Privacy policy

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

Our Privacy Responsibilities

The law requires us to maintain the privacy and security of certain health information called "Protected Health Information" (PHI). PHI is the information that you provide us and that we create or receive about your dental care, including dental records and billing information. The law also requires us to provide you with this Notice of our legal duties and privacy practices. When we use or disclose (share) your PHI, we are required to follow the terms of this Notice (or the Notice in effect at the time we use or share your PHI). We will promptly notify you if a breach occurs that may have compromised the privacy or security of your PHI. Finally, the law provides you with certain rights, which are described further below in this Notice.

Opportunity to Agree or Disagree with Information Sharing

For certain dental information, you can tell us your preferences about what we share. If you have a clear preference for how we share your information in the situations described below, please let us know in writing.

Disclosures to Relatives, Close Friends, and Your Other Caregivers

We may share your PHI with your family member, other relative, a close personal friend, or another person who you identify as involved in your care if we (1) first provide you with the chance to object and you do not object; (2) infer that you do not object; or (3) obtain your express agreement to share your PHI with these individuals. We may also use or share your PHI to notify these individuals about your location and general dental condition in the case of an emergency. In these circumstances, if you are not present, or you are not able to tell us your preference (because, for example, you are unconscious or there is an emergency), we will use our professional judgment to decide whether sharing your PHI is in your best interest. If it is thought to be in your best interest, we will only share information that is directly relevant to the person’s involvement with your care or payment for your care.

Marketing Communications

We must obtain your written authorization before using your PHI for marketing purposes, with the exception of making a face-to-face communication or providing you with a promotional gift of nominal value. However, we can use your PHI to communicate with you about certain treatment and for health care operations purposes, which are not considered marketing, including communications about prescription refills, e - reminders, products or services we offer, case management, care coordination, and other communications about alternative treatments, therapies, health care providers, or care settings, utilizing web-based software and google ads.

Electronic Exchange of Your Health Information

Sharing your electronic health record your dental care may be managed by both Worcester Smile Studio PLLC and healthcare teams outside of our practice. We believe that fast, secure transmission of health information at the point of care improves quality and safety and reduces costs. In the past, we exchanged your health information with other providers involved in your care using hand delivery, mail, fax, and e-mail. These methods were slower and, in some cases, less secure, than the options that are available today for electronic exchange.

Opting-out of these electronic exchanges:

You may request that we not share your PHI through the electronic exchanges described above. To opt out, you must submit your request in writing on an opt-out form to Worcester Smile Studio PLLC. Contact our Office to receive an opt-out form.

Ways We Can Use and Share Your PHI Without Your Written Permission

In many situations, we can use and share your PHI without your written permission (authorization) for activities that are common in dental practices. In certain other situations, which we will describe below, we must have your authorization to use and/or share your PHI. Although we do not need your authorization for the following uses and disclosures of your PHI, we generally have to meet many conditions in the law before we can share your information for these purposes.

Treatment, Payment, and Health Care Operations

• ‍Treatment: We use and share your PHI to provide and manage your dental care and related services—for example, to diagnose and treat your dental issues. We will share information with those who treated you before we saw you (such as your primary care provider or a referring specialist), and with those who will treat you in the future. This helps to make sure that everyone caring for you has the information they need. ‍
• Payment: We use and share your PHI to receive payment for services that we provide to you. For example, if you have dental insurance, we will share your PHI with your dental plan or government agency in order to collect payment or to confirm that the entity will pay for your dental care.‍
• Health Care Operations: We can use and share your PHI for our health care operations, which include management, planning, and activities that help to improve the quality and efficiency of the care that we deliver. For example, we can use PHI to review the quality and skill of our dental care providers and to provide them training. In addition, we sometimes share PHI with third parties who help us run our organization, including those we hire to perform services on our behalf.

Public Health and Safety Activities

We can share your PHI to help with public health and safety issues, such as:

• Reporting health information to public health authorities for the purpose of preventing or controlling disease, injury, or disability.
• Reporting suspected abuse, neglect, or domestic violence to the appropriate State agencies.
• Reporting information to the U.S. Food and Drug Administration (FDA) about products and activities it regulates.
• Preventing or reducing a serious and imminent threat to anyone’s health or safety.
• As required under laws addressing work-related illnesses and injuries or workplace medical surveillance.

