Patient Consent for Information Collection and Use
Important Information About How Your Data Will Be Collected, Used, and Protected
Dental Primary Office NYC PLLC, d/b/a Dentaprime NY, is committed to protecting your privacy and ensuring compliance with HIPAA regulations. This document explains why and how we collect and use your personal and health information, who will handle it, and your rights regarding this consent. Please review the information carefully and provide your consent as described below.
1. Why We Collect Your Information
We collect your personal and health information to:
- Recommend the best dental treatment options tailored to your needs.
- Determine your suitability for specific dental procedures, including dental implants, bone grafting, and other treatments.
2. Who Will Handle Your Information
- Authorized Parties: Dentaprime Services EOOD and/or Telecom, Inc. will collect additional details about your dental and medical history on behalf of Dentaprime NY.
- Secure Usage: Your information will only be used to plan and evaluate your dental treatments securely and in compliance with all applicable regulations.
3. Information We Will Collect
The specific types of information we will collect include:
- Your dental status and health history.
4. How Long Your Consent is Valid
Your consent for us to collect and use your information will remain valid for 48 months from the date of your confirmation.
5. Your Right to Revoke Consent
You have the right to revoke this consent at any time. To do so:
- Provide written notice to Dentaprime NY at service.us@dentaprime.com or address provided.
- Please note that revocation will not affect any information disclosures or uses made prior to the date of revocation.
