Notice of Privacy Practices

Disclosure of Your Health Care Information

Treatment: We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations.

• “On occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C.”


• “It is our policy to provide a substitute health care provider, authorized by Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C. to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider’s absence due to vacation, sickness, or other emergency situation.”

Payment: We may disclose your health information to your insurance provider for the purpose of payment or health care operations.

Workers’ Compensation: We may disclose your health information as necessary to comply with State Workers’ Compensation Laws.

Emergencies: We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death.

Public Health: As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.

Judicial and Administrative Proceedings: We may disclose your health information in the course of any administrative or judicial proceeding. We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.

Deceased Persons: We may disclose your health information to coroners or medical examiners.

Organ Donation: We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.

Research: We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.

Health Care Operations: We may use or disclose, as needed, your protected health information in order to conduct certain business and operation activities. These activities include, but are not limited to, quality assessment activities, employer review activities, training of students, licensing, and conducting or arranging for other business activities.

• “We may use a health history form at our reception desk where you will be asked to sign your name. We may also call you by name in the waiting room when Dr. Cardarelli is ready to see you.”

Reminders: We may use or disclose your medical information, as necessary, regarding your dental care, or contact you by telephone, electronic mail (e-mail) or mail for appointment reminders.

Business Associates: We may disclose your medical information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. Our business associates are required, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

Public Safety: It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.

Specialized Government Agencies: We may disclose your health information for military, national security, prisoner and government benefits purposes.

Change of Ownership: In the event that Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C. is sold or merged with another organization, your health information/record will become the property of the new owner.

Your Health Information Rights

Restrictions: You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C. is not required to agree to the restriction that you requested.

Confidential Communication: You have the right to have your health information received or communicated through an alternative method or sent to an alternative location, in confidence as you specify, other than the usual method of communication or delivery, upon your request.

Access: You have the right to inspect and copy your health information.

Amendment: You have a right to request that Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C. amend your protected health information. Please be advised, however, that Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C. is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s) and information about how you can disagree with the denial.

Disclosure Accounting: You have a right to receive an accounting of disclosures of your protected health information made by Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C.

Electronic Notice: If you receive this notice on our web site or by electronic mail (e-mail), you have a right to a paper copy of this Notice of Privacy Practices at any time upon request.

Changes to this Notice of Privacy Practices

Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C. reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C. is required by law to comply with this Notice. Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C. is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice, or if you want more information about your privacy rights, please contact our office.

Complaints: Complaints about your Privacy rights, or how Joseph A. Cardarelli, Jr., D.M.D., Orthodontic Associates, P.C. has handled your health information should be directed to Dr. Joseph A. Cardarelli, Jr., by calling the office at 978.372.4172. If Dr. Cardarelli is not available, you may make an appointment for a personal conference, in person or by telephone, within 2 working days.

If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights

200 Independence Avenue, S.W.

Room 509F

HHH Building

Washington, DC 20201

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