Notice of Privacy Practices

Effective Date: January 1, 2018

Last Updated: January 27th, 2026

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE FEEL FREE TO SPEAK TO YOUR DOCTOR, HIS/HER DESIGNEE, OR THE HIPAA PRIVACY OFFICER.

Midtown Dental Group is committed to maintaining and protecting the confidentiality of your personal information. This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). It will inform you about the ways in which we may use and disclose your health information, and the safeguards we have put into place to protect it. It also describes your rights and certain obligations we have regarding the use and disclosure of your health information.

Your Rights

You have the right to:

• Request a copy of your paper or electronic medical record
• Request a correction to your paper or electronic medical record
• Request confidential communications
• Ask us to limit the information we share
• Get a list of certain disclosures we have made of your information
  • Get a copy of this privacy notice
  • Choose someone to act for you, in accordance with certain legal requirements
• File a complaint if you believe your privacy rights have been violated

Your Choices 

You have some choices in the way that we use and share information as we:

• Tell family and friends about your condition
• Include you in our teaching resources
• Use & create content for Marketing Purposes

Our Uses and Disclosures 

We may use and share your information as we:

• Treat you
• Share information with specialists, labs, or other healthcare providers involved in your care
• Run our organization
• Bill for your services and receive payment
• Appointment reminders
• Help with public health and safety issues
• Do research
• Comply with the law
• Address workers’ compensation, law enforcement, and other government requests
• Coroners, funeral directions, and organ donation.
• Respond to lawsuits and legal actions

Additional Rights: 

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities.

Obtain an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and certain other health information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

• You can ask us to correct information about you in your medical record that you think is incorrect or incomplete by writing to the Privacy Officer at the end of this notice.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communication 

•  You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say ‘yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times and with whom we’ve shared your health information for six years prior to the date you ask. We are not required to include disclosures for treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this Privacy Notice

• You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting our Privacy Officer where the violation occurred:
• Privacy officer: Miriam Warsawsky, RDH | mimi@midtowndentalgroup.com
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/

We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will try to accommodate your requests where we can.

In these cases, you have both the right and choice to tell us whether to:

• Share information with your family, close friends, or others involved in your care.
• Health Information Exchange
  • We may also participate in certain health information exchanges that share health information electronically with other healthcare providers, as permitted by federal law.

In these cases, we never share your information unless you give us written permission:

• Certain marketing purposes
  • We may contact you for marketing efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information?
We typically use or share your health information in the following way.

Treat you
We can use your health information to treat you and share it with other professionals who are treating you.
Example: A doctor treating you asks another doctor about your overall health condition.

Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.

Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues
We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do research
We can use or share your information for health research or educational purposes. Any identifying information will be removed.

Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order or in response to a subpoena if certain requirements are met.

Coroners, funeral directors, and organ donation
We may disclose your health information to a coroner or medical examiner. This may be necessary to identify a deceased person or to determine the cause of death. We may also disclose protected health information to funeral directors as authorized by law to assist them in carrying out their duties.

Parental access
Various State laws determine what protected health information can be disclosed to parents, guardians, and persons acting in a similar legal status. We will act consistently with the law and will make disclosures only when necessary.

Individuals involved in your care.
Unless you object, we may use or disclose your health information to notify or assist in the notification of a family member or personal representative of your location, your general condition, or death. If you are present, you will have the opportunity to object to this type of use or disclosure. If you are unable to decide or if it is an emergency, we may disclose information that is directly relevant to the person’s involvement in your healthcare, if we determine that it is in your best interest to do so.

SUBSTANCE USE DISORDER (SUD) RECORDS

SPECIAL PRIVACY PROTECTIONS
Some health information related to substance use disorder (SUD) diagnosis, treatment, or referral may be protected by federal law (42 CFR Part 2) and receives additional confidentiality protections.

Important information about SUD records:

• We may not use or disclose SUD records for treatment, payment, or healthcare operations without your written consent, except as permitted by law.
• These records will not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you without your written consent or a court order.
• If state or federal laws are more restrictive than HIPAA, those stricter laws will apply.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice
We can change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request, and in our office.

Other Instructions for Notice
In addition to the Federal rules regarding privacy, we will follow State laws regarding health care privacy. We will obtain appropriate consents before we share information concerning your genetic information, HIV status, substance abuse and certain mental health information. We also will obtain your consent for other uses and disclosures of your health information when required by State law to do so.

Midtown Dental Group complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Last updated January 26, 2026.  This Notice of Privacy Practices remains in effect until modified by Midtown Dental Group.