Effective Date: June 7, 2026 | Required by 45 C.F.R. § 164.520
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.
1. Our Commitment to Your Privacy
Family Dental Center of Connecticut (also operating as Family Dental of Connecticut) (“we,” “our,” or “the Practice”) is required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect. PHI is information that identifies you and relates to your past, present, or future health, dental treatment, or payment for care. This Notice applies to all of our locations and all members of our workforce.
2. How We May Use and Disclose Your Health Information
Treatment
We use and disclose your PHI to provide, coordinate, and manage your dental care — for example, sharing records or radiographs with a specialist, laboratory, or another provider involved in your treatment.
Payment
We use and disclose your PHI to bill and obtain payment — for example, submitting claims to your dental insurer or verifying coverage.
Health Care Operations
We use and disclose your PHI for operations such as quality assessment, staff training, scheduling, and business management.
Other Permitted Uses and Disclosures
As permitted by law, we may also use or disclose your PHI for:
- Appointment reminders, treatment alternatives, and health-related benefits or services.
- Communication with family or others involved in your care, when you agree or do not object, or in an emergency.
- Purposes required by law, public health activities, health oversight, and reporting of abuse or neglect.
- Judicial and administrative proceedings, law enforcement, coroners, and to avert a serious threat to health or safety.
- Workers’ compensation, specialized government functions, and research as permitted by law.
3. Uses and Disclosures Requiring Your Written Authorization
Most uses and disclosures not described above will be made only with your written authorization, including any sale of PHI, most marketing communications, and (if applicable) psychotherapy notes. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.
4. Your Rights Regarding Your Health Information
- Right to inspect and obtain a copy (45 C.F.R. § 164.524): You may inspect and obtain a copy of your records. If we maintain your records electronically, you may request an electronic copy, and you may direct us to send a copy to a person you designate. We will act on your request within 30 days (with one possible 30-day extension).
- Right to request an amendment of PHI you believe is incorrect or incomplete.
- Right to an accounting of certain disclosures of your PHI.
- Right to request restrictions on uses or disclosures. We will agree to restrict disclosure to a health plan for an item or service you paid for in full, out of pocket, when not otherwise required by law.
- Right to request confidential communications in a certain way or at a certain location.
- Right to a paper copy of this Notice, even if you agreed to receive it electronically.
- Right to be notified of a breach of your unsecured PHI.
5. Our Responsibilities
We are required to maintain the privacy and security of your PHI, to notify you following a breach of unsecured PHI, to abide by the terms of the Notice currently in effect, and not to use or disclose your PHI other than as described here or as permitted by law.
6. Changes to This Notice
We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as information we receive in the future. The current Notice will be posted in our offices and on our website, and will show its effective date.
7. Complaints
If you believe your privacy rights have been violated, you may file a complaint with the Practice (see Section 8) or with the U.S. Department of Health and Human Services, Office for Civil Rights: New England Region, JFK Federal Building, Room 1875, Boston, MA 02203; Customer Response Center (800) 368-1019; email OCRComplaint@hhs.gov. You will not be penalized or retaliated against for filing a complaint.
8. Contact / Privacy Officer
Privacy Officer: Dr. Maher Kasabji, Family Dental Center of Connecticut.
Enfield: 150 Hazard Ave, Unit C3, Enfield, CT 06082 — (860) 763-5522
Wethersfield: 365 Maple Street, Wethersfield, CT 06109 — (860) 430-4388
Email: info@familydentalcenterofconnecticut.com
Effective Date of this Notice: June 7, 2026.