Oral Surgery Specialists of Northern Michigan, PLLC
1507 S. Otsego Ave. Suite B, Gaylord, MI 49735 Phone: 989-732-4189   Fax: 989-732-1916

Privacy Policy

Privacy Policy


We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices that are described in this Notice while it is in effect. This notice takes effect on 09/01/2013 and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make new Notice provisions effective for all protected health information that we maintain. When we make a significant change in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice upon request.

You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed on our Contact Us page.


TREATMENT: We may use and disclose your health information for your treatment. For example, we may disclose your health information to a specialist providing treatment to you.

PAYMENT: We may use and disclose your health information to obtain reimbursement for treatment and services you receive from us or another entity involved with your care. Payment activities include billing, collections, claims management, and determinations of eligibility and coverage to obtain payment from you, and insurance company, or another third party. For example, we may send claims to your dental health plan containing certain health information.

INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE: We may disclose your health information to your family or friends or any other individual identified by you when they are involved in your care or in the payment for your care. Additionally, we may disclose information about you to a patient representative. If a person has the authority by law to make health care decisions for you, we will treat that patient representative the same way we would treat you with respect to your health information.

DISASTER RELIEF: We may use or disclose your health information to assist in disaster relief efforts.

REQUIRED BY LAW: We may use of disclose your health information when we are required to do so by law.

PUBLIC HEALTH ACTIVITIES: We may disclose your health information for public health activities, including disclosures to the following: Prevent or control disease, injury, or disability, Report child abuse or neglect, Report reactions to medications or problems with products or devices, Notify a person of a recall, repair, or replacement of products or devices, Notify a person who may have been exposed to a disease or condition, or Notify the appropriate government authority if we believe a patient has been the victim of abuse.

NATIONAL SECURITY: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody the protected health information of an inmate or patient.

SECRETARY OF HHS: We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA.

WORKMAN'S COMPENSATION: We may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relation to worker's compensation or other similar programs established by law.

LAW ENFORCEMENT: We may disclose your PHI to an oversight for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

JUDICIAL AND ADMINISTRATIVE PROCEEDINGS: If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the request or to obtain an order protecting the information requested.

CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS: We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to enable them to carry out their duties.


ACCESS: You have the right to look at or get copies of your health information, with limited exceptions. You must make the request in writing. You may obtain a form to request access by using the contact information listed at the end of this Notice.

RIGHT TO REQUEST A RESTRICTION: You have the right to request additional restrictions on our use or disclosure of your PHI by submitting a written request to the Privacy Official. Your written request must include what information you want to limit, whether you want to limit our use, disclosure of both, and to whom you want the limits to apply. We are not required to agree to your request except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, and the information pertains solely to a health care item or service for which you or a person on your behalf has paid our practice in full.

ALTERNATIVE COMMUNICATION: You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. You must make your request in writing. Your request must specify the alternative means or location, and provide satisfactory explanation of how payment will be handled under the alternative means or location you request. We will accommodate all reasonable requests.

AMENDMENT: You have the right to request that we amend your health information. Your request must be in writing, must explain why the information should be amended. We may deny your request under certain circumstances. If we agree to your request, we will amend your record and notify you of such. If we deny your request, we will provide you with a written explanation and explain your rights.

You may receive a paper notification of the Notice upon request.

If you want more information about our privacy practices or have questions or concerns, please contact us.

You will receive notifications of breaches of your unsecured PHI as required by law.

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