Notice of Privacy Practices

Linden Dental Associates LDA, LLC

Effective Date: April 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.

1. Our Commitment to Your Privacy

Linden Dental Associates LDA, LLC (“Linden Dental,” “we,” “us,” or “our“) is committed to protecting the privacy and security of your health information. This Notice of Privacy Practices (“Notice“) describes how we may use and disclose your Protected Health Information (“PHI“) to carry out treatment, payment, or healthcare operations, and for other purposes permitted or required by law. It also describes your rights regarding your PHI.

“Protected Health Information” means information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health, the healthcare services you receive, or the payment for those services.

We are required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA“), as amended by the Health Information Technology for Economic and Clinical Health Act (“HITECH“), and their implementing regulations at 45 CFR Parts 160 and 164, to maintain the privacy of your PHI, provide you with this Notice of our legal duties and privacy practices, abide by the terms of the Notice currently in effect, and notify you following a breach of unsecured PHI.

2. Uses and Disclosures That Do Not Require Your Authorization

We may use and disclose your PHI for the following purposes without your written authorization:

A. Treatment

We may use and disclose your PHI to provide, coordinate, or manage your dental care and any related services. This includes communications with other healthcare providers, specialists, laboratories, pharmacies, and institutions involved in your care. For example, we may disclose PHI to a dental laboratory in connection with the fabrication of a crown or prosthesis, or to a specialist to whom we refer you for endodontic or oral surgery services.

B. Payment

We may use and disclose your PHI to obtain payment for the services we provide. This includes determining eligibility and coverage, submitting claims, obtaining pre-authorization, billing, and collection activities. For example, we may send claims to your dental insurance carrier that identify you, your diagnosis, and the services provided.

C. Healthcare Operations

We may use and disclose your PHI to operate our practice. Examples include quality assessment and improvement activities, reviewing the competence of our clinicians, training programs, accreditation and licensing activities, conducting or arranging for medical review and legal services, general administration, business planning, and management.

3. Other Uses and Disclosures Permitted or Required by Law

In addition to uses and disclosures for treatment, payment, and healthcare operations, we are permitted or required by law to use or disclose your PHI, without your authorization, in the following circumstances (as further described in 45 CFR § 164.512):

  • When required by law. We will disclose PHI when required by federal, state, or local law.
  • Public health activities. We may disclose PHI for public health activities, including preventing or controlling disease, injury, or disability; reporting births, deaths, and certain conditions; reporting adverse events related to products or activities regulated by the FDA; reporting suspected abuse, neglect, or domestic violence to authorized government authorities; and notifying individuals who may have been exposed to a communicable disease.
  • Health oversight activities. We may disclose PHI to a health oversight agency for audits, investigations, inspections, licensure, and similar activities authorized by law.
  • Judicial and administrative proceedings. We may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process, subject to applicable requirements and protections.
  • Law enforcement. We may disclose PHI to law enforcement officials for purposes such as identifying or locating a suspect, fugitive, or missing person; responding to a valid court order or warrant; providing information about a victim of a crime under specified circumstances; or reporting a crime that occurred on our premises.
  • Coroners, medical examiners, and funeral directors. We may disclose PHI to coroners, medical examiners, and funeral directors as necessary to carry out their duties.
  • Organ, eye, or tissue donation. We may disclose PHI to organizations that procure or transplant organs, eyes, or tissues, to the extent necessary to facilitate donation.
  • Research. We may use or disclose PHI for research purposes where the research has been approved by an Institutional Review Board or Privacy Board in accordance with HIPAA.
  • Serious threat to health or safety. We may use or disclose PHI when necessary to prevent a serious and imminent threat to the health or safety of a person or the public, consistent with applicable law and standards of ethical conduct.
  • Specialized government functions. We may disclose PHI for specialized government functions, including military and veterans’ activities, national security and intelligence activities, protective services for the President and others, and correctional institution or custodial situations.
  • Workers’ compensation. We may disclose PHI as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or similar programs.

4. Uses and Disclosures Requiring Your Written Authorization

The following uses and disclosures of your PHI will be made only with your prior written authorization:

  • Marketing. Most uses and disclosures of PHI for marketing purposes require your written authorization, as required by 45 CFR § 164.508(a)(3). An authorization is not required for face-to-face communications, communications involving only a promotional gift of nominal value, or certain treatment and healthcare operations communications.
  • Sale of PHI. Any disclosure of PHI that constitutes a sale of PHI requires your written authorization, as required by 45 CFR § 164.508(a)(4).
  • Psychotherapy notes. Most uses and disclosures of psychotherapy notes, where applicable, require your written authorization.
  • Other uses and disclosures not described in this Notice. Any other use or disclosure of your PHI that is not described in this Notice or otherwise permitted by law will be made only with your written authorization.

You may revoke a written authorization at any time by submitting a written revocation to our Privacy Officer, except to the extent we have already relied on your authorization.

5. Appointment Reminders, Treatment Alternatives, and Health-Related Benefits

We may use and disclose your PHI to contact you regarding:

  • Appointment reminders, confirmations, and recalls (by mail, telephone, email, or, if you have enrolled, by text message);
  • Treatment alternatives or other health-related benefits and services that may be of interest to you; and
  • Follow-up care and post-treatment instructions.

