Westborough Dental
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The privacy of your health information is important to us.
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information (PHI), and to notify affected individuals following a breach of unsecured protected health information.
This Notice is newly updated February 16, 2026 (previous version effective January 1, 2005) and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make new Notice provisions effective for all protected health information that we maintain.
When we make a significant change in our privacy practices, we will change this Notice and post the new notice clearly and prominently at our practice location, and we will make the new Notice available upon request.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.
Uses and Disclosures of Health Information
We use and disclose health information about you for treatment, payment, and healthcare operations.
Treatment
We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
Payment
We may use and disclose your health information to obtain reimbursement for the treatment and services you receive from us or another entity involved with your care. Payment activities include billing, collection, claims management, and determinations of eligibility and coverage, or another third party relative to payment and accounts receivable/accounts payable.
For example, we may send claims to your dental health plan containing health information, or to collections if a balance remains unpaid, to verify services were rendered.
Some information, such as HIV-related information, genetic information, alcohol and/or substance use disorder information, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records.
Healthcare Operations
We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, and accreditation, certification, licensing, or credentialing activities.
Your Authorization
In addition to our use of your health information for treatment, payment, or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose.
If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.
Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.
To Your Family and Friends
We must disclose your health information to you, as described in the Patient Rights section of this Notice.
We may disclose your health information to a family member, friend, or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree (verbally, by text, by email, or in writing). If by phone, we will verify using three pieces of identifying information to assist in your protection of health information. We may contact you to verify this person.
All disclosures may be revoked by you at any time (verbally, by text, by email, or in writing). It will be documented in the patient file.
Persons Involved in Care
We may use or disclose health information to notify or assist in the notification of (including identifying or locating) a family member, your personal representative, or another person responsible for your care of your location, your general condition, or death.
If you are present, we will provide you with an opportunity to object prior to use or disclosure of your health information. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment, disclosing only health information that is directly relevant to the person’s involvement in your healthcare.
We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.
Disaster Relief
We may use or disclose your health information to assist in disaster relief efforts.
Marketing Health-Related Services
We do not and will not use your health information for marketing communications for any purpose outside the dental practice. If for any reason the office would implement marketing, we will not do so without your written authorization.
Internal marketing may include dental promotions patients may be eligible for such as discounted whitening and products (for example, discounted prescription pastes or toothbrushes) from our office only, direct to the patient.
In our reminder system, you may opt out at any time in the preferences tab for all patients through both text and email. You may also notify us in any manner if you do not wish to receive discounted items or promotions given to us by the manufacturer that we then pass on to the patient.
Required by Law / Law Enforcement
We may use or disclose your PHI for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order.
Secretary of HHS
We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services only when required to investigate or determine compliance with HIPAA.
Worker’s or Workman’s Compensation
We may disclose your PHI to the extent authorized by and to the extent necessary to comply with law relating to worker’s compensation or other similar programs established by law.
Public Health Activities, Abuse, or Neglect
We may disclose your health information to notify the appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence, trafficking, or the possible victim of other crimes.
We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
Public health disclosures may include: Prevent or control disease, injury, or disability; report child abuse or neglect; report reactions to medications or problems with products or devices; notify a person who may have been exposed to a disease or condition.
Health Oversight Activities
We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings
If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order.
We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made (either by the requesting party or us) to tell you about the request or to obtain an order protecting the information requested.
Research
We may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information.
Coroners, Medical Examiners, and Funeral Directors
We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
We may also disclose PHI to funeral directors consistent with applicable law to enable them to perform their duties.
Fundraising
We do not and will not use your health information for any fundraising.
Appointment Reminders
We may use or disclose your health information (as minimum as possible: name, date, and time) to provide you with appointment reminders by text, email, or phone call (such as voicemail messages, postcards, or letters).
We may send you directly your treatment plans, insurance information, and copays by text and email.
SUD (Substance Use Disorder) Treatment Information
If we receive or maintain any information about you from a substance use disorder treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the Part 2 Program Record for treatment, payment, or health care operations, we may use and disclose your Part 2 record for treatment, payment, insurance reimbursement (as applicable), and health care operations purposes as described in this Notice.
