South Austin Oral Surgery Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

South Austin Oral Surgery

Effective Date: February 16, 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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.

CONTACT INFORMATION

For more information about our privacy practices, to discuss questions or concerns, or to get additional copies of this notice, please contact our Privacy Officer.

Telephone: 512-692-7140

706B W Ben White Blvd #194, Austin, TX 78704

OUR LEGAL DUTY

We are required by law to protect the privacy of your protected health information (“medical information”). We are also required to send you this notice about our privacy practices, our legal duties and your rights concerning your medical information.

We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect on the date set forth at the top of this page and will remain in effect unless we replace it.  We reserve the right at any time to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make any change in our privacy practices and the new terms of our notice applicable to all medical information we maintain, including medical information we created or received before we made the change in practices.

We may amend the terms of this notice at any time. If we make a material change to our policy practices, we will provide to you, the revised notice. Any revised notice will be effective for all health information we maintain. The effective date of a revised notice will be noted. A copy of the current notice in effect will be available in our facility and on our website. You may request a copy of the current notice at any time.  We collect and maintain oral, written and electronic information to administer our business and to provide products, services and information of importance to our patients. We maintain physical, electronic and procedural safeguards in the handling and maintenance of our patients’ medical information, in accordance with applicable state and federal standards, to protect against risks such as loss, destruction and misuse.

USES AND DISCLOSURES OF YOUR MEDICAL INFORMATION

Treatment: We may disclose your medical information, without your prior approval, to another dentist or healthcare provider working in our facility or otherwise providing you treatment for the purpose of evaluating your health, diagnosing medical conditions and providing treatment. For example, your health information may be disclosed to an oral surgeon to determine whether surgical intervention is needed.

Payment: We provide dental services. Your medical information may be used to seek payment from your insurance plan or from you. For example, your insurance plan may request and receive information on dates that you received services at our facility in order to allow your employer to verify and process your insurance claim.

Health Care Operations: We may use and disclose your medical information, without your prior approval, for health care operations. Health care operations include:

• healthcare quality assessment and improvement activities;
• reviewing and evaluating dental care provider performance, qualifications and competence, health care training programs, provider accreditation, certification, licensing and credentialing activities;
• conducting or arranging for medical reviews, audits and legal services, including fraud and abuse detection and prevention; and
• business planning, development, management and general administration including customer service, complaint resolutions and billing, de-identifying medical information, and creating limited data sets for health care operations, public health activities and research.

We may disclose your medical information to another dental or medical provider or to your health plan subject to federal privacy protection laws, as long as the provider or plan has had a relationship with you and the medical information is for that provider’s or health plan’s care quality assessment and improvement activities, competence and qualification evaluation and review activities, or fraud and abuse detection and prevention.

Your Authorization: You (or your legal personal representative) may give us written authorization to use your medical information or to disclose it to anyone for any purpose. Once you give us authorization to release your medical information, we cannot guarantee that the person to whom the information is provided will not disclose that information. You may take back or “revoke” your written authorization at any time, except if we have already acted based on your authorization. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect. Unless you give us written authorization, we will not use or disclose your medical information for any purpose other than those described in this notice. We will obtain your authorization prior to using your medical information for marketing, fundraising purposes or for commercial use. Once authorized, you may opt out of these communications at any time.

Family, Friends and Others involved in your care or payment for care: We may disclose your medical information to a family member, friend or any other person you involve in your care or payment for your health care. We will disclose on the medical information that is relevant to the person’s involvement.

We may use or disclose your name, location and general condition to notify, or to assist an appropriate public or private agency to locate and notify, a person responsible for your care in appropriate situations, such as a medical emergency or during disaster relief efforts.

We will provide you with an opportunity to object to these disclosures, unless you are not present or are incapacitated or it is an emergency or disaster relief situation. In those situations, we will use our professional judgment to determine whether disclosing your medical information is in your best interest under the circumstances.

Health-Related Products and Services: We may use your medical information to communicate with you about health-related products, benefits, services, payment for those products and services and treatment alternatives.

Reminders: We may use or disclose medical information to send you reminders about your dental care, such as appointment reminders via US Mail, email and telephone.  By providing your email address to us, you agree that you may receive reminders and breach notifications via email as a possible alternative to US Mail.  It is the policy of our office to leave a message on any voicemail or answering machine that may be attached to a number that you provide (home, cell or work).  If you prefer that we NOT leave a message to confirm treatment or your appointments, please check this box.

Plan Sponsors: If your dental insurance coverage is through an employer’s sponsored group dental plan, we may share summary health information with the plan sponsor.

