Notice of Privacy Practices

Daisy Song-Cha, D.D.S., P.C.
Effective date: September 28, 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.

This notice applies to protected health information maintained by Daisy Song-Cha, D.D.S., P.C. ("the Practice") in connection with its dental and orthodontic services. Protected health information includes information about your health, care, and payment for care that identifies you. Other independently practicing health care professionals may have their own notices of privacy practices. Please contact us if you are unsure which notice applies to a particular service.

Your rights

You have the right to:

See or get a copy of your record. You may ask to inspect or receive a paper or electronic copy of the health information we maintain about you. We will respond within the time required by applicable law. We may charge a reasonable, cost-based fee where the law permits. Some limited exceptions apply.
Ask us to correct your record. If you believe information is incorrect or incomplete, you may ask us to amend it. We may deny a request in certain circumstances and will explain a denial in writing.
Request confidential communications. You may ask us to contact you in a particular way or at a particular location. We will accommodate reasonable requests.
Ask us to limit certain uses or disclosures. You may request limits on how we use or disclose information for treatment, payment, or health care operations, or on disclosures to people involved in your care. We generally do not have to agree. If you pay in full out of pocket for a specific service or item, however, you may ask us not to disclose information about that service or item to your health plan for payment or health care operations, unless a law requires the disclosure.
Get an accounting of certain disclosures. You may ask for a list of certain disclosures we made during the preceding six years. The first accounting in a 12-month period is free; a reasonable, cost-based fee may apply to additional requests.
Get a paper copy of this notice. You may request one at any time, even if you agreed to receive it electronically.
Choose someone to act for you. A legally authorized personal representative may exercise your rights as permitted by law. We may ask for documentation of that authority.
File a complaint. You may complain to us or to the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. We will not retaliate against you.

To exercise these rights, please call or write to the Privacy Official listed at the end of this notice. We may ask for a written request or information needed to verify your identity and process it.

Your choices

When appropriate under the law, you may tell us your preference about sharing information with a family member, friend, or another person involved in your care or payment for your care, or for disaster relief. If you cannot tell us your preference, we may share information when we believe it is in your best interest, as permitted by law. You may also give us written instructions or authorizations for other disclosures.

We will obtain your written authorization before using or disclosing protected health information for most marketing purposes, selling protected health information, or disclosing psychotherapy notes when applicable, except where the law permits otherwise. This includes using identifiable patient information or photographs in advertising when authorization is required. Other uses or disclosures not described in this notice will be made only with your written authorization, unless permitted or required by law. You may revoke an authorization in writing, except to the extent we have already acted in reliance on it.

If we use your information to contact you about fundraising, you may opt out of future fundraising communications. If we maintain records subject to the special federal substance use disorder rules described below and seek to use those records for fundraising, we will first give you a clear opportunity to decline those communications.

How we may use and disclose your information

We may use and disclose your protected health information without your written authorization for the following purposes, subject to applicable limits:

Treatment. We may use your records to plan and provide care and share relevant information with another professional treating you. For example, we may send orthodontic records to a specialist involved in your care.
Payment. We may use and disclose information to bill for services and obtain payment. For example, we may submit a claim to your dental insurer.
Health care operations. We may use and disclose information to run the Practice, review quality of care, train staff, manage our business, and contact you when necessary. For example, we may review treatment records to improve our services.
People involved in your care or payment. We may share information with a person involved in your care or payment, consistent with your preferences and applicable law.
Public health and safety. We may report information when permitted or required for disease control, product recalls, reporting of abuse or neglect, or to prevent or lessen a serious threat to health or safety.
Health oversight and government functions. We may disclose information for lawful audits, investigations, licensing, and other authorized oversight activities, or for certain military, national security, and correctional functions as permitted by law.
Required by law. We may disclose information when a federal, state, or local law requires it, including to the U.S. Department of Health and Human Services when required to demonstrate compliance with federal privacy law.
Legal proceedings and law enforcement. We may disclose information in response to a valid court or administrative order, subpoena, or other lawful process, and for other law enforcement purposes when the applicable legal requirements are met.
Workers' compensation. We may disclose information as authorized by laws governing workers' compensation or similar programs.
Research. We may disclose information for research only when the legal conditions for the research use or disclosure are satisfied, such as approval by a review board or your authorization when required.
After death. We may disclose information to a coroner, medical examiner, or funeral director when permitted by law. We may also disclose information for organ or tissue donation when applicable and permitted by law.
Disaster relief. We may share information with an organization assisting in disaster relief as permitted by law.

Information subject to additional protections. Some information, including HIV-related information, genetic information, substance use disorder treatment records, and mental health records, may have additional protections under federal or New York law. For example, New York law limits disclosure of confidential HIV-related information. We will disclose that information only with an appropriate authorization or when a specific law permits or requires it; a disclosure to a treating provider when necessary for appropriate care is one example of a permitted disclosure. We will follow the additional protections that apply to other such records.

Substance use disorder records. We may receive records from a substance use disorder treatment program that are protected by 42 CFR Part 2. If you have given that program a written consent covering treatment, payment, and health care operations, we may use and share the records as HIPAA permits, subject to Part 2's protection against their use in proceedings against you. If records are disclosed for a purpose outside that consent under a more specific consent, we will follow the applicable consent and legal limits. We will not use or disclose your Part 2 records, or testimony describing them, in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a qualifying Part 2 court order accompanied by a subpoena or similar legal requirement.

Our responsibilities

We are required by law to protect the privacy of your protected health information, give you this notice of our legal duties and privacy practices, and notify affected individuals after a breach of unsecured protected health information as required by law. We must follow the terms of the notice currently in effect.

We may change this notice and make the revised terms apply to all protected health information we maintain, including information created or received before the change. When we make a material change, we will issue a revised notice with a new effective date. The current notice will be available at our office, upon request, and on our website.

Questions and complaints

Contact Daisy Song, D.D.S., our Privacy Official, to ask questions, request records or a copy of this notice, exercise a privacy right, or make a complaint:

Daisy Song-Cha, D.D.S., P.C.
Attn: Daisy Song, D.D.S., Privacy Official
42-23 212th Street, Suite B1
Bayside, NY 11361
Telephone: (718) 225-0919