NOTICE OF PRIVACY PRACTICES
Oak Forest Dental Center
Effective Date: October 1, 2026
Your Information. Your Rights. Our Responsibilities.
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.
Privacy Contact
If you have questions about this notice or our privacy practices, please contact:
Dr. Mohamed Hindy
Oak Forest Dental Center
15544 S Cicero Ave
Oak Forest, IL 60452
Phone: +1 708-518-3001
Email: oakforest.info@gmail.com
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
We may say “no” to your request, but we’ll tell you why in writing within 60 days. Request confidential communications
You can ask us to contact you in a specific way, such as at your home, office, or cell phone, or to send mail to a different address.
We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no,” for example, if it could affect your care. If we agree to your request, we may still share this information if you need emergency treatment.
If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include disclosures except for those concerning treatment, payment, and healthcare operations and certain other disclosures, such as disclosures you asked us to make.
We’ll provide one accounting per year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you’ve agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
If someone has legal authority to act as your personal representative, such as through a medical power of attorney or legal guardianship, that person may exercise your rights and make choices about your health information.
We will verify that the person has this authority before taking action.
File a complaint if you feel your rights are violated
You may complain if you believe we have violated your privacy rights by contacting:
Dr. Mohamed Hindy
Oak Forest Dental Center
15544 S Cicero Ave
Oak Forest, IL 60452
Phone: +1 708-518-3001
Email: oakforest.info@gmail.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:
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
HHS — File a HIPAA Complaint
We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference regarding how we share your information in the situations described below, tell us what you want us to do and we will follow your instructions.
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.
If you are unable to tell us your preference, such as if you are unconscious, we may share your information if we believe doing so is in your best interest. We may also share information when necessary to lessen a serious and imminent threat to health or safety.
Marketing and sale of information
We will not sell your health information.
We will not use or share your health information for marketing purposes unless you give us written permission.
Most sharing of psychotherapy notes also requires written permission.
Fundraising
We may contact you regarding fundraising efforts, but you can tell us not to contact you again.
If we maintain substance use disorder patient records subject to 42 CFR Part 2, we will provide clear advance notice and a choice about whether to receive fundraising communications that use that information.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Treat you
We can use your health information and share it with other professionals who are treating you.
Example: A healthcare professional treating you may ask another healthcare professional about your overall health condition.
Run our organization
We can use and share your health information to run our dental practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your dental treatment and services. Bill for your services
We can use and share your health information to bill and obtain payment from health plans or other entities.
Example: We may provide information about you to your dental or health insurance plan so it can pay for covered services.
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. We must meet applicable legal requirements before sharing information for these purposes.
Public health and safety
We may share health information about you for certain situations, including:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to someone’s health or safety Research
We may use or share your information for health research as permitted by law. Comply with the law
We will share information about you if state or federal law requires it, including with the U.S. Department of Health and Human Services if it wants to determine whether we are complying with federal privacy law.
Organ and tissue donation
We may share health information with organ procurement organizations as permitted by law. Medical examiners and funeral directors
We may share health information with a coroner, medical examiner, or funeral director when an individual dies.
Workers’ compensation, law enforcement and government requests We may use or share health information:
- For workers’ compensation claims
- For law-enforcement purposes or with law-enforcement officials
- With health-oversight agencies for activities authorized by law
- For certain special government functions, including military and national-security purposes
Lawsuits and legal actions
We may share health information about you in response to a court or administrative order or in response to a subpoena, as permitted or required by law.
Substance Use Disorder Records
To the extent that Oak Forest Dental Center maintains substance use disorder patient records subject to 42 CFR Part 2, we will not use or disclose information from those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a court order and subpoena as required by applicable law.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We will notify you 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 provide you with a copy of it.
We will not use or share your information other than as described in this notice unless you give us permission in writing. If you give us permission, you may change your mind at any time by notifying us in writing.
Learn more about your HIPAA privacy rights from HHS
Illinois Law
Oak Forest Dental Center complies with applicable Illinois laws governing the confidentiality, maintenance, and disclosure of dental and healthcare information. Where applicable Illinois law provides greater privacy protection or imposes more restrictive requirements than federal law, Oak Forest Dental Center will follow the requirements of Illinois law. Dental records are maintained in accordance with applicable Illinois record-retention requirements.
Changes to the Terms of This Notice
We may change the terms of this notice, and those changes may apply to all information we have about you.
If the notice changes, the updated notice will be available upon request, at our office, and on our website.
Contact Information
Oak Forest Dental Center
15544 S Cicero Ave
Oak Forest, IL 60452
United States
Privacy Contact: Dr. Mohamed Hindy
Phone: +1 708-518-3001
Email: oakforest.info@gmail.com
Effective Date: October 1, 2026