HIPAA NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THISINFORMATION. PLEASE REVIEW IT CAREFULLY. For purposes of this Notice, “we,” “our,” and “us” refer to the health care facility named above. “You” and“your” refer to our patients or their authorized legal representatives. We are committed to protecting the privacy of your Protected Health Information(PHI). We follow the Health Insurance Portability and Accountability Act (HIPAA), its implementing regulations, and all amendments, including the 2026revisions concerning Substance Use Disorder (SUD) treatment information governed by 42 CFR Part 2.

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OUR RESPONSIBILITIES: We are required to:

• Maintain the privacy of your PHI, including SUD information that may carry extra confidentiality protectionsunder 42 CFR Part 2
• Provide you with this Notice of our legal duties and privacy practices
• Notify you following a breach of unsecured PHI
• Follow theterms of this Notice

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HOW WE MAY USE AND DISCLOSE YOUR PHI WITHOUT YOUR WRITTEN AUTHORIZATION:

• Treatment: We may use and share your PHI with other dentists,physicians, or health care professionals who are treating you. Example: We send x-rays to a specialist for a consultation
• Payment: We may use and shareyour PHI to bill and get payment from health plans or other entities. Example: We submit information to your dental plan to obtain payment
• Health careoperations: We may use and share your PHI to run our practice, improve your care, and contact you when necessary. Example: Quality assessment, auditing,or customer service
• Public health and safety: We may share PHI for public health reporting, to report abuse or neglect, to avert a serious threat to healthor safety, or for product recalls, as permitted by law
• Health oversight and law enforcement: We may share PHI with health oversight agencies, for lawenforcement purposes, or as required by a court or administrative order, subpoena, or similar process, as permitted by law
• Research: We may use or sharePHI for research under specific conditions approved by an Institutional Review Board or privacy board, or with your authorization
• Workers’ compensationand other government functions: We may share PHI for workers’ compensation claims and for specialized government functions as permitted by law
• Business associates: We may share PHI with third parties who provide services for us (business associates) under contracts requiring them to protect yourinformation

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USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION:

• Most uses and disclosures of psychotherapy notes (if any)
• Marketing communications,sales of PHI, and other uses not described in this Notice
• Sharing your PHI for purposes not permitted by law without your written permission

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YOUR RIGHTS REGARDING YOUR PHI:

• Right to access: You can ask to see or get an electronic or paper copy of your dental record and other PHI we haveabout you. We will provide a copy or a summary of your health information within required time frames and may charge a reasonable, cost-based fee
• Right to request an amendment: You can ask us to correct information you think is incorrect or incomplete. We may say “no,” but we will tell you why inwriting within 60 days
• Right to request restrictions: You can ask us not to use or share certain PHI for treatment, payment, or health care operations. Weare not required to agree, except when you pay out-of-pocket in full and request that we not share information with your health plan for that service
• Right to request confidential communications: You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a differentaddress
• Right to an accounting of disclosures: You can ask for a list of certain disclosures we have made of your PHI for the six years prior to your request
• Right to a paper copy of this Notice: You can ask for a paper copy of this Notice at any time
• Right to choose a personal representative: If you have givensomeone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your healthinformation, consistent with applicable law

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OUR DUTIES: We are required by law to maintain the privacy and security of your PHI. We will let you know promptly if a breach occurs that may havecompromised the privacy or security of your PHI. We must follow the duties and privacy practices described in this Notice and give you a copy of it. We’ll notuse or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time

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SPECIAL NOTICE ABOUT SUBSTANCE USE DISORDER (SUD) RECORDS (42 CFR PART 2): If we create, maintain, or receive SUD records protected by 42 CFRPart 2, those records are subject to additional protection. Part 2 prohibits us from using or disclosing SUD records for many purposes without your writtenconsent, including certain treatment, payment, and health care operations. Part 2 records generally may not be used or disclosed in civil, criminal,administrative, or legislative proceedings against you without your written consent or a specific court order. You may revoke your consent as permitted byPart 2. We may combine this notice with Part 2 Patient Notice so long as all required elements are included.You will be asked to sign an acknowledgment that you received this Notice.

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QUESTIONS AND COMPLAINTS: If you have questions or want to exercise your rights, contact: You may file a complaint with: U.S. Department of Health &Human Services — Office for Civil Rights 200 Independence Ave., SW Washington, DC 20201 Phone: 877-696-6775

Electronic Disclosure of Protected Health Information

As a course of doing business, our office may create, receive, maintain and (in some instances) disclose Protected Health Information (PHI) in electronicformat. (Insurance Company, Pharmacy & Doctor-to-Doctor Correspondence). All of our electronic disclosures are in accordance with the Health InsurancePortability and Accountability Act to Omnibus Rule Federal Standard and Texas HB 300 Standards. This posting is to satisfy Texas Health and Safety Code,section 181.154 (Notice and Authorization Required for Electronic Disclosure of Protected Health Information).Our office will also secure a separate authorization form from you (the patient or patient’s legal guardian), to authorize other transfers of patient ProtectedHealth information (PHI), as deemed necessary by you and as required by law. If you believe that our office has violated the obligations described in thisnotice, you have the right to file a complaint with our HIPAA Privacy Officer via mail, email or phone:

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HIPAA Privacy Officer’s Name: Karina Jimenez

Our HIPAA Privacy Officer’s email address: manager@myaestheticsmiles.com

Our address: 8821 Metropark Dr. Suite 1500. Shenandoah, TX 77385

Our Phone Number: 281-501-7770

Effective Date: January 1st 2026