Public Health and Benefit Activities: We may use and disclose your medical information, without your permission, when required by law and when authorized by law for the following kinds of public health and public benefit activities;

• for public health, including to report disease and vital statistics, child abuse, adult abuse, neglect or domestic violence;
• to avert a serious an imminent threat to health or safety;
• for health care oversight, such as activities of state insurance commissioners, licensing and peer review authorities and fraud prevention agencies;
• for research;
• in response to court and administrative orders and other lawful process;
• to law enforcement officials with regard to crime victims and criminal activities;
• to coroners, medical examiners, funeral directors and organ procurement organizations;
• to the military, to federal officials for lawful intelligence, counterintelligence, and national security activities, and to correctional institutions and law enforcement regarding persons in lawful custody; and
• as authorized by state worker’s compensation laws.

Special protections for SUD records: Substance Use Disorder (SUD) Treatment records have enhanced protections. They cannot be used in legal proceedings without your consent or court order.

If a use or disclosure of health information described above in this notice is prohibited or materially limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law.

Business Associates: We may disclose your medical information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. Our business associates are required, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

Data Breach Notification Purposes: We may use your contact information to provide legally required notices of unauthorized acquisition, access or disclosure of your health information.

Additional Restrictions on use and disclosure: Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you. “Highly Confidential Information” may include confidential information under Federal laws governing reproductive rights, alcohol and drug abuse information and genetic information as well as state laws that often protect the following types of information:

1) HIV/AIDS;

2) Mental Health;

3) Genetic Tests (in accordance with GINA 2009);

4) Alcohol and drug abuse;

5) Sexually transmitted diseases and reproductive health information; and

6) Child or adult abuse or neglect, including sexual assault.

YOUR RIGHTS

1. You have a right to see and get a copy of your health records.
2. You have a right to amend your health information.
3. You have a right to ask to get an Accounting of Disclosures of when and why your health information was shared for certain purposes.
4. You are entitled to receive a Notice of Privacy Practices that tells you how your health information may be used and shared.
5. You may decide if you want to give your Authorization before your health information may be used or shared for certain purposes, such as marketing.  It is the policy of our office NOT to sell or disclose your information to any outside firms or business partners.  Your information may be used, only within our office, for the purposes of presenting to you certain products or services which our dentist(s) or staff feel may present a benefit for you, your oral health or happiness with your smile.  If you would like to opt out of this level of service, you may do so by checking this box. 
6. You have the right to receive your information in a confidential manner and restrict certain communication methods.
7. You have a right to restrict who receives your information.
8. You have a right to request amendment to be made to your health records by submitting the request in writing to our privacy officer. Your request does not guarantee the amendment, but does guarantee that it will be reviewed and considered.
9. If you believe your rights are being denied or your health information is not being protected, you can:
   1. File a complaint with your provider or health insurer
   1. File a complaint with the U.S. Government
10. Right to opt out of fundraising activities.  If you would like to opt out of any fundraising programs that our office may participate in, such as cancer walks, or other fundraising programs you may do so by checking this box.

COMPLAINTS

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your medical information, about amending your medical information, about restricting our use or disclosure of your medical information, or about how we communicate with you about your medical information (including a breach notice communication), you may contact our Privacy Officer to register either a verbal or written complaint.  You may also submit a written complaint to the Office for Civil Rights of the United States Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, Washington, DC, 20201. You may contact the Office for Civil Rights’ hotline at 1-800-368-1019.  We support your right to privacy of your medical information. We will not retaliate in any way if you choose to file a complaint with us or with the US Department of Health and Human Services.

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.

When you register with South Austin Oral Surgery (SAOS), we receive, create and maintain information about your health, treatment, and payment for services. We will not use or disclose your information without your written authorization (permission) except as described in this notice.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use and disclose your health information without your authorization for treatment, payment, and health care operation purposes. Examples include but are not limited to:
• Using or sharing your health information with other health care providers involved in your treatment or with a pharmacy that is filling your prescription.
• Using or sharing your health information with your health plan to obtain payment for services or using your health information to determine your eligibility for government benefits in a health plan.
• Using or sharing your health information to run our business, to evaluate provider performance, to educate health professionals, or for general administrative activities.

We may share your health information with our business associates who need the information to perform services on our behalf and agree to protect the privacy and security of your health information according to agency standards.

We may use or share your health information without your authorization as authorized by law for our patient directory, to family or friends involved in your care, or to a disaster relief agency for purposes of notifying your family or friends of your location and status in an emergency situation.

We may use and disclose your health information without your authorization to contact you for the following activities, as permitted by law and agency policy: providing appointment reminders; describing or recommending treatment alternatives; providing information about health-related benefits and services that may be of interest to you; or fundraising.

