Effective Date: 7/20/2026
Last Updated: 7/20/2026
Premier Institute of Oral & Facial Surgery
2855 N Hwy 67
Florissant, MO 63033
Phone: 314-627-1953
This Notice of Privacy Practices describes how medical and dental information about you may be used and disclosed and how you can access this information. Please review it carefully.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an Electronic or Paper Copy of Your Medical Record
You may ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you.
We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask Us to Correct Your Medical Record
You may ask us to correct health information about you that you believe is incorrect or incomplete.
We may deny your request, but we will explain the reason in writing within 60 days.
Request Confidential Communication
You may ask us to contact you in a specific way, such as by home phone, cell phone, work phone, text message, email, or mail to a different address.
We will consider all reasonable requests and will say “yes” when required by law.
Ask Us to Limit What We Use or Share
You may ask us not to use or share certain health information for treatment, payment, or healthcare operations.
We are not required to agree to every request, but we will review your request carefully.
If you pay for a service or healthcare item out-of-pocket in full, you may ask us not to share that information with your health insurance plan for payment or healthcare operations. We will agree unless a law requires us to share that information.
Get a List of Those With Whom We Have Shared Information
You may ask for a list, also called an accounting, of the times we have shared your health information for certain purposes.
This list will not include disclosures made for treatment, payment, healthcare operations, or certain other disclosures allowed by law.
Get a Copy of This Privacy Notice
You may ask for a paper copy of this notice at any time, even if you agreed to receive the notice electronically. We will provide a paper copy upon request.
Choose Someone to Act for You
If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information.
We will make reasonable efforts to confirm that the person has authority to act for you before taking action.
File a Complaint If You Believe Your Rights Are Violated
You may file a complaint if you believe your privacy rights have been violated.
You may file a complaint with Premier Institute of Oral & Facial Surgery by contacting us at:
Premier Institute of Oral & Facial Surgery
2855 N Hwy 67
Florissant, MO 63033
Phone: 314-627-1953
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you may tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations below, please tell us. We will follow your instructions when possible and when required by law.
You May Tell Us Whether We Can:
Share information with your family, close friends, caregiver, or others involved in your care
Share information in a disaster relief situation
Contact you for appointment reminders, treatment follow-up, or care coordination
Contact you about treatment options, services, or health-related benefits that may interest you
If you are unable to tell us your preference, for example if you are unconscious or unavailable, we may share your information if we believe it is in your best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.
Marketing and Sale of Information
We will not sell your protected health information.
We will not use or share your protected health information for marketing purposes without your written authorization, unless permitted by law.
Our Uses and Disclosures
We use and share your health information in several ways. The following examples explain common uses and disclosures.
Treatment
We may use and share your health information to provide, coordinate, or manage your care.
For example, we may share information with another dentist, physician, specialist, laboratory, imaging provider, anesthesia provider, pharmacy, or other healthcare professional involved in your treatment.
Payment
We may use and share your health information to bill and receive payment from health plans, dental plans, insurance companies, financing providers, or other responsible parties.
For example, we may send information to your dental or medical insurance plan so it will pay for covered services.
Healthcare Operations
We may use and share your health information to run our practice, improve patient care, train team members, support quality assurance, manage business operations, and contact you when needed.
For example, we may use your health information to review treatment outcomes, evaluate staff performance, improve patient communication, or manage scheduling and billing processes.
Appointment Reminders and Follow-Up
We may use and disclose your health information to contact you about appointments, reminders, follow-up care, post-operative instructions, treatment planning, financial coordination, or other matters related to your care.
We may contact you by phone, voicemail, text message, email, mail, or other communication methods you provide to us.
Business Associates
We may share your health information with outside companies or individuals that help us operate our practice. These may include billing services, software providers, IT support, website vendors, communication platforms, imaging systems, consultants, accountants, attorneys, collection services, and other business partners.
When required by law, these business associates must agree in writing to protect your health information.
Other Uses and Disclosures Allowed or Required by Law
We may use or share your health information in other ways, usually in ways that contribute to public health, safety, legal, or regulatory purposes.
We May Share Information For:
Public health and safety activities
Reporting adverse events, product defects, or disease exposure
Reporting suspected abuse, neglect, or domestic violence as required by law
Health oversight activities, such as audits, investigations, inspections, or licensing reviews
Workers’ compensation claims
Law enforcement purposes when permitted or required by law
Court or administrative proceedings in response to a valid legal order or subpoena
Coroners, medical examiners, or funeral directors
Organ, eye, or tissue donation organizations
Research, when specific legal requirements are met
Specialized government functions, such as military, national security, or protective services
Compliance with federal, state, and local laws
Special Protections
Certain types of health information may receive additional protection under federal or state law. This may include information related to substance use disorder treatment records, mental health records, HIV/AIDS status, genetic information, reproductive health care, or other sensitive information.
We will follow any additional legal requirements that apply to these types of information.
Written Authorization
We will ask for your written authorization before using or sharing your health information for reasons not described in this notice or not otherwise allowed by law.
You may revoke your authorization in writing at any time. If you revoke your authorization, we will stop using or sharing your information for that purpose, except to the extent we have already acted based on your authorization.
Our Responsibilities
Premier Institute of Oral & Facial Surgery is required by law to:
Maintain the privacy and security of your protected health information
Provide you with this Notice of Privacy Practices
Follow the duties and privacy practices described in this notice
Notify you if a breach occurs that may have compromised the privacy or security of your health information
Not use or share your information other than as described here unless you authorize us in writing
Changes to This Notice
We may change the terms of this notice at any time. Changes may apply to all health information we have about you.
The updated notice will be available upon request, in our office, and on our website.
Contact Information
For questions about this notice, to request a copy, to exercise your rights, or to file a complaint, please contact:
Premier Institute of Oral & Facial Surgery
2855 N Hwy 67
Florissant, MO 63033
Phone: 314-627-1953