organ, eye, or tissue procurement, banking, or transplantation, as necessary to facilitate donation and transplantation.
Research
Under limited circumstances we may use or disclose your health information for research. Any use or disclosure of identifiable information for research is made only after an institutional review board or a privacy board has reviewed the project and approved a waiver of authorization under an established protocol that protects the privacy of your information, or after you have signed a written authorization. We may also disclose information to a researcher preparing a research protocol, or for research on the information of decedents, subject to the representations and limits the law requires. In practice, this office does not routinely participate in research.
To avert a serious threat to health or safety
Consistent with applicable law and standards of ethical conduct, we may use or disclose your health information when we believe in good faith that the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of you or of another person or the public. Any such disclosure would be made only to someone able to prevent or lessen the threat, including the target of the threat, or to law enforcement authorities as the law permits.
Specialized government functions
If you are or were a member of the armed forces, we may disclose your health information as required by military command authorities, and we may disclose information about foreign military personnel to the appropriate foreign military authority. We may disclose information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law, and for the provision of protective services to the President and others or to conduct authorized investigations. If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may disclose your information to that institution or official where necessary for your health and safety, the health and safety of others, or the safety and security of the institution.
Workers' compensation
We may disclose your health information as authorized by, and to the extent necessary to comply with, laws relating to workers' compensation or other similar programs established by law that provide benefits for work related injuries or illness without regard to fault.
Uses and disclosures that always require your written authorization
The following uses and disclosures will be made only with your written authorization.
Psychotherapy notes
Most uses and disclosures of psychotherapy notes require your written authorization. As a dental practice we do not ordinarily create or maintain psychotherapy notes. If we ever were to hold notes of that kind, we would not use or disclose them except with your written authorization or in the narrow circumstances federal law specifically permits without one.
Marketing
We will obtain your written authorization before using or disclosing your protected health information for marketing purposes. If we would receive payment from a third party in connection with the communication, the authorization will say so. Federal law treats a limited set of communications as something other than marketing, including a face to face communication with you in this office and a promotional gift of nominal value, and those do not require an authorization.
Sale of protected health information
We do not sell your protected health information, and we have never done so. Any disclosure that would constitute a sale of protected health information requires your written authorization, and that authorization must state that we would receive payment in exchange for your information.
All other uses and disclosures, and your right to revoke
Other uses and disclosures of your protected health information not described in this notice will be made only with your written authorization. You may revoke an authorization at any time by giving us written notice. Send your revocation to the Privacy Officer at the address, email, or phone number in Who to contact with questions below, and we will stop the use or disclosure covered by the authorization. A revocation cannot undo a use or disclosure we already made while the authorization was in effect, and it does not apply where we have already taken action in reliance on the authorization or where the law gives an insurer the right to contest a claim or the policy itself.
Your rights regarding your health information
You hold the rights described below over the health information we maintain about you. Unless a right says otherwise, make your request in writing to the Privacy Officer, by mail to Jacqueline Younesi Dentistry, Attn: Privacy Officer, 2121 East Coast Hwy, Suite 230, Corona Del Mar, CA 92625, or by email to office@jyounesidentistry.com. If you would rather not put the request in writing yourself, call (949) 409-9895 and a team member will write it down for you, read it back, and log it. Calling is a fully equivalent route, not a lesser one.
Right to inspect and obtain a copy of your record
You have the right to inspect and to receive a copy of the health information that we use to make decisions about your care, which HIPAA calls the designated record set, including your dental and billing records. Ask in writing and tell us what you want. California law generally allows you to inspect your records within five business days after we receive your written request, and to receive copies within fifteen days, and where state law gives you faster access than the federal thirty day period we follow state law.
Electronic copies. We maintain your record electronically, so if you ask for an electronic copy we will give you one in the form and format you request when we can readily produce it, and otherwise in a readable electronic form and format that we agree on with you. You may also direct us in a signed writing to transmit a copy of your record to another person or entity you clearly identify, such as another dentist or an attorney.
We may charge a reasonable, cost based fee for copies, which covers labor for making the copy, supplies, postage, and preparing an explanation or summary if you asked for one. The fee will never exceed what state and federal law allow, we will tell you the amount before we do the work, and there is no fee to inspect your record. In limited circumstances we may deny a request for access. If we do, we will tell you in writing why, and in certain cases you may ask for the denial to be reviewed by a licensed health care professional we designate who was not involved in the original decision. That reviewer's determination is binding on us.
