HIPAA Notice of Privacy Practices
Modern Dental
Effective Date: January 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Responsibilities
Modern Dental is required by law to:

• Maintain the privacy and security of your protected health information (PHI)

• Provide you with this notice of our legal duties and privacy practices

• Follow the terms of this notice currently in effect

• Notify you promptly if a breach occurs that may compromise the privacy or security of your information

We reserve the right to change our privacy practices and the terms of this notice at any time. Any revised notice will be available upon request and posted in our office.
 
Uses and Disclosures of Protected Health Information
We may use and disclose your health information for the following purposes:

Treatment
We may use and share your information with dentists, specialists, laboratories, anesthesiologists, and other healthcare providers involved in your care.
 
Payment
We may use and disclose your information to obtain payment, including:

• Insurance verification

• Claims submission and processing

• Billing and collections

 
Healthcare Operations
We may use your information to operate our practice, including:

• Quality assessment and improvement

• Staff training and education

• Licensing and credentialing

• Business management and administrative activities

 
Other Permitted Uses and Disclosures
We may disclose your information without your authorization in the following situations:

• As required by federal or state law

• Public health activities (e.g., disease control, reporting)

• Health oversight activities (e.g., audits, inspections)

• Judicial and administrative proceedings

• Law enforcement purposes

• To prevent or lessen a serious threat to health or safety

• Workers’ compensation claims

• Coroners, medical examiners, and funeral directors

 
Uses Requiring Your Authorization
We will not use or disclose your information without your written authorization for:

• Marketing purposes

• Sale of your information

• Most sharing of psychotherapy notes (if applicable)

You may revoke your authorization at any time in writing.

Electronic Communication
We may communicate with you via phone, text message, or email for:

• Appointment reminders

• Treatment follow-ups

• Billing notifications

Please note that electronic communications may not always be secure. You may request alternative communication methods at any time.

Your Rights
You have the right to:

• Inspect and obtain copies of your health records

• Request corrections (amendments) to your records

• Request restrictions on certain uses or disclosures

• Request confidential communications (e.g., alternative address or phone)

• Receive an accounting of disclosures

• Receive a paper copy of this notice at any time

To exercise any of these rights, please contact our office.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with:

• Modern Dental, or

• The U.S. Department of Health and Human Services

You will not be retaliated against for filing a complaint.

Contact Information
HIPAA Privacy Officer
Modern Dental
19 Phelps Ave
Tenafly, NJ 07670

Phone: (201) 377-7374
Email: info@mdtenafly.com