Notice of Privacy Practices

Your Rights

Get a Copy of Your Health Record

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

Ask Us to Correct Your Record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say no to your request, but we will tell you why in writing within 60 days.

Request Confidential Communications

You can ask us to contact you in a specific way, such as by 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, and we may say no if it would affect your care. If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or operations. We will say yes unless a law requires us to share it.

Get a List of Those We’ve Shared With

You can ask for a list of the times we have shared your health information in the six years before your request, who we shared it with, and why. The list will include all disclosures except those about treatment, payment, and health care operations, and certain others, such as any you asked us to make. We provide one list a year for free, and may charge a reasonable, cost-based fee for another within 12 months.

Get a Copy of This Notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide it 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 confirm the person has this authority before we take any action.

File a Complaint

If you feel we have violated your rights, you can contact us using the information below. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or online at hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.

Your Choices

How We Use and Share Your Information

To Treat You

We use your health information and share it with other professionals who are treating you, such as your orthodontist, dentist, physician, or the hospital where your surgery is performed.

To Run Our Practice

We use and share your health information to run our practice, improve your care, and contact you when necessary, including appointment reminders.

To Bill for Your Services

We use and share your health information to bill and get payment from health plans or other entities.

Other Uses Allowed or Required by Law

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 safety, research, and complying with the law. These include preventing disease, reporting adverse reactions to medications or devices, reporting suspected abuse or neglect, preventing a serious threat to anyone’s health or safety, responding to organ and tissue donation requests, working with a medical examiner or funeral director, workers’ compensation claims, health oversight activities, law enforcement purposes, specialized government functions, and responding to court orders and other legal processes. We must meet many conditions in the law before we can share your information for these purposes.

New Jersey Law

Where New Jersey law gives greater protection to certain health information, we follow the stricter law.