Distinctive Dentistry by Mullens & Nguyen | Jacksonville, FL | (904) 399-3163 | www.distinctivedentistryjax.com
Effective Date: April 2026
Our Legal Duty
Distinctive Dentistry by Mullens & Nguyen is required by law to maintain the privacy of your protected health information, to provide you with this Notice of Privacy Practices, and to abide by the terms of this notice as currently in effect. We are committed to protecting your health information and to being transparent about how it is used and shared.
Protected health information, referred to throughout this notice as “PHI,” includes any information that identifies you and relates to your past, present, or future physical or mental health condition, the provision of healthcare services to you, or the payment for those services.
Website Communications Disclaimer
Information submitted through our website, including contact forms and general inquiries, may not be transmitted through secure or encrypted channels unless explicitly stated and should not be considered protected health information (PHI). Please do not submit sensitive health information through website forms or standard email. For secure communication, please contact our office directly or use any designated patient portal if available.
How We May Use and Disclose Your Health Information
The following describes the ways we may use and disclose your protected health information. Not every use or disclosure in a category will be listed, but all of the ways we are permitted to use and disclose information will fall within one of these categories.
Treatment
We may use and disclose your PHI to provide, coordinate, and manage your healthcare and related services. This includes sharing information with other healthcare providers involved in your care, specialists to whom you are referred, hospitals, laboratories, and other entities that play a role in your treatment.
Payment
We may use and disclose your PHI to obtain payment for services we provide to you. This includes submitting claims to your insurance company or other payers, verifying insurance eligibility, obtaining prior authorizations, and responding to billing inquiries.
Healthcare Operations
We may use and disclose your PHI for the general operations of our practice. This includes quality assessment and improvement activities, staff training and supervision, licensing and credentialing, business planning, and initiatives to enhance the overall quality of care and service we provide.
Appointment Reminders
We may contact you to remind you of scheduled appointments or to inform you about treatment alternatives or other health-related benefits and services that may be of interest to you. We may do this by phone, text message, email, or mail, consistent with your stated communication preferences and applicable privacy regulations.
Please note that standard text messaging and email may not be secure methods of communication and may not be HIPAA-compliant. By providing your contact information, you acknowledge and accept the potential risks associated with these communication methods.
As Required by Law
We will disclose your PHI when required to do so by federal, state, or local law.
Public Health Activities
We may disclose your PHI to authorized public health authorities for activities including the prevention or control of disease, injury, or disability, reporting births and deaths, and reporting reactions to medications or problems with medical devices.
Health Oversight Activities
We may disclose your PHI to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure actions necessary for oversight of the healthcare system.
Serious Threats to Health or Safety
We may use or disclose your PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, and the disclosure is to someone reasonably able to prevent or lessen that threat.
Workers Compensation
We may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs.
Legal Proceedings
We may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process.
Law Enforcement
We may disclose your PHI to a law enforcement official as required by law or in compliance with a court order, warrant, subpoena, or summons.
Coroners, Medical Examiners, and Funeral Directors
We may disclose PHI to a coroner or medical examiner for the purpose of identifying a deceased person or determining the cause of death, and to funeral directors as necessary to carry out their duties.
Organ and Tissue Donation
If you are an organ donor, we may disclose your PHI to organizations that handle organ procurement or organ, eye, or tissue transplantation.
Military and Veterans
If you are or were a member of the armed forces, we may disclose your PHI as required by military command authorities.
National Security and Intelligence
We may disclose your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Uses and Disclosures That Require Your Written Authorization
The following uses and disclosures of your PHI will be made only with your written authorization unless an exception applies under applicable law:
Most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing purposes, and any sale of your PHI require your written authorization. You have the right to revoke any authorization you have given us at any time, in writing. Your revocation will be effective for future uses and disclosures, but will not affect any actions we have already taken in reliance on your prior authorization.
Your Rights Regarding Your Health Information
You have the following rights with respect to your protected health information. To exercise any of these rights, please submit a written request to our Privacy Officer using the contact information listed at the end of this notice, or contact our office directly if a specific Privacy Officer is not designated.
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI that we maintain in a designated record set, which generally includes your medical and billing records. We may charge a reasonable fee for the cost of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy in certain limited circumstances. If your request is denied, we will explain the reason in writing.
Right to Request an Amendment
If you believe that your PHI is incorrect or incomplete, you have the right to request that we amend it. We may deny your request if the information was not created by us, if it is not part of the records we maintain, if it is not information you would be permitted to inspect and copy, or if we determine the information is accurate and complete. If we deny your request, we will explain why in writing and you may submit a written statement of disagreement.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your PHI. This right does not apply to disclosures made for treatment, payment, or healthcare operations, or to disclosures you authorized in writing.
Right to Request Restrictions
You have the right to request that we restrict the use or disclosure of your PHI for treatment, payment, or healthcare operations. We are not required to agree to your requested restriction except in one circumstance: if you request that we not disclose your PHI to your health plan for a service you paid for out of pocket in full, we must honor that request unless disclosure is required by law.
Right to Request Confidential Communications
You have the right to request that we communicate with you about your health information in a certain way or at a certain location. For example, you may ask that we contact you only at a specific phone number or by mail only. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this notice at any time, even if you have previously agreed to receive it electronically. Please contact our office to request a paper copy.
Right to Be Notified of a Breach
You have the right to receive notification in the event that we discover a breach of your unsecured protected health information, in accordance with applicable federal and state law and within the timeframes required by law.
Changes to This Notice
We reserve the right to change the terms of this notice at any time, and to make the revised notice effective for all PHI we maintain, including information we created or received before the revision. The current version of this notice will always be posted in our office and on our website at www.distinctivedentistryjax.com. The effective date appears at the top of every version of this notice.
Complaints
If you believe your privacy rights have been violated, you have the right to file a complaint with Distinctive Dentistry by Mullens & Nguyen or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized or retaliated against in any way for filing a complaint.
To file a complaint with us, please contact our Privacy Officer using the contact details listed below.
To file a complaint with the federal government, visit www.hhs.gov/ocr or call 1-800-368-1019.
Contact Us
For questions about this notice or about our privacy practices, please contact:
Distinctive Dentistry by Mullens & Nguyen
3215 Hendricks Ave, Ste 1
Jacksonville, FL 32207
Phone: (904) 399-3163
Email: appointments@rcmdds.com
Website: www.distinctivedentistryjax.com
This notice is effective as of April 2026 and supersedes all previous versions.
