Notices of Privacy Practices

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

Polo Dental still respects your privacy.  We understand that your personal health information is very sensitive. we will not disclose your personal health information to others unless you request us to do so in writing or unless the law authorizes us or require us to do so. The law protects the privacy of health information, we create and obtain in providing our care and services to you. For example, we protected health information include symptoms, test result, diagnosis, health information from other providers, billing and payment information related to these services. federal and state law allows us to use and disclose your protected health information for purpose of treatment and health care operations. State law requires us to get your authorization to disclose your information for payment purposes.

Example of use and Disclosures of Protected Health Information for Treatment, Payment and Health option.

For Treatment :

For payment :

For Healthcare Information :

Your Health Information Rights :

The health and billing record we create and store the property of practices the protected health information in it generally belongs to you. You have the right to :

For help with these rights during normal business hours, Please contact  :

Polo Dental

15 Noble Ave

Westfield, MA 01085




Our Responsibility :

We are required to :

We have the right to change our practices regarding the protected health information we maintain. if we make changes, We will update this notice. You may receive the most recent copy of the notice by calling and asking for it. or by visiting our office to pick one up.

To ask for help or complain :

If you have questions, need more information, or want to report a problem about the handling of your protected health information, you may contact: Polo Dental

15 Noble Ave

Westfield, MA 01085



If you believe your privacy right has been violated, you may discuss your concern with any staff members. you may also deliver a written complaint to privacy officer at our practice.  you may also file a complaint with the US Secretary of Health and Human Services.

We respect your right to file a complaint with us U.S secretary of Health and Human Services. If you complain, we are not retaliated against you.

Other Disclosures and uses of Protected Health Information

Notification to family and others :

Unless your object, We may release information about you to a friend or family members who are involved in your medical care. We may also give information to someones who help or pay for your care. We may tell your family and friends your condition that you are in the hospital. In addition, we may disclose health information about you to assist in disaster relief efforts.

You have the right to object to this use or disclosures of your information. If you object, We will not use or disclose it.

We may use or disclose your protected information without your authorization as follows :

Other uses and Disclosures of protected health information