Privacy Policy

At KOS, we place the highest priority on a patient’s right to privacy. We are committed to providing you with exceptional care and forming a relationship that is built on trust. This means that we respect your privacy rights and will endeavor to protect the confidentiality of your health care information–whether this information is stored in a paper or electronic file.

KOS adheres to the requirements outlined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as well as applicable Texas General Laws. Following these regulations ensures the privacy and security of an individual’s health care information. This serves to promote and maintain trust between the doctor and patient, which is the foundation of the relationship.

What is HIPAA?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) or Public Law 104-191 became law August 21, 1996. The Privacy Rule provides federal protections for personal information held by a covered entity, such as KOS.

As of April 14, 2003, the Federal Office of Civil Rights implemented new rules related to the privacy and confidentiality of your health care information. As part of those new rules, we are required to obtain your signature acknowledging how we use and share your health care information. Our Notice of Privacy Practices describes how we may use or disclose your health care information and your rights to access and/or change that information. As described in our Notice, you may request copies of your healthcare information, or request a list of people or organizations that you did not authorize but who have received your healthcare information from us.

KOS staff members are trained in the appropriate use and disclosure of health care information. They know the importance of maintaining the availability of the information so that we may continue to provide care to you and for other legitimate purposes. We strive hard to protect your information and to address any violation of confidentiality or failure of a staff member to protect your information from accidental or unauthorized access.

THIS NOTICE DESCRIBES HOW YOUR HEALTH CARE INFORMATION MAY BE USED OR DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY. We make a record each time you receive health care or services or we discuss your care in person, by telephone, email, or fax. Your records have information about your symptoms, examination, test results, diagnosis, and billing for services.

Notice of Privacy Practices

Health Insurance Portability and Accountability Act (HIPAA)

We are allowed by law, in some instances, to use and disclose your health care information without your permission. We briefly describe these uses and disclosures and give you some examples. Some health care information has stricter requirements for disclosure. Examples of these are: certain mental health conditions, drug and/or alcohol abuse, and HIV and genetic testing, all of which have more stringent requirements. Your permission will be obtained prior to some uses and disclosures. However, there are still circumstances in which these types of information may be used or disclosed without your permission.

FOR TREATMENT. We may use health information about you to provide you with treatment or services. We may disclose health information about you to health care providers, including dentists, physicians, dental laboratories, health care facilities, etc., who are involved in providing care to you, including, but not limited to, offering health care advice and utilizing interpreters in order to make your treatment more accessible and comprehensible. For example, a health care provider may use the information in your health care record to determine what type of medications, therapy, or procedures are appropriate for you. The treatment plan selected by your health care provider will be documented in your record so that other health care professionals can coordinate the different actions/items you may need, such as prescriptions, lab tests, referrals, etc. We also may disclose health care information about you to people outside of KOS who may be involved in your continuing health care care needs, such as skilled nursing facilities, other health care providers, case managers, transport companies, community agencies, family members, and contracted/affiliated pharmacies.

TO OBTAIN PAYMENT FOR HEALTH CARE SERVICES. We may use and disclose your health care information so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or other third-party payer. For example, we may need to give your insurance health plan information about a treatment you received so your health plan will pay us. We may also tell your health plan about a proposed treatment to determine whether your plan will cover the treatment or medication. We may also share your information, when appropriate, with  government programs such as Medicare in order to coordinate your benefits and payments. We may use or disclose health care information about you to determine eligibility for plan benefits, obtain premiums, facilitate payment for the treatment and services you receive from KOS, determine plan responsibility for benefits, and to coordinate benefits. We may also provide your health care information to our business associates who assist us with billing, such as billing companies, claims processing companies and others that process our health care claims. We will only disclose the minimum amount of information needed to obtain payment. However, by act of law, if you pay for your treatment and services yourself in full (i.e., with no health plan billing or contribution), you have a right to request that we not disclose your health care information pertaining to such treatment and services to your health plan, if the disclosure is for the purpose of seeking payment and is not otherwise required by law.

FOR HEALTH CARE OPERATIONS. We may use and disclose health care information about you for certain health care operations. For example, we may use your health care information to review the quality of the treatment and services we provided, to educate our health care professionals, and to evaluate the performance of our staff in caring for you. Your healthcare information may also be used or disclosed for licensing or accreditation purposes. We may use and disclose health information about you to carry out necessary insurance-related activities. Examples include underwriting, premium rating, conducting or arranging health care review, legal and audit services, fraud and abuse detection, business planning, management, and general administration.

