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HIPAA Notice

Effective date: May 15, 2026

This notice describes how medical and dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record.
  • Ask us to correct health information you believe is incorrect or incomplete.
  • Request confidential communications.
  • Ask us to limit certain uses or disclosures of your information.
  • Get a list of certain disclosures we have made.
  • Get a paper copy of this notice at any time.
  • Choose someone to act for you.
  • File a complaint if you believe your privacy rights have been violated.

Get an electronic or paper copy of your medical record

You may ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. We will provide a copy or summary, usually within 30 days of your request, and may charge a reasonable cost-based fee when allowed by law.

Ask us to correct your medical record

You may ask us to correct health information you believe is incorrect or incomplete. We may deny the request in some circumstances, but if we do, we will explain why in writing within 60 days.

Request confidential communications

You may ask us to contact you in a specific way or send mail to a different address. We will agree to reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or share certain information for treatment, payment, or health care operations. We are not always required to agree. If you pay for a service out of pocket in full, you may ask us not to share information about that service with your health plan for payment or operations, and we will honor that request unless a law requires us to share it.

Get a list of disclosures

You may ask for an accounting of certain disclosures of your health information made during the six years before your request. The list will not include disclosures for treatment, payment, health care operations, or disclosures you authorized.

Get a copy of this notice

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

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information as allowed by law.

File a complaint

You may complain if you believe we violated your rights by contacting our Privacy Officer or by filing 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.

Your Choices

For certain health information, you may tell us your choices about what we share. You may tell us whether we may share information with family, close friends, or others involved in your care or payment for your care, or in a disaster-relief situation.

If you cannot tell us your preference, such as when you are unconscious, we may share information when we believe it is in your best interest or when needed to lessen a serious and imminent threat to health or safety.

We will not use or share your information for marketing purposes, sale of your information, or most sharing of psychotherapy notes unless you give us written permission.

How We May Use and Share Your Information

We may use and share your protected health information for permitted purposes including:

  • Treating you and coordinating your care.
  • Running our practice and improving care.
  • Billing for services and obtaining payment.
  • Complying with legal requirements.
  • Helping with public health and safety issues.
  • Responding to lawsuits, law enforcement requests, or government oversight activities when legally allowed.
  • Working with coroners, medical examiners, funeral directors, organ donation organizations, or workers’ compensation programs when applicable.

If we receive substance use disorder treatment records protected by 42 CFR Part 2, we will not use or disclose information from those records in civil, criminal, administrative, or legislative investigations or proceedings against you unless permitted by law, including with your consent or a court order and subpoena when required.

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. You may change your mind at any time by telling us in writing.

Changes to This Notice

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

Questions or Complaints

If you have questions about this notice or believe your privacy rights have been violated, contact our Privacy Officer at team@capeperiosurgery.com or 508-204-3145. 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.

Practice Covered by This Notice

This notice applies to Cape & Islands Periodontics and Oral Surgery, P.C.