Notice of Privacy Practices

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 a copy of your health records

• You can ask to see or get a paper or electronic copy of your dental 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 records

• 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 will tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or mobile 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” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information with your health insurer for the purpose of payment or our operations. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we have shared information

• You can ask for a list (an accounting) of the times we have shared your health information in the six years before the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

Be told if there is a breach

• You have the right to be notified if your health information is affected by a breach that compromises its privacy or security.

File a complaint if you feel your rights are violated

• See “Complaints” below. 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 for how we share your information in the situations described below, 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 the choice to tell us to:

• share information with your family, close friends or others involved in your care;
• share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• marketing purposes, as HIPAA defines marketing;
• sale of your information;
• most sharing of psychotherapy notes.

We do not use or disclose your health information for advertising on social media or other advertising platforms without your written authorization. If you give us permission, you may change your mind at any time by telling us in writing.

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 dental specialist we refer you to asks us for your X-rays and treatment history.

Run our organization

We can use and share your health information to run our practice, improve your care and contact you when necessary, including to remind you of appointments and to tell you about treatment alternatives or other services that may interest you. Example: we review treatment records to check the quality of our care and to train our team.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities. Example: we give information about you to your dental plan, or to you, so that a claim can be submitted for your treatment.

Work with our business associates

We may share your health information with companies that help us run our practice, such as billing, IT, records and communication providers. They must protect your information and may use it only for the services they provide to us, under a written agreement.

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. For more information, see the U.S. Department of Health and Human Services guidance for consumers.

• Help with public health and safety issues. For example: preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
• Do research. We can use or share your information for health research.
• Comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
• Work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner or funeral director when an individual dies.
• Address workers’ compensation, law enforcement and other government requests. We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security and presidential protective services.
• Respond to lawsuits and legal actions. We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Uses and disclosures not described in this notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

Information we disclose under this notice may be redisclosed by the person who receives it and may no longer be protected by federal privacy law.

Substance use disorder treatment records

Records of substance use disorder (SUD) treatment that we receive from a program covered by federal regulations at 42 CFR Part 2 have additional protection. We use or disclose those records only as HIPAA and Part 2 allow.

• With your written consent, we may use and disclose your Part 2 records for future treatment, payment and health care operations. A single consent can cover all of these future uses and disclosures.
• You may revoke that consent at any time by telling us in writing.
• Part 2 records, or testimony describing their content, may not be used or disclosed in a civil, criminal, administrative or legislative proceeding against you without your written consent or a court order that follows the notice and hearing requirements of Part 2.
• If we receive your Part 2 records under a consent for treatment, payment and health care operations, we may redisclose them only as HIPAA permits.

Our responsibilities

• 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 here 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.

Massachusetts law

We also follow Massachusetts law. Where Massachusetts law gives you greater privacy protection or greater rights over your health information than federal law, we follow the law that is more protective. For example, Massachusetts dental board regulations require us to keep your dental record confidential, to keep it for at least seven years after your last treatment (longer for patients who are minors), and to provide copies of it within 30 days of your request.

Changes to 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, on our website and in our offices.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us using the contact details below, or with the U.S. Department of Health and Human Services Office for Civil Rights:

• Send a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201.
• Call 1-877-696-6775.
• Visit hhs.gov/hipaa/filing-a-complaint.

We will not retaliate against you for filing a complaint.

Contact our Privacy Officer

To exercise any of the rights above, ask a question about this notice, or make a complaint, contact our Privacy Officer at either office.

Email: [email protected]. Please do not include health information in email. For information about how we handle personal information collected through our website and online advertising, see our Privacy Policy.