HIPAA Notice of Privacy Practices

This notice applies to Canobie Dental PLLC and its workforce.

Your rights

Contact us below to exercise these rights:

• Review or obtain electronic or paper copies of your health and billing records.
• Ask us to correct information you believe is wrong or incomplete.
• Ask us to contact you in a specific way or place. We will accommodate reasonable requests.
• Ask us to limit certain uses or disclosures. We generally do not have to agree. If you pay in full out of pocket for a service, we will honor your request not to share information about that service with your health plan for payment or health care operations, unless the law requires disclosure.
• Request an accounting of certain disclosures made in the past six years.
• Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Have a legally authorized personal representative act for you.

Your choices

You may tell us your preferences about sharing information with people involved in your care or payment and for disaster relief.

We need your written authorization for marketing, sales of your health information, most uses or disclosures of psychotherapy notes, and uses or disclosures not described here. You may revoke an authorization in writing, except where we have already relied on it.

How we use and share information

Where permitted or required by law, we may use or share your information to:

• Treat you and coordinate care, such as sharing dental x-rays with a specialist treating you.
• Obtain payment, such as sending a claim to your dental benefit plan.
• Run our practice, including staff training, compliance and care improvement, such as reviewing records to improve care.

Other permitted purposes include public health and safety; research; health oversight; workers’ compensation; law enforcement and authorized government functions; responding to court orders, subpoenas or other legal requirements; and working with coroners, medical examiners, funeral directors and organ-donation organizations. We may also share relevant information with people involved in your care or payment when permitted.

New Hampshire law generally requires consent to disclose confidential medical information, subject to legal exceptions. Certain genetic-test information requires written informed consent, with exceptions including clinical care. We follow more protective laws when they apply.

If we hold substance use disorder records protected by 42 CFR Part 2, those records or testimony about them cannot be used or disclosed in civil, criminal, administrative or legislative investigations or proceedings against you without written consent or a qualifying court order after notice and an opportunity to be heard. The order must also be accompanied by a subpoena or other legal requirement compelling disclosure.

Our responsibilities

We must protect the privacy and security of your protected health information, provide this notice of our legal duties and privacy practices, and follow the notice in effect. We must notify you as required by law after a breach of unsecured protected health information.

We may change our practices and this notice. Changes may apply to information we already hold. The revised notice will be available at our office, upon request and on our website.

Questions or complaints

Contact the Privacy Officer to ask a question, exercise your rights or file a privacy complaint.

If you believe your privacy rights were violated, you may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. See the HHS privacy complaint process or call 1-877-696-6775. We will not retaliate against you for filing a complaint.