Privacy Notice
Privacy Notice
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.
Our obligations
We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to maintain the privacy of your protected health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How we use your information
- Treatment. We use your records to provide dental care and to coordinate with specialists, laboratories and other providers involved in your treatment.
- Payment. We use your information to bill you or your insurance carrier and to obtain prior authorization for treatment.
- Operations. We use your information for quality review, staff training, licensing and business planning.
Your rights
- Request a copy of your dental records in paper or electronic form.
- Ask us to correct information you believe is inaccurate.
- Request confidential communication at an alternate address or number.
- Ask for a list of disclosures we have made outside of treatment, payment and operations.
- File a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights without fear of retaliation.
State law
Where state law provides greater protection than HIPAA, the state requirement applies. Residents of California, Colorado, Connecticut, Texas, Utah and Virginia have additional rights under their state privacy statutes, including the right to request deletion of personal information that is not part of a protected dental record.
Contact
Questions about this notice or about your records may be directed to our Privacy Officer at hello@example.com or +1 212 555 0110.