Notice of Privacy Practices

Effective Date: June 21, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Glendale Oral Surgery is committed to protecting the privacy and security of your health information. This Notice describes how we may use and disclose your Protected Health Information (PHI), your rights regarding that information, and our legal obligations under the Health Insurance Portability and Accountability Act (HIPAA).

Our Commitment to Your Privacy

We understand that information about your health is personal. We are required by law to:

  • Maintain the privacy of your Protected Health Information (PHI)
  • Provide you with this Notice of our legal duties and privacy practices
  • Notify you following a breach of unsecured protected health information when required by law
  • Follow the terms of this Notice currently in effect

How We May Use and Disclose Your Health Information

For Treatment

We may use and disclose your health information to provide, coordinate, and manage your oral surgery and dental care.

Examples include:

  • Consulting with your referring dentist
  • Coordinating care with specialists
  • Reviewing diagnostic images and treatment plans
  • Communicating with laboratories or healthcare providers involved in your care

For Payment

We may use and disclose your health information to obtain payment for services provided.

Examples include:

  • Billing insurance companies
  • Verifying insurance coverage
  • Obtaining prior authorizations
  • Processing claims and payment information

For Healthcare Operations

We may use and disclose health information to support business and operational activities.

Examples include:

  • Quality assessment and improvement activities
  • Staff training and education
  • Licensing and accreditation activities
  • Compliance reviews and audits

Appointment Reminders

We may contact you regarding appointments, treatment follow-up, or related healthcare services using phone calls, text messages, voicemail messages, email, or mail.

Individuals Involved in Your Care

Unless you object, we may share relevant information with family members, caregivers, or other individuals involved in your care or payment for your care.

As Required by Law

We may disclose your information when required by federal, state, or local law.

Public Health and Safety Activities

We may disclose information for public health activities, including:

  • Disease prevention and control
  • Reporting adverse events
  • Preventing serious threats to health or safety

Law Enforcement and Legal Proceedings

We may disclose information when authorized or required by law, including in response to court orders, subpoenas, or law enforcement requests.

Workers’ Compensation

We may disclose information as authorized by workers’ compensation laws and similar programs.

Uses and Disclosures Requiring Your Authorization

Certain uses and disclosures require your written authorization, including:

  • Most marketing communications
  • Sale of Protected Health Information
  • Uses not otherwise described in this Notice

You may revoke an authorization at any time in writing, except to the extent action has already been taken based on that authorization.

Your Rights Regarding Your Health Information

Right to Inspect and Obtain Copies

You have the right to inspect and obtain copies of your health records, subject to certain legal limitations.

Right to Request Corrections

You may request that we amend information that you believe is incorrect or incomplete.

Right to Request Restrictions

You may request restrictions on certain uses or disclosures of your information. While we are not always required to agree, we will consider all reasonable requests.

Right to Request Confidential Communications

You may request that we communicate with you in a specific way or at a specific location.

Right to Receive an Accounting of Disclosures

You may request a list of certain disclosures we have made of your health information.

Right to Receive a Paper Copy of This Notice

You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

Right to File a Complaint

You may file a complaint if you believe your privacy rights have been violated.

You may contact our office directly or file a complaint with the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.

Our Responsibilities

We are required by law to:

  • Maintain the privacy and security of your Protected Health Information
  • Provide notice of our privacy practices
  • Notify affected individuals following certain breaches of unsecured PHI
  • Comply with federal and state privacy regulations

Changes to This Notice

We reserve the right to modify this Notice at any time. Any revised Notice will apply to all health information maintained by our practice and will be posted in our office and on our website.

Contact Information

If you have questions regarding this Notice or wish to exercise your privacy rights, please contact:

Glendale Oral Surgery

238 N Glendale Ave
Glendale, CA 91206

Phone: (818) 484-8939

Website: https://glendaleoralsurgery.com

Complaints

You may file a complaint with:

U.S. Department of Health and Human Services
Office for Civil Rights

You will not be retaliated against for filing a complaint concerning our privacy practices.