HIPAA NOTICE OF PRIVACY PRACTICES
Greenwich Dental Care
a trade name of Dr. Chase Whitlow D.D.S. PLLC
Effective Date: _____12/11/25_____________
This Notice explains how we may use and share your health information and what rights you have regarding that information. We are required by law to give you this Notice and to follow it.
Our Responsibilities
We are required to:
- Protect the privacy and security of your protected health information (“PHI”).
- Give you this Notice describing our legal duties and privacy practices.
- Follow the terms of the Notice that is currently in effect.
- Notify you if a breach occurs that may have compromised the privacy or security of your information, when required by law.
We may change our privacy practices and this Notice at any time, as permitted by law. If we make material changes, we will update this Notice and make the new version available in our office and on our website (if applicable).
How We May Use and Share Your Information
We typically use or share your health information in the following ways:
- For Treatment We use and share PHI to provide, coordinate, or manage your dental care. For example, we may share information with another dentist, specialist, physician, or dental laboratory involved in your treatment.
- For Payment We use and share PHI to obtain payment for services we provide. For example, we may send information about your treatment to your dental insurance plan so it can process claims, determine coverage, or obtain prior authorization.
- For Health Care Operations We use and share PHI for our practice operations, such as quality improvement, staff training, licensing, accreditation, and internal audits. These activities help us run the office and improve the quality of care we provide.
- Appointment Reminders and Communications We may use your contact information (phone, text, email, mail) to remind you of appointments, follow up on treatment, or provide information about services related to your care, as permitted by law.
Other Uses and Disclosures Allowed or Required by Law
We may also use or disclose your PHI without your written authorization when permitted or required by law, including:
- To family members or others involved in your care or payment, when appropriate and allowed by law.
- For public health activities, such as reporting certain diseases or adverse events.
- To report abuse, neglect, or domestic violence to authorized agencies.
- For health oversight activities, such as inspections or investigations by health regulators.
- For judicial and administrative proceedings, such as responding to a court order or subpoena, when legally required.
- For certain law enforcement purposes and to avert a serious threat to health or safety.
- To comply with other federal, state, or local laws that require disclosure of health information.
We will limit the information disclosed to the minimum amount reasonably necessary, as required or permitted by law.
Uses and Disclosures Requiring Your Authorization
Other uses and disclosures of your PHI that are not described in this Notice will be made only with your written authorization. For example, most uses of PHI for marketing purposes or any sale of your PHI require your authorization.
If you give us a written authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosure made before we received your revocation.
Your Rights Regarding Your Health Information
You have the following rights regarding your PHI:
- Right to Inspect and Copy You may request to see or get a copy of your dental records and other health information we maintain about you, with limited exceptions. We may charge a reasonable, cost-based fee as allowed by law.
- Right to Request an Amendment If you believe information in your record is incorrect or incomplete, you may request that we amend it. We may deny your request in certain circumstances, but we will explain our reasons in writing if we do.
- Right to an Accounting of Disclosures You may request a list of certain disclosures of your PHI that we made in the past, excluding those for treatment, payment, healthcare operations, and certain other disclosures permitted by law.
- Right to Request Restrictions You may ask us to limit how we use or share your PHI for treatment, payment, or operations, or with certain individuals involved in your care. We are not required to agree to all requests, but if we do agree, we will comply except in emergencies or when permitted by law.
- Right to Request Confidential Communications You may request that we contact you in a specific way (for example, at a certain phone number or address), and we will accommodate reasonable requests.
- Right to a Paper or Electronic Copy of this Notice You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
Questions or Complaints
If you have questions about this Notice or our privacy practices, or if you want to exercise your rights or file a complaint with us, contact us at:
Greenwich Dental Care (Dr. Chase Whitlow D.D.S. PLLC)
500 West Putnam Ave. STE #425
Greenwich, CT 06830
(203) 869-2510
If you believe your privacy rights have been violated, you may file a complaint with us using the contact information above, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.
