Smile Studio · 137 South St, 2nd Floor, Boston, MA 02111 · (617) 362-8032 · smilestudio137@gmail.com
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a federal program requiring that all medical records and other individually identifiable health information used or disclosed by us in any form — electronically, on paper, or orally — be kept properly confidential. This Act gives you, the patient, significant rights to understand and control how your protected health information is used, and provides penalties for covered entities that misuse it.
As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your protected health information and how we may use and disclose it.
We may use and disclose your protected health information only for the following purposes: treatment, payment activities, and health care operations.
- Treatment — providing, coordinating, or managing health care and related services by one or more health care providers; for example, a dental cleaning.
- Payment — activities such as obtaining reimbursement for services, confirming insurance coverage, billing or collection, and utilization review; for example, sending a bill for your visit to your dental insurance company.
- Health care operations — the business aspects of running our practice, such as quality assessment and improvement, auditing, cost-management analysis, and customer service.
We may also create and distribute de-identified health information by removing all references to individually identifiable information. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may interest you. Any other uses and disclosures will be made only with your written authorization, which you may revoke in writing at any time; we are required to honor that request except to the extent we have already acted in reliance on your authorization.
Your rights
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to our Privacy Officer:
- To request restrictions on certain uses and disclosures, including disclosures to family members, other relatives, close personal friends, or any other person you identify. We are not required to agree to a requested restriction — but if we do agree, we must abide by it unless you agree in writing to remove it.
- To reasonably request confidential communications from us by alternative means or at alternative locations.
- To inspect and copy your protected health information.
- To amend your protected health information.
- To receive an accounting of disclosures of your protected health information.
- To obtain a paper copy of this notice from us upon request.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices. This notice is effective August 17, 2026, and we are required to abide by its current terms. We reserve the right to change the terms of our Notice of Privacy Practices and to make new provisions effective for all protected health information we maintain; a revised notice will be posted and is available in writing upon request.
Complaints
If you feel your privacy protections have been violated, you have the right to file a written complaint with our office — Privacy Officer, Smile Studio, 137 South St, 2nd Floor, Boston, MA 02111 — or with the U.S. Department of Health & Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, DC 20201. We will never retaliate against you for filing a complaint.