If you would prefer to restrict or change the manner in which we contact you for these purposes, please contact our Privacy Officer using the information in Section 10.

6. Your Rights Regarding Your Protected Health Information

You have the following rights with respect to your PHI:

A. Right to Inspect and Obtain a Copy

You have the right to inspect and obtain a copy of PHI that may be used to make decisions about your care, including dental and billing records. Your request must be made in writing to the Privacy Officer. We will respond within 30 days (or within 60 days if the information is not maintained onsite, with one 30-day extension available). We may charge a reasonable, cost-based fee permitted by law for copies. If we maintain PHI electronically in a designated record set, you have the right to request an electronic copy.

In limited circumstances, we may deny your request to inspect or copy PHI. If we deny your request, we will provide a written explanation and, in certain cases, you may request that the denial be reviewed.

B. Right to Request Amendment

If you believe PHI we maintain about you is incorrect or incomplete, you have the right to request that we amend it. Your request must be in writing and must include the reason for the amendment. We may deny the request in certain circumstances, including if the information was not created by us, is not part of our records, or is accurate and complete. If we deny your request, you may submit a statement of disagreement, which will be included with future disclosures of the disputed information.

C. Right to an Accounting of Disclosures

You have the right to request an accounting of certain disclosures of your PHI made by us in the six years prior to the date of your request. The accounting will not include disclosures made: for treatment, payment, or healthcare operations; pursuant to your authorization; to you or your personal representative; for a facility directory or to persons involved in your care; for national security or intelligence purposes; to correctional institutions or law enforcement officials; or as part of a limited data set. The first accounting in any 12-month period will be provided free of charge; we may charge a reasonable, cost-based fee for additional requests within that period.

D. Right to Request Restrictions

You have the right to request a restriction or limitation on how we use or disclose your PHI for treatment, payment, or healthcare operations, or to persons involved in your care. We are not required to agree to a requested restriction, except that we must agree to a request to restrict disclosure of PHI to a health plan if the disclosure is for payment or healthcare operations (and is not otherwise required by law) and the PHI pertains solely to a healthcare item or service for which you, or another person on your behalf, has paid us in full out-of-pocket.

E. Right to Request Confidential Communications

You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may request that we contact you only at a specific phone number or only by mail to a particular address. We will accommodate reasonable requests.

F. Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice at any time upon request, even if you have agreed to receive it electronically.

G. Right to Be Notified of a Breach

You have the right to be notified in the event of a breach of your unsecured PHI, as required by 45 CFR §§ 164.400–414.

H. Right to Choose Someone to Act for You

If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your PHI. We will verify that the person has this authority before taking any action.

7. Our Responsibilities

We are required by law to:

  • Maintain the privacy and security of your PHI;
  • Provide you with this Notice of our legal duties and privacy practices with respect to PHI;
  • Abide by the terms of the Notice currently in effect;
  • Notify you if we are unable to agree to a requested restriction;
  • Accommodate reasonable requests you may have to communicate PHI by alternative means or at alternative locations; and
  • Notify you following a breach of your unsecured PHI.

We will not use or disclose your PHI other than as described in this Notice unless you give us permission in writing. If you give us permission, you may revoke it in writing at any time, and we will stop using or disclosing your PHI for the purposes covered by the revocation, except to the extent we have already acted in reliance on it.

8. Changes to This Notice

We reserve the right to change the terms of this Notice and to make the new terms effective for all PHI we maintain, including PHI we created or received before the change. If we make a material change to this Notice, we will post the revised Notice in our office and on our Website at www.lindendentalassociates.com/notice-of-privacy-practices. The effective date of the current Notice will be shown at the top of the Notice. You may request a copy of the current Notice at any time.

9. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services.

To file a complaint with us, please contact:

Privacy Officer Linden Dental Associates LDA, LLC 909 N Wood Ave Linden, NJ 07036 Phone: 908-486-5252 Email: privacy@lindendentalassociates.com

To file a complaint with the federal government, you may contact:

U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 Phone: 1-877-696-6775 Online: www.hhs.gov/ocr/privacy/hipaa/complaints

We will not retaliate against you for filing a complaint.

10. Contact Information

If you have questions about this Notice, wish to exercise any of your rights described above, or wish to obtain additional information, please contact:

Privacy Officer Linden Dental Associates LDA, LLC 909 N Wood Ave Linden, NJ 07036 Phone: 908-486-5252 Email: privacy@lindendentalassociates.com

Acknowledgment of Receipt

(For in-office use — this page should be signed by each new patient at first visit and retained in the patient record per 45 CFR § 164.520(c)(2)(ii).)

I, ______________________________________________ (print name), acknowledge that I have received a copy of the Notice of Privacy Practices of Linden Dental Associates LDA, LLC.

Signature: ______________________________________

Date: ______________________________________

Relationship to patient (if not the patient): ______________________________________

If acknowledgment cannot be obtained, the practice must document its good-faith efforts to obtain the acknowledgment and the reason it was not obtained, as required by 45 CFR § 164.520(c)(2)(ii).