Health Oversight Activities

To the extent authorized by law, we can share your PHI with a health oversight agency that oversees the health care system and ensures the rules of government health programs are being followed.

Legal and Administrative Proceedings

If certain conditions are met, we can share your PHI in response to a court or administrative order. In most cases, we won’t share your information in response to a subpoena, unless it is accompanied by a binding court order or your written permission.

Law Enforcement Purposes

We can share your PHI with the police or other law enforcement officials as required or permitted by law, or in compliance with a court order.

Decedents

• We can share PHI with a coroner, medical examiner, or funeral director as authorized by law.
• After your death, we can also share limited information with friends or family who were involved in providing or paying for your care, unless doing so is inconsistent with any prior expressed preference that you have made known to us.
• We are required to comply with federal privacy protections for your PHI for a period of fifty (50) years following your death.

Workers’ Compensation

We can share your PHI as permitted or required by state law relating to workers’ compensation claims or other similar programs.

As Required by Law

We will use and share your PHI if state or federal law requires it.

Written Permission to Use and Share Your Protected Health Information

For purposes other than the types described above, we will only use or share your PHI when you give us your written permission. For example, you will need to give us your written permission before we send your PHI to your life insurance company or your attorney. You may change your mind about your authorization to disclose your PHI by sending a written "revocation statement" to our Privacy Office. Their vocation will not apply to the extent that we have already taken action based on your prior authorization.‍

Certain Health Information

Some categories of health information are protected by additional state or federal privacy laws and regulations. In most cases, we will not be able to share the following types of health information without your written authorization:

• HIV testing and test results (except to other health care providers treating you, when sharing is necessary to protect your health)
• Genetic testing and test results
• Substance use disorder treatment records protected under 42C.F.R. part 2‍

Your Rights Regarding Your Protected Health Information

All requests to exercise your rights described in this section must be in writing. If you wish to obtain request forms or want additional information about how to exercise any of your rights described in this section, please contact our Privacy Office.‍

Right to Receive an Electronic or Paper Copy of Your Medical Records

You have a right to receive your PHI in a format that works for you, including an electronic or paper copy of your dental records. This includes your medical and billing records, and other dental records used to make decisions about your care. You can also ask us to send an electronic copy of these records to other individuals or entities that you identify. We will provide a copy of your records within thirty (30) days of receipt of your written request. We may charge a reasonable, cost-based fee.

Right to Request Additional Restrictions

You have the right to ask us not to share or use your PHI for treatment, payment, or health care operations, including sharing your PHI with your family or friends involved in your care. We are not required to agree to these requests, except for requests to restrict disclosures of your PHI to a health plan if the PHI relates to a dental service for which you paid in full at the time of service.

Right to Request Confidential Communications

You have the right to ask us to contact you about your PHI in a specific way (for example, by home or office phone) or to send mail to a different address. We will accommodate all reasonable requests.‍

Right to Request an Amendment to Your Medical Records

You have the right to request an amendment to your PHI if you believe that the information is incomplete or inaccurate. We may deny your request in certain circumstances, such as if the information was not created by us or if we believe the current information is accurate.

Right to an Accounting of Disclosures

You have the right to request a list (an "accounting") of certain disclosures that we have made of your PHI. This accounting will not include disclosures for treatment, payment, health care operations, and certain other purposes, as permitted by law. We will provide you with the first accounting of disclosures within a twelve (12) month period at no charge, but we may charge a reasonable, cost-based fee if you request another accounting within twelve (12) months.‍

Right to a Copy of This Notice

You have the right to a paper copy of this Notice at any time. You may obtain a copy from our office or download it from our website.

Changes to the Terms of This Notice

We can change the terms of this Notice at any time, and the changes will apply to all PHI that we have about you. The new notice will be available upon request, in our office, and on our website.

Questions or Complaints

If you have any questions about this Notice or believe that your privacy rights have been violated, you may contact our Privacy Office using the information provided below. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. By law, we cannot retaliate against you for filing a complaint.

Privacy Officer Contact Information:
Dr. Ankur Oswal, MPH, DMD‍
62 S Ludlow St, Worcester, MA 01603