Protecting the Privacy of Your Personal Health Information

Your health care provider understands that your health information is personal and that it must be protected. The purpose of this pamphlet is to provide you with information to help you understand how your personal information is collected, used and disclosed (i.e. shared).

Processor :

Dental Treatment Center SPRL / 235 Rue de la Loi - 1040 Brussels / 0032 2 231 04 32 / brusselsdentistry@gmail.com


Boulenc Maxime / 235 Rue de la Loi - 1040 Brussels / 0032 4 79 115 449 / boulenc.maxime@gmail.com


In addition to information needed to identify you, such as your name, address, telephone number and health insurance number, your personal information also includes information about your health.

Personal health information relates to health services you have received, past health conditions, current symptoms, medications prescribed, examination and test results, diagnoses, and treatment plans.

This information is often referred to as your health record.

Knowing what is in your health record and understanding how your personal information is used, helps you to:

● ensure its accuracy;

● better understand who, what, where, why and how others may access your personal health information;

● make informed decisions regarding disclosures to others.


● Any personal information collected will be used for your care and treatment.

● Your consent will be implied for the collection, use and disclosure of your personal information for care and treatment purposes if, once you know your privacy rights, you continue with care and treatment.

● Your personal information will not be disclosed to anyone who is not directly involved in your care and treatment unless you give permission. Those involved in your direct care may include nurses, other doctors, pharmacists, laboratory technicians, radiologists, dentists, psychologists, social workers, physiotherapists, nutritionists and other health care providers. .

● Some of your personal information may also be disclosed without your permission to governments (Ministries of Health and others), where this is required or authorized by law.

● A high level of confidentiality around the collection, use and disclosure of your personal information is maintained. You are assured that your personal information is handled appropriately and with care.

● Your personal information should be accurate and will be stored in a secure location.

● Any personal information that is stored electronically will be protected by appropriate security measures.

● Your health care provider will be available to respond to your questions.


● Your privacy rights include knowing why your personal information is collected, and how it is used and to whom it is disclosed.

● The right to request access to your personal information and to be provided with a copy of that information for a minimal fee.

● To ask how and to whom your personal information may have been disclosed.

● Assurances that your personal information is protected regardless of the format in which it is held (e.g. paper/electronic).

● Assurances that your personal information is safeguarded from unauthorized access, disclosure, copying, use or modification.

● The right to question the accuracy and completeness of your personal information and the right to seek amendment to that information.

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Your health care provider can advise you about complaint procedures and will refer you to the appropriate authorities.

Notice of Nondiscrimination

Discrimination is Against the Law

Dental Treatment Center SPRL complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Dental Treatment Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Dental Treatment Center :

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)

  • Provides free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages

If you need these services, contact Mr Boulenc Maxime

If you believe that Dental Treatment Center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Mr Boulenc Maxime, brusselsdentistry@gmail.com, 003222310432. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Mr Boulenc Maxime is available to help you.

Our Office


235 Rue de la Loi,
Bruxelles, 1040
02 231 04 32
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We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.