HIPAA Notice of Privacy Practices | Worcester Kids' Dentist

Effective Date: July 15, 2026

Worcester Kids' Dentist
41 Lancaster Street, Suite 100
Worcester, MA 01609
(508) 754-9825

The terms of this Notice of Privacy Practices ("Notice") apply to Worcester Kids' Dentist, its affiliates, and its employees. Worcester Kids' Dentist will share patients' protected health information as necessary to carry out treatment, payment, and health care operations as permitted by law.

We are required by law to maintain the privacy of our patient's protected health information and to provide patients with Notice of our legal duties and privacy practices for protected health information.

We are required to abide by the terms of this Notice for as long as it remains in effect. We reserve the right to change the terms of this Notice as necessary and to make a new notice of privacy practices effective for all protected health information maintained by Worcester Kids' Dentist.

We are required to notify you in the event of a breach of your unsecured protected health information. We are also required to inform you that there may be a provision of state law that relates to the privacy of your health information that may be more stringent than a standard or requirement under the Federal Health Insurance Portability and Accountability Act ("HIPAA").

You may obtain a copy of any revised Notice of Privacy Practices or information pertaining to a specific State law by mailing a request to the Privacy Officer at the address below.

Uses and Disclosures of Your Protected Health Information

We may use and disclose your Protected Health Information in the following situations:

Authorization and Consent: Unless outlined below, we will not use or disclose your protected health information for any purpose other than treatment, payment, or health care operations unless you have signed a form authorizing such use or disclosure. You have the right to revoke such authorization in writing, with such revocation being effective once we receive the request in writing; however, such revocation shall not be effective to the extent that we have taken any action in reliance on the authorization or if the authorization was obtained as a condition of obtaining insurance coverage.
Treatment: We may use or disclose your Protected Health Information to provide medical treatment and/or services to manage and coordinate your medical care — for example, sharing information with physicians, hospitals, laboratories, and other providers so your care team has what it needs.
Payment: Your Protected Health Information will be used to obtain payment for your health care services, including providing your health plan with the information it requires prior to paying us.
Health Care Operations: We may use and disclose your Protected Health Information to manage, operate, and support the business activities of our practice, including quality assessment, licensing, and appointment reminders.
Minors: Protected Health Information of minors will be disclosed to their parents or legal guardians unless prohibited by law.
Required by Law: We will use or disclose your Protected Health Information when required by local, state, federal, and international law.
Abuse, Neglect, and Domestic Violence: Disclosed to the appropriate agency where there is belief a patient has been or is a victim, or to prevent a serious threat to health or safety.
Judicial and Administrative Proceedings: Disclosed as required by court order, subpoena, or other legal process, only after efforts to inform you or obtain a protective order.
Law Enforcement: Disclosed when all applicable legal requirements are met (identifying suspects, complying with warrants, etc.).
Coroners and Medical Examiners: Disclosed to assist in their investigations.
Public Health: Disclosed as required by law for disease control, child abuse reporting, adverse event reporting, and similar public-health purposes.
Health Oversight Activities: Disclosed to oversight agencies for audits, investigations, and licensures authorized by law.
Inmates: Disclosed to a correctional facility when necessary for institutional health care or the safety of others.
Military, National Security, and Specialized Government Functions: Disclosed to authorized officials where required.
Immunizations: Proof of immunizations provided to a school requiring a patient's record where you have agreed to the disclosure.
Worker's Compensation: Disclosed only the information necessary to comply with Worker's Compensation laws.
Practice Ownership Change: If our practice is sold, acquired, or merged, your protected health information becomes the property of the new owner, and you retain the right to request copies of your records.
Breach Notification: If there is an unsecured breach of your Protected Health Information, we will notify you as required by law.
Research: Disclosed to researchers only when an Institutional Review or Privacy Board has approved the research and it complies with law.
Business Associates: Disclosed to business associates who perform services for us, under contract and bound by the same HIPAA privacy and security rules.

Uses and Disclosures in Which You Have the Right to Object and Opt-Out

Communication with family and/or individuals involved in your care: Unless you object, disclosure may be made to a family member, friend, or other individual you identify as involved in your care or payment.
Disaster: Disclosed to disaster relief organizations to coordinate care and notify family, where possible after giving you an opportunity to agree or object.
Fundraising: We may contact you regarding fundraising. You have the right to opt out — let our office know if you prefer not to receive such communications.

Uses and Disclosures That Require Your Written Authorization

We will not use or disclose your Protected Health Information without written authorization except as described above. This includes, but is not limited to:

Psychotherapy Notes: Not disclosed without written authorization except in limited circumstances (continued treatment, litigation defense, law, averting a serious threat, or coroner/medical examiner upon death).
Genetic Information: Specific written authorization required before using or disclosing genetic information for treatment, payment, or health care operations, except where permitted by law.
Marketing: Authorization required for marketing communications, except face-to-face communication or a nominal-value promotional gift.
Sale of Protected Information: Authorization required before receiving remuneration in exchange for health information, with limited legal exceptions.

Your Rights Regarding Protected Health Information

Inspect and copy: You may inspect and copy your records (reasonable fees may apply); some records are restricted by law. We have up to 30 days to provide them.
Summary or explanation: You may request only a summary of your information, with an explanation if you request your full record.
Electronic copy: You may request an electronic copy of your medical record for yourself or another party.
Notice of breach: You have the right to be notified in the event of a breach of your unsecured Protected Health Information.
Request amendments: If you believe information on file is inaccurate or incomplete, you may request an amendment in writing.
Accounting of disclosures: You may request an accounting of disclosures made of your information (excluding treatment, payment, operations, and those required by law).
Request restrictions: You may request restrictions on disclosures to others, submitted in writing. We are not required to agree except for a restriction on disclosing to your health plan for care you paid in full out-of-pocket.
Confidential communications: You may request we communicate by alternative means or at an alternative location (e.g., work phone only).
Paper copy: Even if you agreed to an electronic copy, you may request this notice in paper form at any time.

Changes to This Notice

We reserve the right to change the terms of this notice and will notify you of such changes. We will make copies of any new notice available. We will not retaliate against you for filing a complaint.

Complaints

If you believe your privacy rights have been violated, you may file a complaint in writing with the Privacy Officer, or with the Secretary of the U.S. Department of Health and Human Services:

Office for Civil Rights
Department of HHS
Jacob Javits Federal Building
26 Federal Plaza – Suite 3312
New York, NY 10278
Voice: (212) 264-3313 · FAX: (212) 264-3039 · TDD: (212) 264-2355

For Further Information

Contact the Worcester Kids' Dentist Privacy Officer by phone at (508) 754-9825 or at:
41 Lancaster Street, Suite 100, Worcester, MA 01609.