FOR HEALTH-RELATED BENEFITS AND SERVICES. We may contact you about benefits or services that we provide. We will not sell or give your information to an outside agency for the purposes of marketing their products to you.

FOR TREATMENT ALTERNATIVES. We may tell you about or recommend possible treatment options or alternatives that may be of interest to you.

TO FAMILY AND OTHERS WHEN YOU ARE PRESENT. Sometimes a family member or other person involved in your care will be present when we are discussing your health care information. If you object, please alert us and we will not discuss your health care information, or we will ask the person to leave.

TO FAMILY AND OTHERS WHEN YOU ARE NOT PRESENT. There may be times when it is necessary to disclose your health care decision-making capacity to agree or object. In those instances, we will use our professional judgment to determine if it is in your best interest to disclose your health care information. If so, we will limit the disclosure to the health care information that is directly relevant to the person’s involvement with your health care needs. For example, we may allow someone to pick up a prescription for you.

AS REQUIRED BY LAW. We will disclose health care information about you when required to do so by federal, state, or local law.

TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY. We may use or disclose your health care information if a serious and imminent threat to your or another person’s health or safety exists. Any disclosure would be to someone able to help eliminate or reduce the threat.

FOR DISASTER RELIEF. We may disclose your name, city where you live, age, sex, and general condition to a public or private disaster relief organization to assist disaster relief efforts, and to notify your family about your location and status, unless you object at the time.

FOR WORKERS’ COMPENSATION. We may release health care information about you to workers’ compensation or similar programs, as required by law. For example, we may communicate your health care information regarding a work-related injury or illness to claims administrators, insurance carriers, and others responsible for evaluating your claim for workers’ compensation benefits.

FOR PUBLIC HEALTH DISCLOSURES. We may use or disclose health care information about you for public health purposes. These purposes generally include the following:

  • To prevent or control disease (such as cancer or tuberculosis), injury, or disability;
  • To report suspected child abuse or neglect, or to identify suspected victims of abuse, neglect, or domestic violence;
  • To report reactions to medications or problems with products or health care devices;
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and
  • To comply with federal and state laws that governs workplace safety.


  • We will not use or disclose your health care information for marketing purposes without your written authorization.
  • We may communicate with you in the form of face-to face conversations about services and treatment alternatives.
  • We may provide you with promotional gifts or nominal value.

FOR HEALTH OVERSIGHT ACTIVITIES. As health care providers we are subject to oversight by accrediting, licensing, federal, and state agencies. These agencies may conduct audits on our operations and activities, and in that process they may review your healthcare information.

FOR LAWSUITS AND OTHER LEGAL ACTIONS. In connection with lawsuits, or other legal proceedings, we may disclose healthcare information about you in response to a court or administrative order, or in response to a subpoena, discovery request, warrant, summons, or other lawful process. We may disclose your health care information to courts, attorneys, and court employees in the course of conservatorship and certain other judicial or administrative proceedings. We may also use and disclose your health care information, to the extent permitted by law, without your consent to defend a lawsuit.

FOR LAW ENFORCEMENT. If asked to do so by law enforcement, and as authorized or required by law, we may release healthcare information:

  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About a suspected victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s  agreement;
  • About a death suspected to be the result of criminal conduct;
  • About criminal conduct at one of our facilities; and
  • In case of a health care emergency, to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.

FOR OTHERS. We may release health care information to a coroner or health care examiner to identify a deceased person or to determine cause of death. We may also release healthcare information about patients to funeral directors as necessary to carry out their duties.

INMATES / CORRECTIONAL INSTITUTIONS. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health care information about you to the correctional institution for certain purposes. For example, to protect your health or safety or someone else’s. Note: Under the federal law that requires us to give you this Notice, inmates do not have the same rights to control their health care information as other individuals.

ALL OTHER USE AND DISCLOSURES OF YOUR HEALTH CARE INFORMATION REQUIRE YOUR PRIOR WRITTEN AUTHORIZATION. Except for the exceptions detained in this Notice, we will not use your health care information for marketing or disclose your health care information in a manner that constitutes a sale of your health care information without your authorization. Other uses and disclosures of health care information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose healthcare information about you, you may revoke that permission, in writing, at any time. Please note that the revocation will not apply to any authorized use or disclosure of your healthcare information that took place before we received your revocation. Also, if you gave your authorization to secure a policy of insurance, including health care coverage from us, you may not be permitted to revoke it until the insurer can no longer contest the policy issued to you or a claim under the policy.

