Notice of Privacy Practices

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.

This Notice of Privacy Practices describes how Haverhill Prime Dental may use and disclose your protected health information ("PHI"), how Massachusetts and federal law protect your health information, and the rights you have regarding your information.

Please review this notice carefully.

YOUR RIGHTS

You have the right to:

Obtain a copy of your records. You may request to inspect or obtain a copy of your dental and health information maintained by our practice, subject to applicable federal and Massachusetts law.
Request corrections. You may ask us to correct information that you believe is inaccurate or incomplete.
Request confidential communications. You may ask us to contact you in a particular way or at a particular location.
Request restrictions. You may ask us to limit how we use or disclose your health information. We are not required to agree to every restriction request, except where applicable law requires otherwise.
Request an accounting of certain disclosures. You may request information about certain disclosures of your PHI made by us, subject to applicable law.
Receive a copy of this Notice. You may request a paper copy of this notice at any time.
Choose a personal representative. If someone has legal authority to act on your behalf, that person may exercise applicable rights concerning your health information.
File a complaint. You may complain to us or to the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you may have choices regarding how we use or disclose information.
You may ask us about:

Sharing information with family members or other persons involved in your care or payment for your care.
Communications regarding appointments and treatment.
Certain marketing communications.
Fundraising communications, if applicable.
Other uses or disclosures for which your authorization may be required.

If you have questions about these choices, please contact our Privacy Contact listed.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use or disclose your PHI as permitted or required by federal and Massachusetts law.

Treatment
We may use and disclose your PHI to provide, coordinate, or manage your dental treatment.

For example, we may share appropriate information with another dentist, physician, specialist, dental laboratory, or other health care professional involved in your care.

Payment
We may use and disclose your PHI to obtain payment for services we provide. This may include submitting claims to dental or medical insurance plans, verifying eligibility or benefits, obtaining payment, and responding to insurance inquiries.

Health Care Operations
We may use and disclose your PHI for activities necessary to operate our dental practice, including quality assessment, employee training, credentialing, auditing, compliance activities, scheduling, and practice administration.

Appointment Reminders
We may use your contact information to remind you about appointments or communicate with you regarding scheduled or recommended dental care.

Treatment Alternatives and Health-Related Benefits
We may contact you about treatment alternatives or health-related products and services that may be of interest to you.

Business Associates
We may disclose PHI to third-party service providers that perform services for us involving PHI, such as billing companies, electronic health record vendors, IT providers, laboratories, transcription services, or other business associates. These service providers are required to appropriately safeguard your information.

Individuals Involved in Your Care
When permitted by law, we may disclose appropriate information to a family member, friend, or other person you identify who is involved in your dental care or payment for your care.

Required by Law
We may use or disclose your PHI when federal, Massachusetts, or other applicable law requires us to do so.

Public Health
We may disclose PHI for public-health activities when permitted or required by law.

Health Oversight
We may disclose PHI to governmental agencies for activities authorized by law, including audits, investigations, inspections, licensing activities, and disciplinary proceedings.

Judicial and Administrative Proceedings
We may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process when permitted by applicable law.

Law Enforcement
We may disclose PHI to law-enforcement officials when permitted or required by applicable federal or Massachusetts law.

Serious Threats to Health or Safety
We may use or disclose PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, when permitted by law.

Workers' Compensation
We may disclose PHI as authorized by and to the extent necessary to comply with workers' compensation laws and other similar programs.

Emergencies
We may use or disclose PHI as necessary to provide emergency treatment or respond to an emergency.

USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION

For uses and disclosures not otherwise permitted or required by law, we will generally obtain your written authorization.

Examples may include certain:

Marketing activities;
Disclosures involving the sale of PHI; and
Other uses or disclosures for which federal or Massachusetts law requires authorization.

You may revoke an authorization in writing at any time, except to the extent we have already relied upon the authorization.

MASSACHUSETTS PRIVACY PROTECTIONS

We comply with applicable Massachusetts confidentiality and privacy requirements in addition to federal HIPAA requirements.

Massachusetts law may provide additional protections for certain categories of health information, including certain information relating to HIV testing, genetic information, sexually transmitted or venereal disease information, and other specially protected information.

Where Massachusetts law provides greater privacy protection than federal law, we will comply with the applicable legal requirements.

SUBSTANCE USE DISORDER RECORDS

If our practice creates, receives, or maintains records that are subject to the federal confidentiality requirements applicable to substance use disorder patient records under 42 U.S.C. § 290dd-2 and 42 CFR Part 2, we will comply with the applicable federal requirements governing those records.

Certain substance use disorder records may receive additional protections and may be subject to requirements concerning consent, use, disclosure, and confidentiality.

YOUR RIGHT TO REQUEST RESTRICTIONS

You may request that we restrict the use or disclosure of your PHI for treatment, payment, or health care operations.

We are not required to agree to your request in most circumstances.

However, if you or another person on your behalf pays for a service or health care item completely out of pocket and requests that we not disclose information concerning that service or item to your health plan for purposes of payment or health care operations, we will generally agree to the restriction unless disclosure is otherwise required by law.

YOUR RIGHT TO CONFIDENTIAL COMMUNICATIONS

You may request that we communicate with you about your health information by alternative means or at alternative locations.

For example, you may request that we contact you at a particular telephone number, email address, or mailing address.

We will consider reasonable requests.

YOUR RIGHT TO ACCESS YOUR RECORDS

You generally have the right to inspect and obtain a copy of your PHI maintained by our practice, subject to applicable law.

Massachusetts dental regulations require dental patient records to contain specified identifying and clinical information, and those records must be maintained and made available as required by law.

To request access to your records, please contact:

Name: Atul Bansal
Phone: 978-912-0900
Email: info@haverhillprimedental.com
Mailing Address 126 Main Street
Haverhill, MA 01830

We may charge fees for copies when permitted by applicable law.

OUR RESPONSIBILITIES

We are required by law to:

Maintain the privacy and security of your PHI.
Provide you with this Notice describing our legal duties and privacy practices.
Follow the terms of the Notice currently in effect.
Notify you as required by law if a breach occurs that compromises the privacy or security of your protected health information.
Provide you with a copy of this Notice upon request.
Comply with applicable federal and Massachusetts privacy laws.

We reserve the right to change our privacy practices and this Notice.

If we make a material change to our privacy practices, we will make the revised Notice available as required by law, including by posting the revised Notice on our website and making it available at our office.

QUESTIONS OR PRIVACY COMPLAINTS

If you have questions about this Notice or believe that your privacy rights have been violated, please contact:

Name: Atul Bansal
Practice Name: Haverhill Prime Dental
Mailing Address 126 Main Street
Haverhill, MA 01830
Phone: 978-912-0900
Email: info@haverhillprimedental.com

We may charge fees for copies when permitted by applicable law.

You may also submit a complaint to the U.S. Department of Health and Human Services, Office for Civil Rights.

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Telephone: 1-877-696-6775

You may also submit a complaint through the HHS Office for Civil Rights website.

We will not retaliate against you for filing a privacy complaint.

EFFECTIVE DATE AND AVAILABILITY
August1, 2026