Notice of Privacy Practices
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.
Your rights. You have the right to:
- See and get a copy of your record. Ask in writing. We will provide it, usually within 30 days, in the form you ask for if we can easily produce it, including electronic copies. We may charge a reasonable fee, based on our cost, for copies and postage. We will not withhold your records because of an unpaid balance.
- Ask us to correct your record. If you think something is wrong or missing, ask in writing and tell us why. We may say no, and if we do, you may add a statement to your record saying you disagree.
- Get a list of the times we shared your information for reasons other than treatment, payment, running the practice (and a few other exceptions), for up to six years back. One list per year is free.
- Ask us to limit what we use or share. We are not required to agree, except: if you pay in full out of pocket for a service, you may ask us not to share information about that service with your health plan for payment or operations, and we must agree.
- Ask for confidential communications — a different address, number, or method. We will say yes to reasonable requests.
- Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
- Choose someone to act for you. A person with a valid power of attorney or legal guardianship may act for you; we will confirm they have that authority first. For a child, a parent or guardian generally may see the child's record, except where Virginia law lets the minor consent to care on their own.
- Be told of a breach of your unsecured health information.
How we contact you — your choices. You choose how we reach you. If you give us a mobile number or email and choose text or email, we may send appointment reminders, post-visit instructions, and replies to questions you send us by those channels. Text messages and ordinary email are not encrypted and could be seen by others; by choosing them you accept that risk for the messages you choose to receive. You can change your choice or stop texts or emails at any time by telling us or replying STOP. You may also ask us to contact you at a different address or number, or in a different way, and we will say yes to reasonable requests.
How we use and share your information. We may do the following without your written permission.
- Treatment. To provide, coordinate, and manage your dental care. Example: we send your x-rays and notes to a specialist we refer you to, or send a prescription to your pharmacy, or a case to a dental lab.
- Payment. To bill and collect for your care. Example: we send a claim with your diagnosis and the procedures done to your dental plan or to Virginia Medicaid, and we may share information needed to collect an unpaid balance.
- Health care operations. To run our practice and improve care. Example: reviewing charts for quality, training staff, scheduling, and contacting you about appointments.
- Appointment reminders, treatment options, and services. We may contact you to remind you of appointments and to tell you about treatment options or dental services that may interest you.
- People involved in your care or payment. We may share information with a family member, friend, or other person you identify as involved in your care or in paying for it, unless you tell us not to. If you are not able to tell us, we will use our professional judgment about what is in your best interest.
- Business associates. We share information with companies that do work for us, under written contracts that require them to protect it.
- As required by law. When federal, state, or local law requires it.
- Public health and safety. To public health authorities (for example, to report a disease); to report suspected abuse or neglect of a child or a vulnerable adult, as Virginia law requires; to the Food and Drug Administration about a product problem; and to prevent a serious threat to someone's health or safety.
- Health oversight. To agencies that oversee dental care and payment, such as the Virginia Board of Dentistry or the Department of Medical Assistance Services, for audits, inspections, and licensing.
- Lawsuits and legal proceedings. In response to a court or administrative order, or a subpoena or other lawful request when the law's requirements are met.
- Law enforcement. To a law-enforcement official in the limited situations the law allows, such as a court order or to identify a suspect, witness, or missing person.
- Coroners, medical examiners, and funeral directors. As needed for them to do their jobs; dental records are often used to identify a person after death.
- Workers' compensation. For workers' compensation or similar programs that pay for work-related injuries.
- Military, national security, and correctional settings. For members of the armed forces, national-security activities, and people in custody, as the law allows.
- Research. Only under rules that protect your privacy, such as approval by a review board, or with your permission.
Uses that require your written permission. We will not use or share your information for marketing, or sell your information, without your written permission (called an authorization). Any use or sharing not described in this notice will be made only with your written permission. You may cancel that permission at any time in writing; cancelling does not undo anything we already did while it was in effect. We do not raise funds using your information. If that ever changes, you will be told and given a way to opt out first.
Once we share it. Information we share with others as this notice allows may be re-shared by the person who receives it and may no longer be protected by federal privacy law.
Substance use disorder treatment records. We are not a substance use disorder treatment program. If we receive treatment records from a program covered by federal confidentiality rules (42 CFR Part 2), those records — and any testimony about them — will not be used or disclosed in a civil, criminal, administrative, or legislative proceeding against you unless you give written consent or a court orders it after you have had notice and a chance to be heard; a court order must be accompanied by a subpoena or other legal requirement before the record is used or disclosed.
Our duties. We are required by law to keep your health information private, to give you this notice of our legal duties and privacy practices, and to tell you promptly if a breach may have exposed your information. We must follow the notice that is currently in effect. We may change this notice, and the changes will apply to all health information we keep, including information we already have. If we make an important change, we will post the new notice in our office and on our website, and you may ask for a copy at any time.
Complaints. If you believe your privacy rights have been violated, you may complain to us and to the U.S. Department of Health and Human Services. To us: contact our Privacy Officer, Dr. Zan Pervaiz, DDS, Owner, at 703-349-0099, or write to Lunar Dental, Attn: Privacy Officer, 7120 Heritage Village Plaza, Suite 101, Gainesville, VA 20155, or email [email protected]. To HHS: Office for Civil Rights, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201; 1-800-368-1019 (TDD 1-800-537-7697); or online at hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.
Who we are. This notice is from Lunar Dental (Zoogy Dental Company PLLC, doing business as Lunar Dental), 7120 Heritage Village Plaza, Suite 101, Gainesville, VA 20155, 703-349-0099. It covers everyone who works here — our dentist, staff, and temporary staff. It also covers the companies that do work for us and must protect your information the same way we do (our "business associates," such as our claims, scheduling and messaging, phone, and data-backup vendors). Effective date: September 29, 2026.
Questions. Ask for our Privacy Officer at 703-349-0099. This notice is effective September 29, 2026. Virginia law also protects your health records and may give you additional rights (Va. Code § 32.1-127.1:03).
Language assistance.
ATTENTION: If you speak a language other than English, or need help communicating because of a disability, language assistance services and communication aids are available to you at no cost to you. Call 703-349-0099 or ask any team member.
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