OM3 Oral Surgery DBA Kim, Wahan, Brady & Altmann OMS PLLC 

Notice of Privacy Practices 

Effective Date: 04/15/2025 

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. 

Our Commitment to Your Privacy 

OM3 Oral Surgery is committed to protecting the privacy of your Protected Health Information (PHI). We understand that your health information is personal, and we are dedicated to maintaining its confidentiality. This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws. It also describes your rights regarding your PHI. 

How We May Use and Disclose Your Protected Health Information (PHI) 

We may use and disclose your PHI for the following purposes: 

  • Treatment: We may use and disclose your PHI to provide you with medical treatment or services. This includes sharing information among doctors, nurses, and other healthcare professionals involved in your care. For example, we may disclose your PHI to your referring dentist or other specialists involved in your treatment. 
  • Payment: We may use and disclose your PHI to bill and collect payment for the services we provide to you. For example, we may disclose your information to your health insurance plan, Medicare, Medicaid, or other payers. 
  • Healthcare Operations: We may use and disclose your PHI for our healthcare operations, which include activities necessary to run our practice and ensure quality care. For example, we may use your information for quality assessment, employee reviews, licensing, and accreditation purposes. 

Other Uses and Disclosures 

In addition to the uses and disclosures described above, we may use and disclose your PHI without your authorization in the following situations: 

  • As Required by Law: We will disclose your PHI when required to do so by federal, state, or local law. 
  • Public Health Activities: We may disclose your PHI to public health authorities for activities such as preventing or controlling disease, injury, or disability; reporting vital events; and conducting public health surveillance. 
  • Health Oversight Activities: We may disclose your PHI to health oversight agencies for activities authorized by law, such as audits, investigations, and licensure actions. 
  • Law Enforcement: We may disclose your PHI to law enforcement officials for certain law enforcement purposes, such as identifying or locating a suspect, fugitive, material witness, or missing person. 
  • Coroners, Medical Examiners, and Funeral Directors: We may disclose your PHI to a coroner or medical examiner for identification purposes or to determine the cause of death. We may also disclose information to funeral directors as necessary for their duties. 
  • Organ and Tissue Donation: We may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of facilitating organ, eye, or tissue donation and transplantation. 
  • Research: Under certain circumstances, we may use and disclose your PHI for research purposes. All research projects are subject to a special approval process. 
  • To Avert a Serious Threat to Health or Safety: We may disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. 
  • Workers’ Compensation: We may disclose your PHI to workers’ compensation programs or similar programs that provide benefits for work-related injuries or illness. 
  • Individuals Involved in Your Care or Payment: We may disclose your PHI to a family member, friend, or other person involved in your care or payment for your care, but only if you agree, or if you are unable to agree, we believe it is in your best interest. 
  • National Security and Intelligence Activities: We may disclose your PHI to authorized federal officials for national security and intelligence activities authorized by law. 
  • Correctional Institutions: If you are an inmate of a correctional institution, we may disclose your PHI to the institution or law enforcement officials as necessary for your health and the health and safety of others. 

Uses and Disclosures That Require Your Written Authorization 

For any other uses and disclosures of your PHI that are not described above, we will obtain your written authorization. You may revoke your authorization at any time, in writing, except to the extent that we have taken action in reliance on the authorization. 

The following uses and disclosures will be made only with your written authorization: 

  • Marketing: We will not use or disclose your PHI for marketing purposes without your authorization. 
  • Sale of PHI: We will not sell your PHI without your authorization. 
  • Psychotherapy Notes: We will not disclose psychotherapy notes without your authorization, except in limited circumstances. 

Your Rights Regarding Your PHI 

You have the following rights with respect to your PHI: 

  • Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHI that is contained in a designated record set, except for certain limited exceptions. You must submit your request in writing. We may charge a reasonable fee for the costs of copying, mailing, or other expenses associated with your request. 
  • Right to Amend: You have the right to request that we amend your PHI that you believe is incorrect or incomplete. You must submit your request in writing, and you must include a reason that supports your request. We may deny your request under certain circumstances. 
  • Right to an Accounting of Disclosures: You have the right to receive an accounting of certain disclosures of your PHI that we have made. This is a list of disclosures, other than those for treatment, payment, healthcare operations, and certain other disclosures. You must submit your request in writing, specifying a time period, which may not be longer than six years from the date of the disclosure. We will provide one accounting per 12-month period free of charge. We may charge a reasonable fee for additional accountings. 
  • Right to Request Restrictions: You have the right to request that we restrict or limit the PHI we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a restriction on disclosures to family members, friends, or others involved in your care. We are not required to agree to your request, except in the case where the request is to restrict disclosure to a health plan for payment or health care operations and you have paid for the service out-of-pocket in full. If we agree to a restriction, we will abide by it except as otherwise required by law. 
  • Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can request that we only contact you at home or by mail. We will accommodate all reasonable requests. You must make your request in writing. 
  • Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this Notice of Privacy Practices. You may request a copy at any time, even if you have agreed to receive the Notice electronically. 
  • Right to be Notified of a Breach: You have the right to be notified if there is a breach of your unsecured PHI. 
  • Right to Complain: If you believe your privacy rights have been violated, you have the right to file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. 

Our Legal Duties 

We are required by law to: 

  • Maintain the privacy of your PHI. 
  • Provide you with this Notice of our legal duties and privacy practices with respect to your PHI. 
  • Notify you following a breach of your unsecured PHI. 
  • Abide by the terms of this Notice that are currently in effect. 

Changes to This Notice 

We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the revised Notice effective for PHI we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our office and on our website. If we make material changes to this Notice, we will provide you with a revised Notice. 

Contact Information 

If you have any questions about this Notice of Privacy Practices, or if you would like to exercise your rights regarding your PHI, please contact: 

Alicia Bright 

Practice Manager 

OM3 Oral Surgery 

(360) 386-9201 

[email protected] 

Filing a Complaint 

If you believe that your privacy rights have been violated, you may file a complaint with us or with the Secretary of Health and Human Services. 

To file a complaint with us, contact: 

Alicia Bright 

Practice Manager 

OM3 Oral Surgery 

(360) 386-9201 

[email protected] 

To file a complaint with the Secretary of Health and Human Services, contact: 

Office for Civil Rights 

U.S. Department of Health and Human Services 

200 Independence Avenue, S.W. 

Washington, D.C. 20201 

https://www.hhs.gov/ocr/privacy/index.html 

You will not be penalized for filing a complaint.