Notice of Privacy Practices
Chicago Oral Surgery and Implant Center
Effective Date: January 20, 2026
As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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.
Understanding Your Health Record / Information
Each time you visit a hospital, physician, dentist, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment.
This information, often referred to as your health or medical record, serves as:
- A basis for planning your care and treatment
- A means of communication among health professionals who contribute to your care
- Documentation to ensure accuracy
- A tool to help you make informed decisions when authorizing disclosure
Your Health Information Rights
Unless otherwise required by law, your health record is the physical property of the healthcare practitioner or facility that compiled it. However, you have certain rights with respect to the information.
- Receive a copy of this Notice of Privacy Practices upon enrollment or upon request.
- Request restrictions on uses and disclosures of your protected health information for treatment, payment, and healthcare operations. This includes requesting that we not disclose your health information to a health plan if you have paid in full out-of-pocket. We reserve the right not to agree to a requested restriction.
- Request confidential communications regarding your protected health information.
- Inspect and obtain a copy of protected health information contained in your medical and billing records. If electronic records are maintained, you may request a copy be forwarded to a third party. A reasonable copying or labor charge may apply.
- Request an amendment to your protected health information if you believe it is incorrect or incomplete. We may deny your request if the record:
- Was not created by us
- Is not part of our records
- Is not available for inspection
- Is accurate and complete
Any approved amendment will be added to the existing record rather than replacing it.
- Receive an accounting of disclosures, except those made for:
- Treatment, payment, and healthcare operations
- Persons involved in your care
- Law enforcement or correctional purposes
- National security
- Incidental disclosures
- Limited data sets
- Disclosures authorized by you
- Revoke your authorization to use or disclose health information, except where action has already been taken.
- Receive notification if affected by a breach of unsecured PHI.
How Medical Information About You May Be Used and Disclosed
Treatment
We may use and disclose protected health information to coordinate or manage your healthcare, including consultations and referrals.
Payment
We may use your information to obtain reimbursement, determine eligibility, and conduct utilization reviews.
Regular Healthcare Operations
This includes quality assurance, case management, compliance programs, audits, administrative activities, and business planning.
Use of Artificial Intelligence (AI)
We may use secure, HIPAA-compliant AI technologies to support treatment, payment, and healthcare operations. These tools help improve accuracy, efficiency, and service quality.
Examples include:
- Supporting clinical decision-making
- Assisting with documentation and scheduling
- Enhancing security monitoring
- Improving patient education and communication
How Your Information Is Protected
AI tools must meet strict privacy and security standards. Your PHI will never be used for training, marketing, or product development.
Your Rights Regarding AI Use
You may request additional information about how AI tools are used and how your data is protected by contacting the Privacy Officer listed in this notice.
Additional Situations Where Information May Be Disclosed
- Appointment reminders
- Treatment alternatives
- Health-related benefits and services
- Individuals involved in your care or payment
- Business associates performing services on our behalf
- Organ and tissue donation
- Worker’s compensation programs
- Communicable disease notifications
- Health oversight activities
- Law enforcement requests or subpoenas
- Military command authorities
- Lawsuits and disputes
- Correctional institutions
- Abuse or neglect reporting
- Fundraising efforts (you may opt out)
- Coroners, medical examiners, and funeral directors
- Public health activities
- Serious threats to health or safety
- Food and Drug Administration reporting
- Approved research
Our Responsibilities
We are required to maintain the privacy of your health information and provide notice of our legal duties and privacy practices. We must abide by the terms of this notice and reserve the right to update it as needed.
Your health information will not be used or disclosed without your written authorization except as described here.
The following always require explicit authorization:
- Marketing uses
- Sale of health information
- Any use not described in this notice
You may revoke authorization in writing at any time.
For More Information or To Report a Problem
If you have questions or believe your privacy rights have been violated, you may file a written complaint with our Privacy Officer or with the U.S. Department of Health and Human Services within 180 days.
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: 1-877-696-6775
https://www.hhs.gov/contacts/
Chicago Oral Surgery & Implant Center
Privacy Officer: Jordan Ledger
1229 W Washington Blvd., Suite 220, Chicago IL 60607
951 W. Touhy Ave., Park Ridge, IL 60068
3621 N. Western Ave., Suite A, Chicago IL 60618
Email: info@oralsurgerychi.com
Notice of Privacy Practices Availability
This notice will be prominently posted in the office where registration occurs. You will be offered a hard copy at the time services are first delivered. Thereafter, copies are available upon request and will be maintained on the organization’s website for download.