We may also use and disclose your health information without your authorization for the following purposes:
• For public health activities such as reporting diseases, injuries, births or deaths to a public health authority authorized to receive this information, or to report medical device issues to the FDA;
• To comply with workers compensation laws and similar programs;
• To alert appropriate authorities about victims of abuse, neglect, or domestic violence; if the agency reasonably believes you are a victim of abuse, neglect, or domestic violence we will make every effort to obtain your permission, however, in some cases we may be required or authorized to alert the authorities;
• For health oversight activities such as audits, investigations, and inspections of SAOS facilities;
• For research approved by an Institutional Review Board or privacy board; for preparing for research such as writing a research proposal; or for research on decedents information;
• To create or share de-identified or partially de-identified health information (limited data sets);
• For judicial and administrative proceedings such as responding to a subpoena or other lawful order;
• For law enforcement purposes such as identifying or locating a suspect or missing person;
• To coroners, medical examiners, or funeral directors as needed for their jobs;
• To organizations that handle organ, eye or tissue donation, procurement, or transplantation;
• To avert a serious threat to health or public safety;
• For specialized government functions such as military and veteran activities, national security and intelligence activities, and for other law enforcement custodial situations;
• For incidental disclosures such as when information is overheard in a waiting room despite reasonable steps to keep information confidential; and
• As otherwise required or permitted by local, state, or federal law.

Additional privacy protections under state or federal law apply to substance abuse information, mental health information, certain disease-related information, or genetic information. We will not use or share these types of information unless expressly authorized by law. We will not use or disclose genetic information for underwriting purposes.

We will always obtain your authorization to use or share your information for marketing purposes, to use or share your psychotherapy notes, if there is payment from a third party, or for any other disclosure not described in this notice or required by law. You have the right to cancel your authorization, except to the extent that we have taken action based on your authorization. You may cancel your authorization by writing to the privacy officer per below.

YOUR PRIVACY RIGHTS

Although your health record is the property of SAOS, you have the right to:
• Inspect and copy your health information, including lab reports, upon written request and subject to some exceptions. We may charge you a reasonable, cost-based fee for providing records as permitted by law.
• Receive confidential communications of your health information, such as requesting that we contact you at a certain address or phone number. You may be required to make the request in writing with a statement or explanation for the request.
• Request amendment of your health information in our records. All requests to amend health information must be made in writing and include a reason for the request.
• Request an accounting (a list) of certain disclosures of your health information that we make without your authorization. You have the right to receive one accounting free of charge in any twelve-month period.
• Request that we restrict how we use and disclose your health information for treatment, payment, and health care operations, or to your family and friends. We are not required to agree to your request, except when you request that we not disclose information to your health plan about services for which you paid with your own money in full.
• Obtain a paper copy of this notice upon request.

You may make any of the above requests in writing to SAOS. You can reach SAOS at (512) 692-7140 or by email at . To request copies of your records, please call (512) 692-7140.

OUR DUTIES

We are required to provide you with notice of our legal duties and our privacy practices with respect to your health information. We must maintain the privacy of information that identifies you and notify you in the event your health information is used or disclosed in a manner that compromises the privacy of your health information.

We are required to abide by the terms of this notice. We reserve the right to change the terms of this notice and to make the revised notice effective for all health information that we maintain. We will post revised notices on our public website at www.southaustinoralsurgery.net and have copies of the notice available for review at our facility. You may request a copy of the revised notice at the time of your next visit.

SMS PRIVACY POLICY

Our office will not initiate first contact through text messaging. You may opt-in for messaging by letting us know in or sending a text message to our office number first. No mobile information will be shared with third-party/affiliates for marketing/promotional purposes and this includes your text messaging originator opt-in data and consent and personal information.

SMS TERMS & CONDITIONS

Patients may communicate with “South Austin Oral Surgery, PLLC” through text messaging (SMS). The purpose of the of the messages are regarding care you will or have received at our office (this includes scheduling appointments, appointment reminders, follow-up care communications, other). Message frequency varies based on the number of appointments you have scheduled. You are responsible for any message and data rates that may apply from your provider. If you would like to to stop receiving messages, replay STOP to no longer receive messages from our office. If you would like help, text HELP and we will call you. Carriers are not liable for delayed or undeliverable messages. South Austin Oral Surgery does not participate in SMS campaigns. Please contact our office if you believe your received a spam text from our office.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint by contacting SAOS at:

South Austin Oral Surgery, Attn: Privacy Officer, 706B W. Ben White Blvd. #194, Austin, TX 78704.

Or by submitting a formal written complaint directly to the Department of Health and Humans Services (“HHS”) by using its Health Information Privacy Complaint Package. If you have questions regarding how to file a complaint with HHS you may contact the agency via email at or by visiting the HHS website at www.hhs.gov.

We will not retaliate against you for filing a complaint.