Melrose Family Dentistry Notice of Privacy Practices

Effective February 16, 2026

For help translating or understanding this Notice, please call (781) 665-2113.

Our Duties as a Covered Entity

Melrose Family Dentistry is a Covered Entity as defined and regulated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Melrose Family Dentistry is required by law to maintain the privacy of your protected health information (PHI). We must provide you with this Notice, which describes our legal duties and privacy practices concerning your PHI. We must follow the terms of the Notice currently in effect, and we must notify you following a breach of your unsecured PHI.

This Notice describes how we may use and disclose your PHI, your rights to access and manage your PHI, and how you may exercise those rights.

Melrose Family Dentistry may change this Notice. We reserve the right to make a revised or changed Notice effective for PHI we already maintain and for PHI we receive in the future. We will promptly update this Notice whenever there is a material change involving:

• Permitted uses and disclosures;
• Your rights;
• Our legal duties; or
• Other privacy practices described in this Notice.

Updated notices will be posted on our website and will be available by mail or email upon request.

Uses and Disclosures of Your PHI

The following describes ways we may use or disclose your PHI without your written authorization:

Treatment

We may use or disclose your PHI to a dentist, physician, or other healthcare provider who is providing treatment to you. We may do this to coordinate your treatment among providers and to assist with prior authorization decisions related to your care or benefits.

Payment

We may use and disclose your PHI to obtain or provide payment for healthcare services you receive. We may disclose your PHI for payment purposes to another health plan, healthcare provider, or other entity, subject to applicable privacy laws. Payment activities may include:

• Processing claims;
• Determining eligibility or coverage for claims;
• Issuing billing statements;
• Reviewing services for medical necessity; and
• Performing utilization review of claims.

Healthcare Operations

We may use and disclose your PHI to perform healthcare operations. These activities may include:

• Providing customer service;
• Responding to complaints and appeals;
• Providing case management and care coordination;
• Conducting clinical or claims review and other quality-assessment activities; and
• Conducting improvement activities.

In conducting healthcare operations, we may disclose PHI to business associates. We will maintain written agreements requiring those business associates to protect the privacy and security of your PHI. We may also disclose PHI to another entity subject to HIPAA when that entity has a relationship with you and the disclosure is for appropriate healthcare operations, such as quality assessment, reviewing professional qualifications, care coordination, or detecting and preventing healthcare fraud and abuse.

Appointment Reminders and Treatment Alternatives

We may use and disclose your PHI to remind you about appointments, provide information about treatment alternatives, or inform you about other health-related benefits and services that may be of interest to you.

As Required by Law

We may use or disclose your PHI when required by federal, state, or local law. Any use or disclosure will be limited to what the applicable law requires. When laws conflict, we will follow the law that provides greater privacy protection when applicable.

Public Health Activities

We may disclose your PHI to a public health authority to prevent or control disease, injury, or disability. We may also disclose PHI to the U.S. Food and Drug Administration when necessary to support the quality, safety, or effectiveness of products or services under its authority.

Victims of Abuse, Neglect, or Domestic Violence

We may disclose your PHI to a local, state, or federal government authority, including a social-services or protective-services agency authorized by law to receive such reports, when we reasonably believe that abuse, neglect, or domestic violence has occurred.

Judicial and Administrative Proceedings

We may disclose your PHI in response to a court or administrative order, subpoena, summons, warrant, discovery request, or similar lawful process, as permitted or required by law.

Law Enforcement

We may disclose relevant PHI to law enforcement when required or permitted by law, including in response to a court order, court-ordered warrant, subpoena, summons issued by a judicial officer, or grand-jury subpoena. We may also disclose relevant PHI to help identify or locate a suspect, fugitive, material witness, or missing person, when permitted by law.

Coroners, Medical Examiners, and Funeral Directors

We may disclose your PHI to a coroner or medical examiner when necessary, such as to identify a deceased person or determine cause of death. We may also disclose PHI to funeral directors as necessary for them to perform their duties.

Organ, Eye, and Tissue Donation

We may disclose your PHI to organ-procurement organizations and others involved in the procurement, banking, or transplantation of organs, eyes, or tissues.

Threats to Health and Safety

We may use or disclose your PHI when we believe in good faith that doing so is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Specialized Government Functions

If you are a member of the United States Armed Forces, we may disclose your PHI as required by military command authorities. We may also disclose PHI to authorized federal officials for national-security or intelligence activities, medical-suitability determinations, or protective services for the President and other authorized persons, as permitted by law.

