Notice of Privacy Practices of Jay Krishna Dentistry PLLC DBA Bee Cave Soft Touch Dental

This notice describes HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION, and HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION.

Effective Date: February 16, 2026

Privacy Contact: Nehalben Patel DMD, Owner

Bee Cave Soft Touch Dental

Email: info@bcsofttouchdental.com

Phone: 512-271-6600

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.

Your Rights

You have the right to:

• Get a copy of your paper or electronic medical record

• Correct your paper or electronic medical record

• Request confidential communication

• Ask us to limit the information we share

• Get a list of those with whom we've shared your information

• Get a copy of this privacy notice

• Choose someone to act for you

• File a complaint if you believe your privacy rights have been violated

• Consent to most uses and disclosures of your health information

• Discuss this notice with someone in our program

• Get a list of those with whom we've shared your electronic records

• Get a list of health care providers who have received your information through certain third parties

• Choose in advance whether to receive fundraising communications

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care or payment for your care

• Share information in a disaster relief situation

• Include your information in a hospital directory

We never share your information unless you give us written permission for:

• Marketing purposes

• Sale of your information

• Most sharing of psychotherapy notes

With your consent, we can use and share your information as we:

• Treat you

• Run our organization

• Bill for our services

• Fulfill your requests to share information

• Prevent multiple program enrollments

• Report about court-referred treatment

• Report to prescription drug monitoring programs

We may use and share your information without your consent as we:

• Communicate within our program and with our contractors

• Help with medical emergencies

• Help with public health

• Report crimes and threats of crimes on our premises and suspected child abuse and neglect

• Aid scientific research

• Respond to audits and evaluations of our program

• Assist cause of death inquiries

• Respond to court orders

In all these circumstances, we must protect your information and limit how we use and share it.

Our Uses and Disclosures

How do we typically use or share your health information?

Treat you: We can use your health information and share it with other professionals who are treating you.

Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Bill for your services: We can use and share your health information to bill and get payment from health plans or other entities.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. In all cases, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.

• Help with public health and safety issues

• Do research

• Comply with the law

• Respond to organ and tissue donation requests

• Work with a medical examiner or funeral director

• Address workers' compensation, law enforcement, and other government requests

• Respond to lawsuits and legal actions

Our Responsibilities

• We are required to obtain your consent for most uses and sharing of your information.

• We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• We must follow the duties and privacy practices described in this notice and give you a copy of it.

• We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of 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 office, and on our web site.

We never market or sell personal information. We will not share your mental health treatment records without your written consent unless it is for treatment or another law requires us to share the information.

File a Complaint

You can complain if you feel we have violated your rights by contacting us using the information above.

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.

We will not retaliate against you for filing a complaint.

---

Consent for Internet Communications

I grant my permission to the dental practice to upload and store confidential patient information including account information, appointment information and clinical information to the secured website for the dental practice. I understand that, for security purposes, the site requires a user ID and password for access and use. I also understand the dental practice and I are responsible for maintaining the strict confidentiality of any ID and password assigned to me and that the dental practice is not liable for any charges, damages or losses that may be incurred or suffered as a result of my failure to maintain confidentiality.

I understand the dental practice is not liable for any harm related to the theft of my ID and password, my disclosure of my ID and password, or my authorization to allow another person or entity to access and use the dental practice website with my ID and password. I also agree to immediately notify the dental practice of any unauthorized use of my ID or of any other need to deactivate my ID due to security concerns.

I also understand that State and Federal laws, as well as ethical and licensure requirements impose obligations with respect to patient confidentiality that limit the ability to make use of certain services or to transmit certain information to third parties. I understand the dental practice will represent and warrant that they will, at all times during the terms of this Agreement and thereafter, comply with all laws directly or indirectly applicable that may now or hereafter govern the gathering, use, transmission, processing, receipt, reporting, disclosure, maintenance, and storage of my information, and use their best efforts to cause all persons or entities under their direction or control to comply with such laws.

I agree that the dental practice has the right to monitor, retrieve, store, upload and use my information in connection with the operation of such services, as is acting on my behalf in uploading my patient information. I understand the dental practice will use commercially reasonable efforts to maintain the confidentiality of all patient information that is uploaded to the website on my behalf.

I understand the dental practice CANNOT AND DOES NOT ASSUME ANY RESPONSIBILITY FOR MY USE OR MISUSE OF PATIENT INFORMATION OR OTHER INFORMATION TRANSMITTED, MONITORED, STORED, UPLOADED OR RECEIVED USING THE SITE OR THE SERVICES.

---

Aviso de Prácticas de Privacidad de Jay Krishna Dentistry PLLC DBA Bee Cave Soft Touch Dental

Este aviso describe CÓMO PUEDE UTILIZARSE Y DIVULGARSE LA INFORMACIÓN SANITARIA SOBRE TI, TUS DERECHOS RESPECTO A TU INFORMACIÓN SANITARIA, y CÓMO PRESENTAR UNA QUEJA RELATIVA A UNA VIOLACIÓN DE LA PRIVACIDAD O SEGURIDAD DE TU INFORMACIÓN SANITARIA.

