Effective Date: January 1, 2026
This Notice describes how medical and dental information about you may be used and disclosed and how you can access this information. Please review it carefully.
Our Legal Duty
White Mountain Dental (“we,” “our,” or “us”) is required by law to maintain the privacy of your protected health information (“PHI”), to provide you with this Notice describing our legal duties and privacy practices, and to notify you following a breach of unsecured PHI.
We must follow the terms of this Notice that are currently in effect.
How We May Use and Disclose Health Information
We may use and disclose your PHI for the following purposes without your written authorization.
Treatment
We may use and share your PHI to provide, coordinate, or manage your dental or medical care.
For example, sharing information with specialists, laboratories, or pharmacies involved in your treatment.
Payment
We may use and share PHI to obtain payment for services provided.
For example, submitting claims to insurance carriers or verifying coverage.
Health Care Operations
We may use and share PHI for administrative, operational, quality assurance, training, auditing, or accreditation purposes.
For example, reviewing treatment outcomes or evaluating staff performance.
Appointment Reminders and Communications
We may contact you by phone, voicemail, text message, mail, or email regarding appointments, billing, or follow-up care.
Individuals Involved in Your Care
We may disclose PHI to family members or others involved in your care or payment for care, unless you object or restrictions apply.
Public Health and Safety
We may disclose PHI to public health authorities, the FDA, or other agencies for reporting disease, injury, adverse events, or vital statistics.
Health Oversight Activities
We may disclose PHI to government agencies for audits, investigations, inspections, or licensure activities as required by law.
Law Enforcement and Legal Requirements
We may disclose PHI when required by law, court order, subpoena, or administrative request, or to identify or locate a suspect, fugitive, or missing person.
Coroners, Medical Examiners, and Funeral Directors
We may disclose PHI as necessary to carry out their legally authorized duties.
Research
We may use or disclose limited PHI for approved research projects, subject to required privacy safeguards and review processes.
Workers’ Compensation
We may disclose PHI as authorized to comply with workers’ compensation laws or similar programs.
Required by Law
We will disclose PHI when required to do so by federal, state, or local law.
Other Uses and Disclosures with Your Authorization
Any other use or disclosure of PHI not described in this Notice will be made only with your written authorization.
You may revoke an authorization in writing at any time, except where we have already relied on it.
Your Rights Regarding Your Health Information
You have the following rights regarding your PHI.
Right to Access
You may request to inspect or obtain a copy of your health and billing records, subject to limited exceptions. Reasonable fees may apply.
Right to Request Amendment
You may request an amendment if you believe your record is incorrect or incomplete. We may deny requests in certain circumstances.
Right to an Accounting of Disclosures
You may request a list of certain disclosures made during the past six years, excluding those made for treatment, payment, or operations.
Right to Request Restrictions
You may request restrictions on the use or disclosure of your PHI. We are not required to agree to all requests.
Right to Request Confidential Communications
You may request that we contact you using a specific method or location. Reasonable requests will be accommodated.
Right to a Paper Copy of This Notice
You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
Right to Notification of a Breach
You have the right to be notified following a breach of unsecured PHI as required by law.
Our Responsibilities
We are required by law to maintain the privacy and security of your PHI.
We will notify you promptly if a breach occurs that may have compromised your information.
We will not use or disclose your PHI other than as described in this Notice unless you authorize us in writing.
We will not sell your PHI or use it for marketing purposes without your written permission.
Changes to This Notice
We reserve the right to revise this Notice at any time. The revised Notice will apply to all PHI we maintain and will be available at our office and on our website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint.
With Us:
Privacy Officer
White Mountain Dental
2759 White Mountain Hwy
North Conway, NH 03860
Phone: (603) 356-6505
Email: mail@whitemountaindental.com
With the U.S. Department of Health and Human Services:
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201
Phone: 1-877-696-6775
Website: https://www.hhs.gov/ocr/privacy/hipaa/complaints/
You will not be retaliated against for filing a complaint.
Acknowledgment of Receipt
You may be asked to sign a separate form acknowledging that you received this Notice. Your signature does not indicate agreement with its terms, only that you received it.
