SUMMARY NOTICE OF PRIVACY PRACTICES THIS IS A SUMMARY OF OUR NOTICE OF PRIVACY PRACTICES, WHICH DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
Our pledge to protect your privacy:
Nabil R. Ibrahim, B.D.S., D.D.S., PLLC is committed to protecting the privacy of your medical information. Your care and treatment is recorded in a dental/ medical record. So that we can best meet your dental needs, we share your dental record with the providers involved in your care. We share your information only to the extent necessary to collect payment for the services we provide, to conduct our business operations, and to comply with the laws that govern health care. We will not use or disclose your information for any other purpose without your permission.
Participant Rights – You have the following rights regarding your medical information:
• to request to inspect and obtain a copy of your dental/medical records, subject to certain limited exceptions;
• to request to add an addendum to or correct your dental/medical record;
• to request an accounting of Nabil R. Ibrahim, B.D.S., D.D.S.,PLLC’s disclosures of your dental/medical information;
• to request restrictions on certain uses or disclosures of your dental/medical information;
• to request that we communicate with you in a certain way or at a certain location;
• and to receive a copy of the full version of our Notice of Privacy Practices.
We may use and disclose medical information about you for the following purposes:
• to provide you with Dental/medical treatment and services;
• to bill and receive payment for the treatment and services you receive;
• for functions necessary to run Nabil R. Ibrahim, B.D.S., D.D.S.,PLLC’s and assure that our participants receive quality care;
• and as required or permitted by law. There are additional situations where we may disclose dental/medical information about you without your authorization, such as:
• for workers’ compensation or similar programs;
• for public health activities (e.g., reporting abuse or reactions to medications);
• to a health oversight agency, such as the Massachusetts Department of Health Services;
• in response to a court or administrative order, subpoena, warrant or similar process;
• to law enforcement officials in certain limited circumstances;
• to a coroner, medical examiner or funeral director
You have recourse if you feel that your privacy protection has been violated, without any threat of retaliation or restriction of care. You may file a complaint with:
US Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, SW
Washington, DC 20201
You may speak to our privacy officer at any time.
You may request a complaint form at any time.
10 Converse Place, Suite 102
Winchester, MA 01890