HIPAA Notice of Privacy Practices

Note to site owner: This is a starter template. Have it reviewed by your attorney or compliance advisor before publishing.

This notice describes how medical and dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Our Responsibilities

We are required by law to maintain the privacy of your protected health information (PHI), to provide this notice of our legal duties and privacy practices, and to notify you following a breach of unsecured PHI.

How We May Use and Disclose Your Information

Treatment — to provide and coordinate your dental care, including with your physicians and facility nursing staff. Payment — to bill and receive payment from you or your insurance. Health care operations — to run our practice and improve care.

Your Rights

You have the right to request access to and copies of your records, request corrections, request restrictions, request confidential communications, receive an accounting of disclosures, and receive a paper copy of this notice.

Contact & Complaints

Contact our Privacy Officer at [email protected] or (908) 800-7600. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.