Notice of Privacy Practices

How your health information may be used and shared, and the rights you have over it.

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.

Your rights

You have the right to:

  • Get an electronic or paper copy of your medical record
  • Ask us to correct your medical record
  • Request confidential communications
  • Ask us to limit the information we share
  • Get a list of those with whom we have shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated

Ask us in writing and we will provide a copy or a summary of your health information, usually within 30 days. We may charge a reasonable, cost-based fee. If you ask us to correct information you believe is incorrect or incomplete, we may say no, and we will tell you why in writing within 60 days.

You can ask us to contact you in a specific way — a different phone number, or mail to a different address — and we will say yes to all reasonable requests. You can ask us not to use or share certain information for treatment, payment or our operations; we are not required to agree, and may say no if it would affect your care. If you pay for a service in full out of pocket, you can ask us not to share that information with your health insurer, and we will say yes unless a law requires us to share it.

You can ask for a list of the times we have shared your health information for the six years before the date you ask, who we shared it with, and why. We will include all disclosures except those about treatment, payment and health care operations, and certain other disclosures. One list a year is free.

Your choices

For certain health information, you can tell us what you want us to do. Tell us your choices and we will follow them: sharing information with your family, close friends or others involved in your care, and sharing information in a disaster relief situation. If you are not able to tell us your preference — for example if you are unconscious — we may share your information if we believe it is in your best interest, or to lessen a serious and imminent threat to health or safety.

We never share your information for marketing purposes or sell it, and we never share psychotherapy notes, without your written permission.

Our uses and disclosures

We typically use or share your health information in the following ways:

  • To treat you. We can use your health information and share it with other professionals who are treating you.
  • To run our practice. We can use and share your health information to run our practice, improve your care, and contact you when necessary.
  • To bill for your services. We can use and share your health information to bill and get payment from health plans or other entities.

We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research — and we have to meet many conditions in the law before we can share it. These include helping with public health and safety issues, doing research, complying with the law, responding to organ and tissue donation requests, working with a medical examiner or funeral director, addressing workers' compensation, law enforcement and other government requests, and responding to lawsuits and legal actions.

Our responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time — let us know in writing.

Complaints

If you believe your privacy rights have been violated, contact us using the details below. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting hhs.gov. We will not retaliate against you for filing a complaint.

Changes to this notice

We can change the terms of this notice, and the changes will apply to all information we hold about you. The new notice will be available on request, in our office, and on this page. This notice took effect on August 4, 2026.

Who to contact

Oral Surgery of New York is responsible for this notice. For any question about it, or to exercise any right described above, contact us:

Oral Surgery of New York
424 Madison Avenue Suite 1500 New York, NY 10017
212-758-4848