Workers' Compensation

We may disclose your PHI as authorized by and necessary to comply with workers' compensation laws and other similar programs established by law.

Emergency Situations

In an emergency, or when you are unable to respond or are not present, we may disclose relevant PHI to a family member, close personal friend, authorized disaster-relief organization, or another person involved in your care. We will use professional judgment to determine whether the disclosure is in your best interests and will disclose only the information directly relevant to that person's involvement in your care.

Research

In limited circumstances, we may disclose your PHI for research that has been appropriately approved and includes safeguards designed to protect the privacy and security of your PHI.

Verbal Agreement to Use and Disclose Your PHI

We may obtain your verbal agreement before using or disclosing PHI to a family member, close personal friend, or another person you identify. You may agree or object in advance or at the time of the proposed use or disclosure. We will limit the information disclosed to what is directly relevant to that person's involvement in your healthcare or payment for your care.

We may also obtain your verbal agreement or objection before using or disclosing PHI in a disaster situation. We may disclose limited information to an authorized disaster-relief organization to notify a family member, personal representative, or another person responsible for your care about your location and general condition.

Uses and Disclosures Requiring Written Authorization

Except as otherwise permitted or required by law, we will obtain your written authorization before using or disclosing PHI for the following purposes:

Sale of PHI

We will obtain your written authorization before making a disclosure that constitutes a sale of your PHI.

Marketing

We will obtain your written authorization before using or disclosing your PHI for marketing purposes, except for limited activities permitted by law, such as certain face-to-face communications or promotional gifts of nominal value.

Social Media

We will obtain your express written authorization before using or disclosing your PHI on social media, including posting identifiable photographs or videos of you.

Psychotherapy Notes

When applicable, we will obtain your written authorization before using or disclosing psychotherapy notes, except in limited circumstances permitted by law.

Other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time by submitting a written request. Your revocation will not affect actions already taken in reliance on the authorization before we received your revocation.

Your Rights

To exercise any of the rights described below, contact us using the information at the end of this Notice.

Right to Inspect and Receive a Copy of Your PHI

With limited exceptions, you have the right to inspect or obtain copies of PHI contained in a designated record set. You may request that the information be provided in a particular form or format. We will provide it in the requested form or format when readily producible. Requests for access must be made in writing. If we deny your request, we will provide a written explanation and tell you whether the denial may be reviewed and how to request a review.

Right to Receive an Accounting of Disclosures

You have the right to request a list of certain disclosures of your PHI made by us or our business associates during the six years before your request. The accounting generally does not include disclosures made for treatment, payment, healthcare operations, disclosures you authorized, or certain other activities excluded by law. We may charge a reasonable, cost-based fee if you request more than one accounting within a 12-month period, and we will notify you of the potential fee before completing the request.

Right to Request an Amendment

You may ask us to amend PHI that you believe is incorrect or incomplete. Your request must be made in writing and explain why the information should be amended. We may deny the request for reasons permitted by law, including when we did not create the information and the person or entity that created it remains available to act on your request. If we deny your request, we will provide a written explanation. You may submit a written statement disagreeing with our decision, which we will attach to the information at issue. If we accept your request, we will make reasonable efforts to notify appropriate persons of the amendment and include the amendment in future disclosures.

Right to Request Restrictions

You may ask us to restrict certain uses or disclosures of your PHI for treatment, payment, or healthcare operations, or disclosures to persons involved in your care or payment for your care. Your request should describe the restriction and identify to whom it applies. We generally are not required to agree to a requested restriction. However, when you have paid in full out of pocket for a service or item, we must agree to your request not to disclose information about that service or item to a health plan for payment or healthcare operations, unless the disclosure is required by law.

Right to Request Confidential Communications

You may ask us to communicate with you about your PHI in a particular way or at a particular location. We will accommodate reasonable requests that specify the alternative method or location.

Right to File a Complaint

You may file a complaint with us if you believe your privacy rights have been violated or that we have not followed the privacy practices described in this Notice. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

Right to Receive a Copy of This Notice

You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

Additional Privacy Protections

We will comply with applicable federal and state laws that provide additional privacy protections for certain categories of health information, including information concerning reproductive healthcare, substance-use-disorder treatment, mental health, communicable diseases, and other specially protected information.

Contact Information

For questions about this Notice, our privacy practices, or how to exercise your rights, contact:

Complaints to the U.S. Department of Health and Human Services