HIPAA
Notice of Privacy Practices
Last updated November 6, 2026
This notice describes how medical and dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This notice applies to Molly Oral & Facial Surgery, Inc. and all of its offices, surgeons, specialists, anesthesia providers and staff.
Our responsibilities
We are required by law to maintain the privacy and security of your protected health information (PHI), to give you this notice, to follow its terms, and to notify you promptly if a breach occurs that may have compromised the privacy or security of your information. Where California law, including the Confidentiality of Medical Information Act, is more protective than HIPAA, we follow California law.
How we may use and disclose your information
- Treatment. We may share your information with others involved in your care, such as the dentist or doctor who referred you, your physician, a prosthodontist, a dental laboratory, or a hospital.
- Payment. We may use and share your information to bill and get payment from dental and medical insurance plans or other payers, including requests for pre-authorization.
- Health care operations. We may use your information to run our practice, maintain accreditation, improve care and safety, and contact you when necessary, including appointment reminders and the call after surgery.
- As required by law and for public health and safety, health oversight, legal proceedings, law enforcement, and workers’ compensation, as permitted by HIPAA and California law.
We will not use or share your information for marketing, sell your information, or share psychotherapy notes without your written authorization. You may revoke an authorization in writing at any time.
Your rights
- Get an electronic or paper copy of your health record, including your imaging
- Ask us to correct your record
- Request confidential communications
- Ask us to limit what we use or share, including with your health plan when you pay in full out of pocket
- Get a list of those with whom we’ve shared information
- Get a copy of this notice
- Choose someone to act for you
- File a complaint if you feel your rights are violated
Complaints
You can complain to our Privacy Officer at privacy@molly.surgery, (949) 555-0100, or 2 Park Plaza, Suite 600, Irvine, CA 92614, or to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
Changes to this notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our offices, and on our website.
Effective date: November 6, 2026.