Notice of Privacy Practices
Notice of Privacy Practices
Effective Date: January 25, 2026
Our Legal Duty
We are required by law to protect your protected health information, provide this notice of our privacy practices, and follow the terms of this notice. We will inform you if a breach occurs that may have compromised the privacy or security of your information.
How We May Use and Share Health Information
We may use or share your health information for:
Treatment
To provide, coordinate, or manage your dental care.
Payment
To obtain payment or reimbursement for services provided.
Healthcare Operations
For office management, quality improvement, staff training, and certification.
Special Protections for Certain Health Information
Some types of health information, including records related to substance use disorder treatment, may be subject to additional federal privacy protections and limitations on use and disclosure under applicable law. When required, we will obtain your written consent before using or sharing this information, except as permitted or required by law.
Other Permitted Disclosures
We may also disclose information:
to family members involved in your care unless you object
to comply with laws, court orders, or public health requirements
to protect the health or safety of you or others
Any other use or disclosure will occur only with your written authorization. You may revoke that authorization in writing at any time.
Your Rights Regarding Health Information
You have the right to:
access and request copies of your records
request corrections to incorrect or incomplete information
request confidential communication, such as mail sent to a different address
request limits on how we use or share information for treatment, payment, or operations
request an accounting of certain disclosures
obtain a paper copy of this notice at any time
file a complaint without retaliation if you believe your privacy rights were violated
Our Responsibilities
We are required to:
maintain the privacy of your health information
notify you of any breach of unsecured information
follow the terms of this notice and provide updated notices if our practices change
Internet Communication Consent
I understand that Sprout Pediatric Dentistry may securely upload and store patient information on protected systems that require login credentials. I agree to maintain the confidentiality of my login information.
I consent to receive digital communication, including email and text messages, for appointments, billing, and treatment follow up. I understand that electronic communication has some security risk even when safeguards are used.
Infection Control and Safety Compliance
Sprout Pediatric Dentistry follows all infection control and sterilization standards required by the California Dental Board, OSHA, and the CDC. Instruments are sterilized or disposed of after each use, and treatment areas are disinfected between patients. Staff participate in ongoing safety and infection control training.
Contact Information
If you have questions or wish to exercise your rights, contact:
Sprout Pediatric Dentistry
925 W Foothill Blvd, Suite C, Monrovia, CA 91016
Phone: (626) 4080800
Email: info@sprout.dental
Website: www.sprout.dental
You may also file a complaint with the United States Department of Health and Human Services, Office for Civil Rights, at www.hhs.gov or by mail at 200 Independence Avenue SW, Washington, DC 20201.
Acknowledgment of Receipt
I acknowledge that I have received and reviewed Sprout Pediatric Dentistry’s Notice of Privacy Practices, Internet Communication Consent, and Infection Control Information. I have had the opportunity to ask questions.