This is a template for Clinics. Under HIPAA, the Notice of Privacy Practices (NPP) is provided by the covered entity (the dental clinic) to its patients — not by the software vendor. DentalX provides this template as a convenience. Each Clinic must customize it with its own name, contact, and practices, and have it reviewed by counsel before giving it to patients.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. Our commitment
[Clinic name] is required by law to protect the privacy of your protected health information (PHI), to provide you this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect.
2. How we may use and disclose your PHI
- Treatment — to provide and coordinate your dental care among providers.
- Payment — to bill and obtain payment for services, including from insurers.
- Health care operations — for quality, administration, and practice management.
- Appointment reminders & communications — to contact you about appointments and care.
- As required by law — for public health, safety, or legal obligations.
3. Uses that require your authorization
Most uses and disclosures not described above — for example, marketing or any sale of PHI — require your written authorization, which you may revoke at any time.
4. Your rights
- Inspect and obtain a copy of your records.
- Request a correction (amendment) of your records.
- Request an accounting of certain disclosures.
- Request restrictions on certain uses and disclosures.
- Request confidential communications (e.g., by a specific method or location).
- Obtain a paper copy of this Notice on request.
- Be notified of a breach of your unsecured PHI.
5. Our duties
We must maintain the privacy of your PHI, notify you following a breach of unsecured PHI, and abide by this Notice. We may change our practices and this Notice; revised Notices will be made available, and the new terms will apply to all PHI we maintain.
6. Business Associates
We use service providers (“Business Associates”), such as our practice-management software vendor, who agree by contract to safeguard your PHI.
7. Complaints
If you believe your privacy rights have been violated, you may complain to us at [clinic contact] or to the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.
8. Contact & effective date
Privacy Officer: [name / contact]. Effective date: [date].