Right to request an amendment
If you believe the health information we hold about you is incorrect or incomplete, you may ask us to amend it for as long as we keep the information. Submit the request in writing and tell us specifically what is wrong, what it should say, and the reason supporting your request. We will act within sixty days, and we may extend that period once by thirty days if we tell you why in writing before the first period runs out.
We may deny the request if the information was not created by us, unless the person who created it is no longer available to act on the request, if it is not part of the designated record set, if it is not information you would be permitted to inspect and copy, or if we determine the record is already accurate and complete. If we deny your request, we will tell you why in writing, and you have the right to submit a written statement of disagreement that we will keep with the record and include with any future disclosure of the disputed information. We may prepare a rebuttal, and if we do we will give you a copy of it.
Right to an accounting of disclosures
You have the right to request a list of the disclosures we made of your protected health information. The accounting covers up to six years before the date of your request and does not include disclosures made for treatment, payment, or health care operations, disclosures made to you or to persons involved in your care, disclosures you authorized, incidental disclosures, disclosures for national security or intelligence purposes, disclosures to correctional institutions or law enforcement officials with custody of you, or disclosures made as part of a limited data set.
Tell us in writing the time period you want covered. We will act within sixty days, with one possible thirty day extension if we notify you in writing. The first accounting you request in any twelve month period is free. For additional requests within the same twelve months we may charge a reasonable, cost based fee, and we will tell you the cost in advance so that you can withdraw or modify your request before any charge is incurred.
Right to request restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations, and on the information we disclose to someone involved in your care or in payment for your care, such as a family member. Put the request in writing and tell us what information you want limited, whether you want to limit our use, our disclosure, or both, and to whom the limit should apply.
Except for the restriction described immediately below, we are not required to agree to a requested restriction. We will tell you plainly whether we agree rather than leaving you to assume. If we do agree, we will honor the restriction except in a medical emergency where the restricted information is needed to treat you. We may end an agreed restriction going forward by notifying you in writing, and you may end one at any time.
Right to restrict disclosure to a health plan when you pay in full
You have an absolute right to require that we not disclose your protected health information to your health or dental plan for the purpose of carrying out payment or health care operations, when the disclosure concerns a service or item that you have paid for in full, out of pocket. We must honor this request. The only exception is where the disclosure is otherwise required by law. Tell us before or at the time of the visit so that no claim is submitted, and pay for that service in full. It helps to make the request in writing, and we will note the restriction in your record.
Right to request confidential communications
You have the right to ask that we communicate with you about dental matters in a certain way or at a certain location. For example, you may ask that we call only your mobile phone and never your work number, that we not leave messages on voicemail, that we send statements to a post office box rather than your home, or that we use email only. Your request must specify how or where you wish to be contacted. We will accommodate any reasonable request, and we will not ask you why you are making it. We may ask you to tell us how payment will be handled and to give us an alternative address or method of contact that actually works.
Right to a paper copy of this notice
You have the right to a paper copy of this notice at any time, even if you agreed to receive it electronically and even if you have already read it on this page. Ask at the front desk or call (949) 409-9895 and we will give you one or mail it to you at no charge. This notice is also posted in the office and is available electronically on this website at any time, without asking anyone for it.
Right to be notified of a breach
You have the right to be notified if we discover a breach of your unsecured protected health information. We will notify you without unreasonable delay and in no case later than sixty days after we discover the breach, and the notice will describe what happened, the types of information involved, the steps you can take to protect yourself, what we are doing to investigate and mitigate the harm, and how to reach us with questions. Where the law also requires notice to the Secretary of the U.S. Department of Health and Human Services, to the media, or to California authorities, we will provide that notice as well.
Right to choose someone to act for you
If you have given someone a medical power of attorney, or if someone is your legal guardian or is otherwise authorized under California law to act for you, that person can exercise the rights described in this notice and make choices about your health information. We will verify the person's authority before we act on the request. A parent or legal guardian generally acts for a minor patient, subject to the exceptions California law makes for services a minor may consent to on their own.
Our legal duties
We are required by law to do all of the following.
- Maintain the privacy and security of your protected health information.
- Give you this notice of our legal duties and privacy practices with respect to your protected health information, and make it available to anyone who asks for it.
- Abide by the terms of the notice that is currently in effect.
- Notify you promptly if a breach occurs that may have compromised the privacy or security of your unsecured protected health information.
- Honor the rights described in this notice, and not retaliate against you for exercising them.