YOUR RIGHTS REGARDING YOUR HEALTHCARE INFORMATION. Your health care information is the property of KOS. You have the following rights, however, regarding your health care information, such as your health care and billing records. This section describes how you can exercise these rights:

RIGHT TO INSPECT AND COPY. With certain exceptions, you have the right to see and receive copies of your health care information that was used to make decisions about your care, or decisions about your health plan benefits. If you would like to see or receive a copy of such a record, please write us. We may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

RIGHT TO ELECTRONIC RECORDS. You have the right to receive a copy of your electronic health records in electronic form.

RIGHT TO CORRECT OR UPDATE YOUR INFORMATION. If you feel that your health care information is incorrect or important information is missing, you may request that we correct or add to (amend) your record. Please write to us and tell us for what you are asking and supply any and all information to support making the correction or addition. Submit your request to Kingwood Oral Surgery, 2300 Green Oak Dr. Suite 600, Kingwood, Texas 77339. We may deny your request if it is not in writing or does not include justification to support the request. In addition, we may deny your request if you ask us to amend information that:

  • Was not created by us;
  • Is not a part of the health care information kept by or for us;
  • Is not part of the information which you would be permitted to inspect and copy; and
  • Is accurate and complete in the record.

We will let you know our decision within 60 days of your request. If we agree with you, we will make the correction or addition to your record. If we deny your request, you have the right to submit an addendum, or piece of paper written by you, not to exceed 250 words, with respect to any item or statement you believe is incomplete or incorrect in your record. If you clearly indicate in writing that you want the addendum to be made part of your health care record, we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.

RIGHT TO AN ACCOUNTING OF DISCLOSURES. You have the right to receive a list of the disclosures we have made of your healthcare information. An accounting or list does not include certain disclosures; for example, disclosures to carry out treatment, payment, and health care operations; disclosures that occurred prior to January 1, 2010; disclosures which you authorized us in writing to make; disclosures of your health care information made to you; disclosures to persons acting on your behalf. To request this list or accounting of disclosures, you must submit your request in writing. Your request must state the time period to be covered, which may not be longer than six years and may not include dates before April 14, 2003. You are entitled to one disclosure accounting in any 12-month period at no charge. If you request any additional accountings less than 12 months later, we may charge a fee.

RIGHT TO BREACH NOTIFICATION. You have a right to be notified if there is a breach of privacy, such that your healthcare information is disclosed or used improperly or in an unsecured way.

RIGHT TO REQUEST LIMITS ON USES AND DISCLOSURES OF YOUR HEALTH CARE INFORMATION. You have the right to request a restriction or limitation on the health care information we use or disclose about you for treatment, payment, or health care operations. However, except for the restriction of disclosure to health plan for payment after you have paid for the treatment and services in full (discussed earlier), we are not required by law to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to KOS.  In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

RIGHT TO CHOOSE HOW WE SEND HEALTHCARE INFORMATION TO YOU. You have the right to request that we communicate with you about health care matters in a certain way or at a certain location. For example, you can ask that we only phone you at work or use a P.O. Box when we send mail to you. To request confidential communications, you must make your request in writing, specify how or where you wish to be contacted, and submit it to KOS. When we can reasonably and lawfully agree to your request, we will.

RIGHT TO A PAPER COPY OF THIS NOTICE. You have the right to a paper copy of this Notice upon request. This can be done in one of three ways: ask for a copy at the Front Desk or call at (281) 358-2002. You may also obtain a copy of this Notice of Privacy Practices on our website at

CHANGES TO THIS NOTICE. We may change this Notice and our privacy practices at any time, as long as the change is consistent with state and federal law. Any revised Notice will apply both to the health care information we already have about you at the time of the change, and any health care information created or received after the change takes effect. We will post a copy of our current Notice in our office and on our website The effective date of the Notice will be on the first page, in the top right-hand corner.

QUESTIONS. If you have any questions about this Notice, please contact our office. The Office for Civil Rights has established a toll-free “privacy line” to enable the public to ask questions related to the privacy regulations. The privacy line can be reached at 1-866-627-7748 or you can call 1-415-437-8310

TO REQUEST INFORMATION OR FILE A COMPLAINT. If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact KOS by telephone or in writing. Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to our office manager.

You may also file a complaint by mailing it to the Secretary of Health and Human Services whose address is:

The US Department of Health and Human Services

Office of Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

Toll free telephone # 1-877-696-6775


  • We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from KOS.
  • We cannot, and will not, retaliate against you for filing a complaint with the Secretary.