NOTICE OF PRIVACY PRACTICES
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.
Who We Are
This Notice applies to Terra Dental PLLC (“we,” “our,” or “us”). We are required by law to maintain the privacy of your Protected Health Information (“PHI”) and to provide you with this Notice of our legal duties and privacy practices.
Our Responsibilities
We are required to:
Maintain the privacy and security of your PHI
Provide you with this Notice of our legal duties and privacy practices
Notify you if a breach occurs that compromises the privacy or security of your PHI
Follow the terms of this Notice currently in effect
How We May Use and Disclose Your Information
We typically use or disclose your PHI in the following ways:
To treat you and provide dental care
To run our practice and improve our services (healthcare operations)
To bill for your services and obtain payment from insurance or other payers
Examples include: sharing information with other healthcare professionals involved in your care, submitting claims to your insurance company, conducting quality assessment activities, training and education of staff, and contacting you for appointment reminders.
Other Uses and Disclosures
We may also use and disclose your PHI:
As required by law
For public health and safety purposes
For research (with your consent or as permitted by law)
To comply with court orders, subpoenas, or legal processes
To law enforcement if required
To health oversight agencies for audits, inspections, or licensure
To coroners, medical examiners, or funeral directors as necessary
To prevent serious threats to health or safety
For specialized government functions, such as military or national security
Uses and Disclosures Requiring Your Authorization
We will not use or disclose your PHI for marketing purposes, the sale of your PHI, or most sharing of psychotherapy notes without your written authorization. If you provide authorization, you may revoke it at any time in writing.
Your Rights
You have the right to:
Get an electronic or paper copy of your dental records and other PHI
Request corrections to your records if you believe they are inaccurate or incomplete
Request confidential communications (for example, to be contacted at a different phone number or address)
Ask us to limit what we use or share for treatment, payment, or operations (we are not required to agree, except when the disclosure is to a health plan and you paid in full out-of-pocket)
Get a list of disclosures we have made of your PHI (accounting of disclosures)
Get a copy of this Notice at any time
File a complaint if you believe your privacy rights have been violated
How to Exercise Your Rights
To exercise any of the rights described in this Notice, please submit your request in writing to:
Terra Dental PLLC
Email: concierge@terradental.nyc
Address: 438 W 51st St Ste 3B, New York, NY 10019
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us at the address above or with the U.S. Department of Health and Human Services (HHS), Office for Civil Rights. We will not retaliate against you for filing a complaint.
Changes to This Notice
We reserve the right to change this Notice and our privacy practices at any time. The revised Notice will be effective for all PHI we maintain. The current version of this Notice will be posted on our Website and in our office.
Contact Information
If you have any questions about this Notice or our privacy practices, please contact us at:
Email: concierge@terradental.nyc
Address: 438 W 51st St Ste 3B, New York, NY 10019
LAST REVISED: 06/09/2025