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Notice of Patient Privacy Practices

DR. JOANNE MARIAN DMD
737 MAIN STREET
BOLTON, MA 01740

PHONE: (978) 779-6223
FAX: (978) 779-6479
WEBSITE: HTTP://WWW.BOLTONFAMILYDENTAL.COM

Health Insurance Portability and Accountability Act of 1996
NOTICE OF PRIVACY Practices
Effective April 14, 2003
Modified: December 21, 2011
Last Modified: October 1, 2013

NOTICE OF PATIENT PRIVACY PRACTICES

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.

If you have any questions about this Notice, please contact our Privacy Officer at the number listed at the end of this Notice.

Each time you visit a healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing related information. This Notice applies to all of the records of your care generated by your healthcare provider.

OUR RESPONSIBILITIES

Joanne Marian, DMD is required by law to maintain the privacy of your health information and to provide you with a description of our legal duties and privacy practices regarding your health information. The current Notice will be posted in the reception area and on our website at www.boltonfamiliydental.com. The Notice will include the effective date. In addition, we will make our best effort to provide you with a copy of this Notice and we request that you acknowledge receipt with your signature.

Changes to the Notice will apply to your medical information that we already maintain as well as new information received after the change occurs. If we change our Notice, it will be made available to anyone who asks for it, and be posted in the reception area and on our website at www.boltonfamilydental.com. You may also request that revised Notice be sent to you in the mail or you may ask for one at your next appointment or appropriate visit. This Notice will also serve as your rights with regard to your medical information.

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