Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed by Tufts University School of Dental Medicine (TUSDM) and how you can get access to this information. Please review it carefully.

YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains your rights and our responsibilities.

Get a copy of your medical record:

• You can ask to see or get an electronic or paper copy of your health record and other health information we have about you. Ask us how to do this.
• We will provide a copy or summary of your health information usually within 30 days of your request. We may charge a reasonable cost-based fee.
• In certain limited circumstances, may say “no” to your request, but we will tell you why in writing usually within 30 days.

Ask us to correct your health record:

• You can ask us to correct the health information we have about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we will tell you why in writing within 60 days.

Request confidential communications:

• You can ask us to contact you in a certain way (for example, send mail to a different address or call you at a different phone number).
• We may say “yes” to all reasonable requests.

Ask us to limit what we use or share:

• You can ask us not to share certain health information for treatment, payment or our operations.
• We are not required to agree to your request and we may say “no” if it would affect your care.
• If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information with your health insurer. We will say “yes” unless the law requires us to share that information.

Get a list of those with whom we’ve shared information:

• You can ask for a list (accounting) of the times we’ve shared your health information during the last 6 years, who we shared it with and why.
• We will include all those disclosures except those about treatment, payment, and our operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another within a 12 month period.
• Your request for this list (accounting) must be made in writing.

Get a copy of this privacy notice:

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you:

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure that this person has the authority and can act for you before we take action.

File a complaint if you feel your rights are violated:

• You can file a complaint if you feel that we have violated your rights.
• You can contact the TUSDM Privacy Officer:

Privacy Officer

Tufts University School of Dental Medicine

One Kneeland Street, Room 1531

Boston, Massachusetts 02111

Email: Dental-Compliance@tufts.edu

• You can make a call to the Tufts confidential (anonymous) reporting hotline at 866-384-4277

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases you have both the right and the choice to tell us:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Contact you for fundraising efforts

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

In the case of fundraising:

• We will not contact you for fundraising efforts.

OUR USES AND DISCLOSURES

How do we typically use or share your health information? We typically use or share your health information in the following ways:

Treat You:

We can use your health information and share it with other professionals who are treating you. Example: We share health information about you with other health care providers who treat or care for you.

Run our organization:

We can use and share your health information to run our clinics, improve your care and contact you when needed. Example: We use health information about you to manage your care or to remind you of your next appointment.

Bill for your services:

We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health or dental insurance plan so it will pay for your services or determine if you are eligible for a service.

How else can we use or share your health information?

We are allowed or required to share your information in other ways—usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

For more information visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers.

Help with public health and safety issues:

We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do research: 

• We can use or share your information for health research.

Comply with the law: 

• We will share information about you if state or federal law requires it, including with the U.S. Department of Health and Human Services if it wants to see that we are complying with federal privacy laws.

Respond to organ donation and tissue requests: 

• We can share health information about you with cancer registries and organ procurement organizations.

Work with a medical examiner or funeral director: 

• We can share health information with medical examiners, coroners, or funeral directors when an individual dies.

Address workers’ compensation, law enforcement and other government requests: 

We can use or share health information about you:

• For worker’s compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective purposes

Respond to lawsuits and legal actions: 

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

We do not contact patients for fundraising purposes.

We may contact you about participating in research studies. We must inform you about the study and give you a chance to ask questions before you can participate in a study. You do not have to agree to participate in any research studies.

Massachusetts provides special privacy protections for particularly sensitive information, such as information related to HIV/AIDS, mental health, genetic testing, and substance abuse.  We will disclose such information only in a manner consistent with these laws.

OUR RESPONSIBILITIES

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to This Notice

We can change the terms of this notice, and the changes will apply to all the information that we have about you. The new notice will be available, upon request, in our clinics and on our website.

This Notice of Privacy Practices applies to all Tufts University School of Dental Medicine locations where our providers screen or treat patients; specifically, the Tufts Comprehensive Care Clinic, Specialty Care Clinics, Tufts Dental Facilities, the Department of Public Health and Community Service programs, and Department of Continuing Education.