If we receive or maintain your Part 2 Program Record through specific consent you provide to us or another third party, we will use and disclose your Part 2 Program record only as expressly permitted by you in your consent as provided to us.
In no event will we use or disclose your Part 2 Program record, or testimony that describes the information contained in your Part 2 Program Record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority against you, unless authorized by your consent or the order of a court after it provides you notice of the order.
Other Uses and Disclosures of PHI
Your authorization is required (with a few exceptions) for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI.
We do not disclose this information without your written authorization before using or disclosing your PHI for purposes other than those provided for in this notice (or as otherwise permitted or required by law).
You may revoke an authorization by any notification (verbal, text, email, or written). We will note it and stop using or disclosing your PHI, except to the extent that we have already acted in reliance on the authorization.
Patient Rights
Access
You have the right to look at or get copies of your health information, with limited exceptions.
Requests should be submitted in writing; however, we may verify your account with you if you have moved or are unable to provide it in writing, and we will utilize methods of verification such as multiple verification and send records to your verified email address if it is able to be authenticated.
We will use the format you request unless we cannot practicably do so. We do not have a fee associated with records.
If you are denied a request for access, you have the right to have the denial reviewed in accordance with the requirements of applicable law.
You may also request access by sending the office a letter to the address at the end of the notice.
Disclosure Accounting
With the exception of certain disclosures, you have the right to receive an accounting of disclosures of your health information in accordance with applicable laws and regulations.
To request an accounting of disclosures of your health information, you must submit your request in writing to the Privacy Official.
If you request this accounting more than once in a 12-month period, we may charge a reasonable cost-based fee for responding to additional requests. This is determined by a number of factors including time, training, effective transfer, completion, and confirmation time.
Restriction
You have the right to request that we place additional restrictions on our use or disclosure of your PHI by submitting a written request to the Privacy Official.
Your written request must include: (1) what information you want to limit, (2) whether you want to limit our use, disclosure, or both, and (3) to whom you want the limits to apply.
We are not required to agree to your request, except in a case where the disclosure is to a health plan for purposes of carrying out payment or healthcare operations, and the information pertains solely to a healthcare item or service for which you (or a person on your behalf, other than the health plan) has paid our practice in full.
If you choose insurance restriction with one of our “in-network” insured providers, our office will not be able to treat for cases involving “in-network” insurances, as anyone is allowed to change the restriction at any time and our office is not agreeable and will not proceed with treatment.
The exceptions to this in which our office would be agreeable are for expressed purposes of: domestic violence, abuse, consent to treating and payment without disclosure to a non-custodial parent or family member which would otherwise result in harm to the person seeking the HIPAA restriction.
If any other situation may apply, we will review and consult our liability insurance to make a determination which would protect all parties.
Alternative Communication
You have the right to request that we communicate with you about your health information by alternative means or to alternative locations, unless we are the referring provider or providing coordination in care amongst multiple clinicians.
You must make your request in writing. Your request must specify the alternative means or location and provide a satisfactory explanation of how payments will be handled under the alternative means or location you request. Written permission protects both yourself and the provider.
Amendment
You have the right to request that we amend your health information.
Your request must be in writing and must explain the reasoning. We may deny your request under certain circumstances. Electronic information should be amended.
If corrections are made to the accuracy of information or detail, we will amend your record and notify you of such.
If the request for amendment is denied, we will provide you with a written explanation of why it was denied and explain your rights.
Right to Notification of a Breach
You will receive notifications of breaches of your unsecured protected health information as required by law.
Electronic Notice
You may receive a paper copy of this notice. It is always available upon request, even if you have agreed to receive this Notice electronically on our website or by email.
Questions and Complaints
If you want more information about our privacy practices or have questions or concerns, please contact us.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may issue a complaint using the contact information listed below.
You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.
We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Privacy Official Name and Contact Information
Contact Officer: Trushar Patel, DMD
Telephone: (508) 366-0550 Fax: (508) 898-0121
Address: 33 Lyman St Suite #203A, Westborough, MA 01581
Email: Attn: HIPAA Privacy Officer – contact@westboroughdental.com
© 2010–2025 American Dental Association. All Rights Reserved. Changes in applicable laws or regulations may require revision. All revisions to this Notice of Privacy Practices will be made available to the public and patients.
