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Dental Republic 



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HIPAA Privacy Notice

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:

  • We are required by law to maintain the privacy of your protected health information (PHI).

  • 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 upon request.

How We May Use and Disclose Your Health Information:

  • For Treatment: We may use your health information to provide you with medical treatment or services.

  • For Payment: We may use and disclose your health information to bill and collect payment for the services we provide to you.

  • For Healthcare Operations: We may use and disclose your health information for activities such as quality assessment, employee review, and training.

Your Rights:

  • You have the right to inspect and obtain a copy of your health information.

  • You have the right to request an amendment to your health information.

  • You have the right to request restrictions on how we use and disclose your health information.


  • If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.

Contact Information:

If you have any questions or concerns about this notice or about how your health information may be used or disclosed, please contact [Provider Name] at [Contact Information].

By signing below, you acknowledge that you have received a copy of this HIPAA Privacy Notice.

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