<!-- ══════════════════════════════════════════════════════════════════════ ⛔ STOP. THIS IS A SKELETON, NOT A NOTICE. DO NOT PUBLISH.
A HIPAA Notice of Privacy Practices is a federally mandated document with legally required content (45 CFR §164.520). Its wording is not a copywriting exercise, and a deficient NPP is a compliance failure — not a bad page.
This file exists ONLY so the import does not fail on a missing required document, and so the practice's privacy officer / counsel can see the required headings in one place. Every section below must be completed, reviewed and approved by the practice's HIPAA privacy officer or attorney before this page goes live.
The practice almost certainly already HAS an NPP — it is required to, and patients sign an acknowledgement of receipt at their first visit. THE FASTEST PATH IS TO PASTE THE EXISTING, APPROVED NOTICE INTO THIS FILE. Ask the front desk for it before anyone writes a word. ══════════════════════════════════════════════════════════════════════ -->
**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.**
Radiant Smiles Family & Aesthetic Dentistry, PLLC · 2240 Madison Avenue, Bridgeport, CT 06606 · (203) 372-0881
Required sections — to be completed by the practice's privacy officer or counsel
- Our commitment to your privacy — [TO BE COMPLETED]
- How we may use and disclose your protected health information — treatment, payment, and health care operations, each with an example. [TO BE COMPLETED]
- Uses and disclosures that may be made without your authorization — as required by law, public health activities, abuse or neglect reporting, health oversight, judicial and administrative proceedings, law enforcement, coroners, organ donation, research, serious threat to health or safety, military, workers' compensation, inmates. [TO BE COMPLETED]
- Uses and disclosures requiring your written authorization — including marketing, sale of PHI, and most uses of psychotherapy notes. [TO BE COMPLETED]
- Your rights regarding your protected health information — to inspect and copy; to request an amendment; to an accounting of disclosures; to request restrictions; to request confidential communications; to a paper copy of this notice; to be notified of a breach; to restrict disclosure to a health plan where you pay out of pocket in full. [TO BE COMPLETED]
- Our duties — including the duty to maintain the privacy of PHI, to abide by the terms of this notice, and to notify you of a breach. [TO BE COMPLETED]
- Changes to this notice — and how a revised notice will be made available. [TO BE COMPLETED]
- Complaints — how to complain to the practice, and how to complain to the Secretary of the U.S. Department of Health and Human Services, with the statement that you will not be retaliated against. [TO BE COMPLETED]
- Contact for questions — the practice's designated privacy officer, by name or title. [TO BE COMPLETED]
- Effective date. [TO BE COMPLETED]
A note relevant to this website
Nothing submitted through the appointment form on radiantsmilesct.com should include detailed health information. The form collects a name, a phone number, an email address and a message so that we can call you back and schedule. Clinical detail belongs in the office, not in an inbox.