We do not use or disclose your protected health information without your written authorization other than as described in this notice. If you tell us we may share information and you later change your mind, you may revoke that permission in writing at any time.
Changes to this notice
We reserve the right to change this notice, and to make the revised notice effective for all protected health information we already maintain as well as any information we receive in the future. We will promptly revise this notice and distribute the new version whenever a material change is made to the uses or disclosures we make, to your rights, to our legal duties, or to any other privacy practice described here.
When this notice changes, we will post the revised notice on this website at jyounesidentistry.com/notice-of-privacy-practices, post it in the office in a clear and prominent location, and make paper copies available at the front desk on request and to anyone who asks for one. The effective date and the last revised date at the top of this page will tell you which version is currently in effect. We encourage you to check the dates at the top when you visit.
Complaints
Complaints to the practice
If you believe your privacy rights have been violated, or you are unhappy with how we handled a request, please tell us. We would much rather hear it than not, and most concerns can be resolved quickly.
- By email:office@jyounesidentistry.com, with "Privacy Complaint" in the subject line
- By phone:(949) 409-9895, and ask for the Privacy Officer
- By mail: Jacqueline Younesi Dentistry, Attn: Privacy Officer, 2121 East Coast Hwy, Suite 230, Corona Del Mar, CA 92625
Please describe what happened and when, and tell us how to reach you. All complaints to the practice should be submitted in writing where possible, and we will document your complaint and our response either way.
Complaints to the Secretary of the U.S. Department of Health and Human Services
You also have the right to complain directly to the Secretary of the U.S. Department of Health and Human Services, through its Office for Civil Rights. You do not need our permission, you do not need to complain to us first, and filing with us does not limit your right to file with the federal government. A complaint must generally be filed within 180 days of when you knew that the act or omission occurred, although the Office for Civil Rights may extend that period for good cause.
- Online complaint portal:ocrportal.hhs.gov/ocr/portal/lobby.jsf
- By mail: U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, D.C. 20201
- By phone: 1-800-368-1019, TDD 1-800-537-7697
- More information and complaint forms:hhs.gov/ocr/complaints
California residents may also contact the California Attorney General or the California Department of Public Health regarding medical information privacy under state law.
You will not be retaliated against
We will never retaliate against you for filing a complaint or for exercising any right described in this notice. You will not be denied care, refused an appointment, discharged from the practice, charged a different amount, or given a different level or quality of service because you complained to us, complained to the Office for Civil Rights or a state agency, asked to see or amend your record, requested a restriction, or refused to sign an authorization. That commitment applies whether you complain to us or to anyone else.
California law and your health information
California gives you protections in addition to those HIPAA provides, principally through the Confidentiality of Medical Information Act, found at California Civil Code section 56 and following. That law restricts when a health care provider may disclose medical information, generally requires a signed authorization in a specific statutory form for disclosures that HIPAA might otherwise allow, and gives you a private right of action if your information is disclosed unlawfully. California also sets its own timelines for access to your records under Health and Safety Code section 123110, applies heightened protection to categories of information such as HIV test results, mental health records, substance use disorder treatment information, and reproductive and gender affirming care information, protects the confidentiality of services a minor may lawfully consent to on their own, and requires notification when certain personal information is breached.
Where California law is more protective of your privacy or gives you a greater right than federal law, we follow California law. Where federal law is more protective, we follow federal law. In either case you get the benefit of the stronger rule, and nothing in this notice should be read to give you less than what either law provides.
Information we collect through this website that is not protected health information, such as analytics data and messages from people who are not yet patients, is covered by our Privacy Policy rather than by this notice. Where the two documents could be read to conflict as to protected health information, this notice controls.
Who to contact with questions
If you have any question about this notice, want to exercise one of the rights described in it, or want a paper copy, contact our Privacy Officer.
- Privacy Officer, by phone:(949) 409-9895
- By email:office@jyounesidentistry.com
- By mail: Jacqueline Younesi Dentistry, Attn: Privacy Officer, 2121 East Coast Hwy, Suite 230, Corona Del Mar, CA 92625
If you need this notice in large print, in plain text, read aloud to you, or in another accessible format, call the office and we will provide it at no cost. See also our Accessibility Statement.
Effective date
This Notice of Privacy Practices is effective 2026-08-05 and was last revised 2026-08-05. It remains in effect until we replace it with a revised notice, and it applies to all protected health information we maintain, including information created or received before the effective date above.