Notice of Privacy Practices for Protected Health Information
Effective Date: April 2025
Last Revised: September 11, 2026
THIS NOTICE DESCRIBES HOW MEDICAL AND DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices applies to Premier Oral & Maxillofacial Surgery and explains our responsibilities regarding your protected health information, commonly called “PHI.”
PHI includes information that identifies you and relates to your past, present, or future physical or mental health, dental condition, healthcare services, or payment for those services. Examples include health histories, examination findings, diagnostic images, treatment plans, prescriptions, surgical records, insurance information, and billing records.
How We May Use and Disclose Your Health Information
Federal law permits us to use and disclose your PHI for treatment, payment, and healthcare operations without obtaining a separate written authorization, except where otherwise required by law.
Treatment
We may use and disclose your health information to provide, coordinate, and manage your care.
For example, we may share relevant information with your dentist, physician, pharmacy, laboratory, hospital, specialist, or another healthcare provider involved in your treatment.
Payment
We may use and disclose your health information to bill for services and obtain payment from you, an insurance company, or another responsible party.
For example, we may provide information to your insurance company so it can determine eligibility, coverage, medical necessity, or payment responsibility.
Healthcare Operations
We may use and disclose your health information for activities necessary to operate our practice and improve the quality of care.
These activities may include:
- Quality assessment and improvement
- Employee training and evaluation
- Credentialing and peer review
- Licensing and accreditation
- Compliance activities
- Auditing and accounting
- Legal and insurance services
- Practice management
- Patient safety initiatives
- Business planning and administration
We may share information with business associates that perform services on our behalf. Business associates are required by law and contract to appropriately protect your information.
Appointment Reminders and Care Communications
We may use your contact information to communicate with you about your care, including:
- Appointment confirmations and reminders
- Scheduling and rescheduling
- Preoperative and postoperative instructions
- Treatment follow-up
- Prescription or care-related notifications
- Billing and payment information
- Information about treatment alternatives
- Other health-related services that may be relevant to you
We will make reasonable efforts to limit the information included in voicemail, email, and text communications.
SMS and Text Message Privacy
If you voluntarily provide your mobile telephone number and consent to receive text messages, Premier Oral & Maxillofacial Surgery may send you SMS or MMS messages concerning your care.
Messages may include appointment reminders, scheduling communications, treatment instructions, follow-up messages, billing notifications, office announcements, and other practice-related information.
SMS Consent
We will obtain appropriate consent before sending automated or recurring text messages. Consent may be provided through a website form, patient registration form, written authorization, direct request, or another documented method.
Consent to receive text messages is not a condition of purchasing services or receiving treatment. Providing your mobile number does not authorize us to send promotional messages unless you separately consent to receive them.
Message frequency will vary depending on your appointments, treatment, and interactions with our office. Message and data rates may apply.
SMS Opt-Out and Assistance
You may withdraw your consent to receive text messages at any time.
To stop receiving text messages, reply STOP to any message. You may receive one final message confirming that your opt-out request has been processed.
For assistance, reply HELP to any message or call Premier Oral & Maxillofacial Surgery at (708) 942-8154.
After you opt out, we will not send additional text messages unless you subsequently provide renewed consent. Opting out of text messages will not affect your ability to receive treatment or communicate with our office by telephone or other available methods.
Mobile carriers are not responsible for delayed or undelivered messages.
Mobile Information Sharing
We do not sell, rent, or share your mobile telephone number, SMS consent, or text messaging opt-in information with third parties or affiliates for their own marketing or promotional purposes.
We may share limited mobile information with vendors and service providers that assist us in delivering text messages, maintaining communication systems, or supporting practice operations. These providers may use the information only to perform services on our behalf and must protect it as required by applicable law and contractual obligations.
Text messaging originator opt-in data and consent will not be shared with third parties for marketing or promotional purposes.
SMS Security
Standard text messaging may not be fully secure or encrypted. Although we take reasonable steps to protect your information and limit the details contained in messages, we cannot guarantee the security of information transmitted through your mobile carrier.
Please do not send highly sensitive medical, dental, financial, or identification information by text message.
Text messaging should not be used for emergencies. If you are experiencing a medical emergency, call 911. For an urgent dental concern, call our office directly at (708) 942-8154.
Other Permitted Uses and Disclosures
We may also use or disclose your health information in the following circumstances, as permitted or required by law.
Individuals Involved in Your Care
Unless you object, we may disclose information relevant to your care or payment for your care to a family member, personal representative, close friend, or another person you identify.
If you are unavailable or unable to express your preferences, we may use professional judgment to determine whether a limited disclosure is in your best interest.
Disaster Relief and Notification
We may disclose limited information to an authorized disaster-relief organization or another appropriate person to help notify your family or personal representative about your location, general condition, or death.
Public Health Activities
We may disclose health information to authorized public health agencies for activities such as:
- Preventing or controlling disease, injury, or disability
- Reporting births or deaths
- Reporting adverse reactions or product defects
- Supporting product recalls
- Conducting public health surveillance
- Preventing or controlling communicable diseases
Food and Drug Administration
We may disclose information to the U.S. Food and Drug Administration concerning adverse events, product defects, tracking requirements, recalls, repairs, or replacements.
Reporting Abuse, Neglect, or Domestic Violence
We may disclose health information to an authorized government agency when required or permitted by law to report suspected abuse, neglect, or domestic violence.
