2200 G.A.R. Hwy
Swansea, MA 02777
508-233-3341
HIPAA Notice of Privacy Practices
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NOTICE OF PRIVACY PRACTICES
Effective Date: February 1, 2026
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. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
OUR RESPONSIBILITIES:
We are required by law to:
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Maintain the privacy and security of your protected health information (PHI)
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Provide you with this Notice of our legal duties and privacy practices
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Follow the terms of the Notice currently in effect
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Notify you promptly if a breach occurs that may have compromised the privacy or security of your information
This Notice applies to all records of your care maintained by our practice.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION:
We may use and disclose your PHI without your authorization for the following purposes:
Treatment: We may use and share your PHI to provide, coordinate, or manage your dental care. Example: Sharing records with a specialist involved in your child’s treatment.
Payment: We may use and disclose your PHI to bill and collect payment for services. Example: Submitting claims to dental insurance plans.
Health Care Operations: We may use your PHI for practice operations such as quality improvement, training, licensing, and compliance activities.
Individuals Involved in Your Care: We may share information with family members or others involved in your care or payment, unless you object.
Public Health & Safety: We may disclose PHI to prevent disease, report abuse or neglect, comply with recalls, or notify authorities of threats to safety.
Required by Law, Law Enforcement, and Oversight: We may disclose PHI when required by law, court orders, audits, investigations, or health oversight activities.
Workers’ Compensation: We may disclose PHI as authorized by workers’ compensation laws.
National Security & Military: Disclosures may occur for lawful intelligence, national security, or military activities.
Research: PHI may be used for approved research with appropriate safeguards.
Coroners & Funeral Directors: PHI may be released to identify a deceased person or determine cause of death.
Fundraising: We may contact you regarding fundraising activities. You may opt out at any time.
USES AND DISCLOSURES REQUIRING AUTHORIZATION:
We will obtain your written authorization before:
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Using or disclosing psychotherapy notes
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Using PHI for marketing
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Selling PHI
You may revoke authorization in writing at any time.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION:
Right to Access and Inspect. You have the right to inspect and receive a copy of your PHI, in paper or electronic form.
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Requests will be fulfilled no later than 30 days
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Electronic copies will be provided in the format you request if readily producible
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Reasonable, cost-based fees may apply
Right to an Accounting of Disclosures: You may request a list of certain disclosures made in the past six years.
Right to Request Restrictions: You may request limits on how your PHI is used or shared. We must agree to restrictions for services paid in full out-of-pocket if requested.
Right to Confidential Communications: You may request communication by alternative means (e.g., email, different address).
Right to Amend: You may request corrections to your PHI. We may deny requests in limited circumstances.
Right to Breach Notification: You will be notified if a breach of unsecured PHI occurs.
Right to a Paper Copy: You may request a paper copy of this Notice at any time.
QUESTIONS OR COMPLAINTS:
If you have questions or believe your privacy rights have been violated, contact us.You may also file a complaint with the U.S. Department of Health and Human Services.We will not retaliate for filing a complaint.
CONTACT INFORMATION:
Privacy Official: Dr. Nicholas A. Lavoie
Telephone: 508-233-3341
Address: 2200 GAR Hwy, Swansea, MA 02777
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