Patient Privacy Policy

Notice of Privacy Practices for Protected Health Information

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Associated Oral and Maxillofacial Surgeons respects you and your privacy. We are committed to keeping all information received or created confidential.

We want you to have a clear understanding of how we use and safeguard information about you. This Notice of Privacy Practices describes how we may use and disclose your protected health information in order to carry out service, voucher for payment and for other purposes permitted by law. It also describes your right to access and control your information.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of legal duties and privacy practices with respect to your protected health.

Health information means any information, whether oral or recorded in any form, that is created or received by AOMS. This relates to the past, present or future physical or mental health and/or condition of an individual

How your protected health information may be used or disclosed

AOMS uses protected health information about you for services, payment and regular dental or health care purposes. We do not require authorization to use your protected health information for these purposes:


Providing you with care and services related to your health, such as working with medical doctors, facilities or other dentists involved in the delivery of services. AOMS is a part of the dental and medical community and may exchange information for the purposes of coordinating services.


Information needed for billing, insurance, or compensation of services, if necessary. We may provide necessary portions of your protected health information to our billing department and to your health plan to get paid/reimbursed for the services we provide to you.

Regular Health Care Operations

Activities that may include quality assessment, program evaluation and monitoring.

Emergency Care

To help you obtain treatment in a medical emergency. An authorization is required as soon as reasonably possible after the emergency and the provider should document the reasons as to why the authorization could not be received.

When Legally Necessary

If required by federal, state or local law. We may make disclosures when a law requires that we report information to government agencies or law enforcement personnel about victims of abuse, neglect, domestic violence or to avoid serious threat to health or safety of a person or public.

We may provide protected health information to a family member, friend or other person that you indicate is involved in your services or the payment for your services unless you object, in whole or part. The opportunity to consent may be obtained retroactively in emergency situations.

All other uses and disclosures require you prior written authorization.

When AOMS may not use or disclose your health information

Except as described in this notice of privacy Practices, we will not use or disclose your health information without your written authorization. If you do not authorize us to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.

Your Health Information Rights

  • You have the right to inspect and obtain a copy of your health information
  • You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to the request restriction.
  • You have a right to request that we amend your health information. An amendment can only be granted if the information requested is created by AOMS.
  • You have the right to receive an accounting of disclosures of your health information. This will not include any dated before April 13, 2003 and cannot be longer than six years from this date.
  • You have a right to receive confidential communications of protected health information and the manner in which it is sent to you. Within reason, you have the right to ask that we send information to you at an alternate address (such as requesting that we send information to your work address rather than you home address ) or alternate means (such as by regular mail versus e-mail, if such methods are reasonably available).
  • You have a right to a paper copy of this Notice of Privacy Practices. You will be asked to sign an Acknowledgment of Receipt of this Notice.
  • You have the right to complain if you believe your privacy rights have been violated or if you are dissatisfied with the services you are receiving. You will not be punished in any way for filing a complaint.

Changes to this Notice of Privacy Practices
We are bound by the terms of this notice currently in effect and reserve the right to amend this Notice of Privacy Practices at any time in the future. If such an amendment is made, all individuals currently active in our programs will be provided a revised Notice of Privacy Practices my mail or at their next scheduled appointment.