Health Oversight Activities
We may disclose information to health oversight agencies for activities authorized by law, including audits, inspections, investigations, licensing actions, and disciplinary proceedings.
Legal and Administrative Proceedings
We may disclose health information in response to a valid court order, administrative order, subpoena, discovery request, or other lawful legal process.
Law Enforcement
We may disclose information for authorized law-enforcement purposes, including disclosures required by law, responses to court orders, locating certain individuals, reporting suspected crimes, or addressing circumstances involving a person in law-enforcement custody.
Correctional Institutions
If you are an inmate or are in the custody of law enforcement, we may disclose health information to the correctional institution or law-enforcement official when necessary for your care, the health and safety of others, or institutional operations.
Workers’ Compensation
We may disclose health information as authorized or required by workers’ compensation laws and similar programs.
Serious Threats to Health or Safety
We may disclose information when necessary to prevent or reduce a serious and imminent threat to the health or safety of a person or the public, consistent with applicable law and professional ethical standards.
Coroners, Medical Examiners, and Funeral Directors
We may disclose health information to coroners, medical examiners, and funeral directors as necessary for them to perform their lawful duties.
Organ and Tissue Donation
We may disclose health information to organizations involved in organ, eye, or tissue donation and transplantation.
Research
We may use or disclose health information for approved research when applicable legal safeguards have been satisfied.
Military, National Security, and Protective Services
We may disclose information for authorized military, veterans’ affairs, national security, intelligence, or protective-service activities as permitted by law.
Required by Law
We will disclose health information when federal, state, or local law requires us to do so.
Uses Requiring Written Authorization
Uses or disclosures not described in this Notice will generally be made only with your written authorization.
Written authorization is generally required for:
- Most uses or disclosures of psychotherapy notes, when applicable
- Most uses or disclosures for marketing purposes
- Disclosures involving the sale of PHI
- Other uses and disclosures not otherwise permitted by law
You may revoke an authorization in writing at any time. Your revocation will not affect actions already taken in reliance on the authorization.
Your Health Information Rights
You have the following rights regarding your PHI, subject to certain legal limitations.
Right to Inspect and Obtain Copies
You may request access to or copies of your health and billing records. You may request an electronic copy when the information is maintained electronically.
We may charge a reasonable, cost-based fee as permitted by law. In limited circumstances, we may deny access. If access is denied, you may have the right to request a review of that decision.
Right to Request an Amendment
If you believe information in your records is incorrect or incomplete, you may request an amendment in writing and explain the reason for your request.
We may deny the request under certain circumstances. If denied, you may submit a written statement of disagreement that will be maintained with your records as required by law.
Right to an Accounting of Disclosures
You may request a list of certain disclosures we made of your PHI during the period permitted by law.
The accounting generally will not include disclosures made for treatment, payment, or healthcare operations; disclosures made directly to you; disclosures you authorized; or certain other disclosures excluded by law.
Right to Request Restrictions
You may ask us to restrict certain uses or disclosures of your information. We are generally not required to agree to every requested restriction.
If you pay for a service completely out of pocket and request that we not disclose information about that service to your health plan for payment or healthcare operations, we will honor the request unless disclosure is required by law.
Right to Request Confidential Communications
You may request that we contact you in a particular way or at an alternative location. For example, you may ask us to call a specific telephone number or send correspondence to a different address.
We will accommodate reasonable requests.
Right to Revoke an Authorization
You may revoke a previously signed authorization by submitting a written request. The revocation will not apply to information already used or disclosed in reliance on the authorization.
Right to Receive a Paper or Electronic Copy
You may request a paper or electronic copy of this Notice at any time, even if you previously agreed to receive it electronically.
Right to Receive Notice of a Breach
You have the right to be notified if a breach occurs that may have compromised the privacy or security of your unsecured PHI, as required by law.
Right to File a Complaint
You may file a complaint with our practice or with the U.S. Department of Health and Human Services if you believe your privacy rights have been violated.
We will not retaliate against you, deny treatment, or require you to waive your right to file a complaint.
Our Responsibilities
Premier Oral & Maxillofacial Surgery is required to:
- Maintain the privacy and security of your PHI.
- Follow the duties and privacy practices described in the Notice currently in effect.
- Provide you with this Notice explaining our legal duties and privacy practices.
- Notify you following a breach of unsecured PHI when required by law.
- Accommodate reasonable requests for confidential communications.
- Notify you if we are unable to agree to a requested restriction.
- Limit uses, disclosures, and requests for PHI to the minimum necessary when the minimum-necessary standard applies.
Changes to This Notice
We reserve the right to change this Notice and our privacy practices. Any revised Notice may apply to information we already maintain as well as information we receive in the future.
When we make a material change, we will update this Notice and make the revised version available at our office and on our website.
You may request the current version at any time by contacting our office.
Questions or Complaints
If you have questions about this Notice, want to exercise your privacy rights, or wish to file a complaint with the practice, please contact:
Abdulkader Ghadiali, DDS
Premier Oral & Maxillofacial Surgery
16523 106th Court, Unit C2
Orland Park, Illinois 60467
Phone: (708) 942-8154
You may also file a complaint with:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/hipaa/filing-a-complaint
Premier Oral & Maxillofacial Surgery will not retaliate against you for filing a complaint.
Website Availability
The current Notice of Privacy Practices is available at:
www.premieromfs.com/notice-of-privacy-practices
You may also request a printed copy by calling (708) 942-8154 or visiting our office.