Fecha de vigencia: 16 de febrero de 2026

Contacto de privacidad: Nehalben Patel DMD, Propietario

Bee Cave Soft Touch Dental

Correo electrónico: info@bcsofttouchdental.com

Teléfono: 512-271-6600

TU INFORMACIÓN. TUS DERECHOS. NUESTRAS RESPONSABILIDADES.

Tus Derechos

Tienes derecho a:

• Conseguir una copia de tu historial médico en papel o electrónico

• Corregir tu historial médico en papel o electrónico

• Solicitar comunicación confidencial

• Pedirnos que limitemos la información que compartimos

• Conseguir una lista de quienes hemos compartido tu información

• Conseguir una copia de este aviso de privacidad

• Elegir a alguien que actúe por ti

• Presentar una queja si crees que se han violado tus derechos de privacidad

• Consentimiento para la mayoría de los usos y divulgaciones de tu información sanitaria

• Comentar este aviso con alguien de nuestro programa

Tus Elecciones

Para cierta información sobre salud, puedes contarnos tus opciones sobre lo que compartimos. Si tienes una preferencia clara sobre cómo compartimos tu información, habla con nosotros. Dinos qué quieres que hagamos y seguiremos tus instrucciones.

En estos casos nunca compartimos tu información a menos que nos des permiso por escrito:

• Fines de marketing

• Venta de tu información

• La mayoría de las notas de psicoterapia

Con tu consentimiento, podemos usar y compartir tu información tal como:

• Tratarte

• Dirigir nuestra organización

• Facturar por nuestros servicios

• Cumplir tus solicitudes para compartir información

• Prevenir la matrícula múltiple en programas

• Informar sobre el tratamiento remitido al tribunal

• Informar a los programas de control de medicamentos con receta

Nuestros Usos y Divulgaciones

Podemos usar y compartir tu información sin tu consentimiento, ya que:

• Comunicarnos dentro de nuestro programa y con nuestros contratistas

• Ayudar con emergencias médicas

• Ayudar con la salud pública

• Denunciar delitos y amenazas de delitos en nuestras instalaciones y sospechas de abuso y negligencia infantil

• Apoyo a la investigación científica

• Responder a auditorías y evaluaciones de nuestro programa

• Ayudar en las consultas sobre la causa de la muerte

• Responder a las órdenes judiciales

Nuestras Responsabilidades

• Estamos obligados a obtener tu consentimiento para la mayoría de los usos y el intercambio de tu información.

• Por ley estamos obligados a mantener la privacidad y seguridad de tu información.

• Debemos informarte con prontitud si ocurre una brecha que pueda haber comprometido la privacidad o la seguridad de tu información.

• Debemos seguir los deberes y prácticas de privacidad descritos en este aviso y proporcionarte una copia.

• No utilizaremos ni compartiremos tu información que no sea la descrita en este aviso a menos que nos lo indiques por escrito.

Nunca comercializamos ni vendemos información personal. No compartiremos tus registros de tratamiento de salud mental sin tu consentimiento por escrito a menos que sea para tratamiento o que otra ley nos obligue a compartir la información.

Presenta una queja si sientes que se han vulnerado tus derechos contactándonos utilizando la información anterior, o ante la Oficina de Derechos Civiles del Departamento de Salud y Servicios Humanos de EE. UU. (200 Independence Avenue, S.W., Washington, D.C. 20201, 1-877-696-6775, https://www.hhs.gov/hipaa/filing-a-complaint/index.html).

---

Consentimiento para Comunicaciones por Internet

Concedo mi permiso a la clínica dental para subir y almacenar información confidencial del paciente incluyendo datos de la cuenta, información de la cita e información clínica en la página web segura de la clínica dental. Entiendo que, por motivos de seguridad, el sitio requiere un ID de usuario y contraseña para acceder y usar. También entiendo que la clínica dental y yo somos responsables de mantener la estricta confidencialidad de cualquier identificación y contraseña que me asignen, y que la clínica dental no se hace responsable de ningún cargo, daño o pérdida que puedan sufrir como resultado de mi falta de confidencialidad.

Entiendo que la clínica dental no se hace responsable de ningún daño relacionado con el robo de mi DNI y contraseña, mi divulgación de mi identificación y contraseña, ni mi autorización para permitir que otra persona o entidad acceda y use la web de la clínica dental con mi identificación y contraseña. También acepto notificar inmediatamente a la clínica dental cualquier uso no autorizado de mi DNI o cualquier otra necesidad de desactivarla por motivos de seguridad.

Entiendo que la clínica dental NO PUEDE NI ASUME NINGUNA RESPONSABILIDAD POR MI USO O MAL USO DE LA INFORMACIÓN DEL PACIENTE U OTRA INFORMACIÓN TRANSMITIDA, MONITORIZADA, ALMACENADA, SUBIDA O RECIBIDA A TRAVÉS DEL SITIO O DE LOS SERVICIOS.