Notice of Privacy Practices
Effective Date: April 17, 2026
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 Duties
We are required by law to maintain the privacy and security of Protected Health Information (PHI) for our patients, including minors. We are required to notify you if a breach occurs involving your unsecured PHI. We are also required to provide you with this Notice of our legal duties and privacy practices and to follow the terms of the Notice currently in effect.
We reserve the right to change the terms of this Notice at any time. Any revised Notice will apply to all PHI we maintain. The current version will always be available in our office and on our website at doverpediatrics.org/, and a copy will be available upon request.
Uses and Disclosures of Protected Health Information (PHI)
We may use and disclose your health information without your written authorization for the following purposes:
Treatment: We may use and disclose your health information to coordinate or manage your health care and related services. For example, we may share information with other pharmacies or other healthcare providers involved in your care.
Payment: We may use and disclose your PHI to bill and collect payment for the services we provide to you, including sharing information with your health insurance plan. This also includes the work involved in determining eligibility and claims processing.
Healthcare Operations: We may use or disclose your health information for our business operations, including quality assessment, staff training, licensing, and other administrative activities.
Appointment Reminders and Communications: We may contact you by phone, voicemail, text message, email, or patient portal to remind you of appointments or provide information about treatment options or health-related benefits and services.
Friends and Family Involved in Your Care: We may share your protected health information (PHI) with a friend or family member who is involved in your care or helps manage it, but only the information relevant to their role or to payment for your care.
If you are present, we may disclose your PHI to such individuals if you give permission, if you are given the chance to object and do not, or if the circumstances reasonably indicate that you would not object.
If you are not present or are unable to agree or object due to an emergency or incapacity, we may share relevant information with those involved in your care when, in our professional judgment, doing so is in your best interest.
Business Associates: We may disclose your health information to our business associates who perform services on our behalf. Business Associates are bound by a Business Associate Agreement (BAA) to protect your information.
Public Policy and Legal Requirements: We may use or disclose your PHI as required or permitted by law, including for:
- Public health activities
- Abuse, neglect, or domestic violence reporting
- Health oversight activities
- Judicial and administrative proceedings
- Law enforcement purposes
- Serious threats to health or safety
- National security and protective services
- Workers’ compensation
- Coroners, medical examiners, and funeral directors
Other Permitted Uses: We may disclose your PHI for:
- Organ and tissue donation
- Research (when approved or as permitted by law)
- Proof of immunization to schools (with appropriate permission)
- Incidental disclosures that occur despite reasonable safeguards
Use and Disclosures Where Special Protections May Apply
Substance Use Disorder Records: Certain records related to substance use disorder (SUD) diagnosis, treatment, or referral are protected under federal law (42 CFR Part 2).
With your written consent, these records may be used and disclosed for treatment, payment, and health care operations. Federal law prohibits redisclosure of substance use disorder records unless expressly permitted by 42 CFR Part 2.
Federal law prohibits the use of SUD records to discriminate against you in areas such as employment, housing, access to health care, or legal proceedings.
Reproductive Health Information: We will not use or disclose your PHI for the purpose of investigating or imposing liability on any person for the provision, receipt, or facilitation of lawful reproductive health care, unless required or permitted by law.
In certain situations, we may require a written attestation that a request for PHI is not for a prohibited purpose before making a disclosure.
Other Sensitive Information: Certain types of information (such as HIV-related information, mental health records, genetic information, and other sensitive data) may be subject to additional protections under state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records.
Minors and Confidential Care: As permitted under New Hampshire law, minors may consent to certain types of care (such as mental health, substance use treatment, and some reproductive health services).
When minors legally consent to their own care, that information may be kept confidential from parents or guardians. We will follow applicable law in determining access.
Uses and Disclosures Requiring your Authorization
There are certain situations where we must obtain your written authorization before using your health information or sharing it, including:
Psychotherapy notes: Most uses and disclosures of psychotherapy notes require your authorization.
Genetic Information: We will not use or disclose genetic information for underwriting purposes.
Marketing: We may not disclose any of your health information for marketing purposes if our practice will receivedirect or indirect financial payment not reasonably related to our practice’s cost of making the communication.
Revocation of Written Authorization: You may revoke your authorization in writing at any time, except when we have already relied on it. To revoke a written authorization, please write to the Privacy Officer at our practice. You may also initiate the transfer of your records to another person by completing a written authorization form.
Redisclosure: Information disclosed to others may be subject to redisclosure and may no longer be protected by HIPAA, except for information protected by 42 CFR Part 2 or other applicable laws.
Your Rights
To exercise any of the rights described below, please contact our Privacy Officer using the contact information listed at the end of this Notice. Some requests must be submitted in writing.
Right to Access: You have the right to inspect and obtain a copy of your health information and to request transmission to a third party. To inspect or obtain a copy of your health information, please submit your request in writing to the practice when required. We may provide forms to assist you. We may charge a reasonable fee for the costs of copying, mailing, or other supplies. If you would like an electronic copy of your health information, we will provide one to you in the form and format requested, if readily producible. If we cannot produce the electronic format you request, we will provide it in a readable alternative format. In certain limited circumstances, we may deny your request. For example, this may occur if access is reasonably likely to endanger your life or physical safety or that of another person, or if the information is subject to legal restrictions. Some denials may be subject to review. We will provide a written explanation and information on how to request a review if applicable.
Right to Amend: If you believe that the health information we have about you is incorrect or incomplete, you may request an amendment in writing. In certain limited circumstances, we may deny your request. If we deny your request, we will provide a written explanation and inform you of your right to submit a written statement of disagreement, which will be included with your record.
Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures of your PHI made within the six (6) years prior to your request.
Right to Breach Notification: You have the right to be notified if there is a breach of your unsecured PHI.
Right to Request Restrictions: You may request that we further restrict the way we use and disclose your health information to treat your condition, collect payment for that treatment, run our normal business operations, or disclose information about you to family or friends involved in your care. Your request must state the specific restrictions requested and to whom you want the restriction to apply. We are not required to agree to your request except if you request that we do not disclose PHI to your health plan when you have paid in full out of pocket.
Right to Confidential Communications: You may request that we only contact you in a specific way (for example, at work or by mail).
Right to Request a Paper Copy: We are required to provide you with a copy of this Notice and will do so upon request.
Right to Choose a Personal Representative: You may designate someone to act on your behalf regarding your health information, subject to applicable law.
Right to File a Complaint: You may file a complaint if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.
Contact Information
If you have questions, or wish to exercise your rights, or file a complaint, please contact our Privacy Officer, at (603) 742-4048, or 121 Broadway, Suite 101, Dover NH 03820.
You may also file a complaint with the Secretary of the Department of Health and Human Services by sending your complaint to: Centralized Case Management Operations, U.S. Department of Health and Human Services 200 Independence Avenue, S.W., Room 509F HHH Building, Washington, D.C., 20201; or by email to OCRComplaint@hhs.gov; or online through the Office for Civil Rights Complaint Portal at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf.