Notice of Privacy Practices
Effective Date: [Insert Date]
Placeholder — not for publication as final.
This page is a placeholder for the practice's official HIPAA Notice of Privacy Practices. Replace this content with the practice's attorney-approved or HIPAA-compliance-approved Notice of Privacy Practices before launch.
Your Rights
- [Patient right to receive a copy of this Notice]
- [Patient right to request access to and copies of their records]
- [Patient right to request corrections or amendments to their records]
- [Patient right to request confidential communications]
- [Patient right to request restrictions on use or disclosure]
- [Patient right to receive an accounting of disclosures]
- [Patient right to file a complaint without retaliation]
How We May Use Protected Health Information
- [Treatment]
- [Payment]
- [Healthcare operations]
- [Appointment reminders and follow-up]
- [Other uses and disclosures permitted or required by law]
Uses That Require Authorization
[Describe situations in which written patient authorization is required, including marketing, sale of PHI, and most uses of psychotherapy notes, as applicable.]
Our Responsibilities
[Describe the practice's obligations to protect the privacy and security of protected health information and to provide notice of breaches when required.]
Privacy Officer / Contact
[Insert Privacy Officer name, title, phone, and email.]
Dentistry on the Square
1064 Lake Sumter Landing
The Villages, FL 32162
(352) 289-0025
Filing a Complaint
[Describe how patients may file a complaint with the practice's Privacy Officer and with the U.S. Department of Health and Human Services. Confirm that no retaliation will occur for filing a complaint.]
Related
See also our Website Privacy Policy and SMS Terms & Conditions.
Do not publish this page as final until the practice's approved Notice of Privacy Practices has been inserted.