Your Information. Your Rights. Our Responsibilities.

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.

Your Rights You have the right to:

● Get a copy of your paper or electronic medical record

● Correct your paper or electronic medical record

● Request confidential communication

● Ask us to limit the information we share

● Get a list of those with whom we’ve shared your information

● Get a copy of this privacy notice

● Choose someone to act for you

● File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

● Tell family and friends about your condition

● Provide disaster relief

● Include you in a hospital directory

● Provide mental health care

Our Uses and Disclosures

We may use and share your information as we:

● Treat you

● Run our organization

● Bill for your services

● Help with public health and safety issues

● Do research

● Comply with the law

● Respond to organ and tissue donation requests

● Work with a medical examiner or funeral director

● Address workers’ compensation, law enforcement, and other government requests

● Respond to lawsuits and legal actions

To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.

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 can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

● We will provide a copy or a summary of your health information, usually within thirty (30) days of your request. We may charge a reasonable, cost-based fee. Ask us to correct your medical record

● You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

● We may say “no” to your request, but we’ll tell you why in writing within sixty (60) days.

Request confidential communications

● You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.

● We will say “yes” to all reasonable requests. Ask us to limit what we use or share

● You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.

● If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

● You can ask for a list (accounting) of the times we’ve shared your health information for six (6) years prior to the date you ask, who we shared it with, and why.

● We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within twelve (12) months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

● If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

● We will make sure the person has this authority and can act for you before we take any action. File a complaint if you feel your rights are violated

● You can complain if you feel we have violated your rights by contacting us using the information on page 1.

● You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.

● We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:

● Share information with your family, close friends, or others involved in your care or payment for your care

● Share information in a disaster relief situation

● Include your information in a hospital directory If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

● Marketing purposes

● Sale of your information

● Most sharing of psychotherapy notes

New updates:

● Some information, such as HIV-related information, genetic information, alcohol and/or substance use disorder treatment records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records.

● In no event will we use or disclose your Part 2 Program record, or testimony that describes the information contained in your Part 2 Program record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena. Help with public health and safety issues

We can share health information about you for certain situations such as:

● Preventing disease

● Helping with product recalls

● Reporting adverse reactions to medications

● Reporting suspected abuse, neglect, or domestic violence

● Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

● For workers’ compensation claims

● For law enforcement purposes or with a law enforcement official

● With health oversight agencies for activities authorized by law

● For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions

● We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities

● We are required by law to maintain the privacy and security of your protected health information.

● We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

● We must follow the duties and privacy practices described in this notice and give you a copy of it.

● We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Other Instructions for Notice

● Effective Date of this Notice: 2.1.2026

● TEXAS CENTER FOR ORAL & FACIAL SURGERY – 817.645.1259 – [email protected] ● we never market or sell personal information, nor do we use patient information for fundraising purposes.

Patient Text Messaging Privacy Policy

TEXAS CENTER FOR ORAL & FACIAL SURGERY

Effective Date of this Notice: 2.1.2026

1. Purpose TEXAS CENTER FOR ORAL & FACIAL SURGERY offers text messaging (SMS) as a convenience to patients for appointment reminders, scheduling updates, limited clinical communication, and general office notifications. This policy explains how text messaging works, potential privacy risks, and patient rights regarding participation.

2. Voluntary Participation Participation in text messaging is completely voluntary. Patients must provide written or electronic consent before receiving text messages. Patients may opt out at any time by: • Replying “STOP” to any message • Contacting our office at 817-645-1259 • Submitting a written request Opting out will not affect the quality of care received.

3. Types of Messages Sent We may send text messages for purposes including: • Appointment reminders • Appointment confirmations • Surgery preparation instructions • Post-operative care reminders • Billing notifications (limited information only) • Office closures or schedule changes We will not send detailed medical diagnoses, test results, or sensitive medical information via standard SMS unless specifically authorized by the patient.

4. Privacy & Security Risks While we take reasonable steps to protect patient information, standard text messaging (SMS) is not a fully secure or encrypted method of communication. Potential risks include: • Messages being viewed by others who have access to your phone • Messages being intercepted during transmission • Messages remaining stored on your mobile device By consenting to receive text messages, patients acknowledge and accept these risks.

5. Protected Health Information (PHI) We limit the amount of Protected Health Information (PHI) included in text messages whenever possible. Messages may include: • Patient first name • Appointment date and time • Provider name • Basic procedural reminders Sensitive or detailed medical information will not be included unless communicated through a secure, encrypted platform and with patient authorization.

6. Patient Responsibilities Patients are responsible for: • Providing a current and accurate mobile phone number • Notifying the office if their number changes • Securing their mobile device with password protection when possible • Informing us if their phone is lost or stolen

7. Message Frequency & Charges Message frequency will vary depending on appointment activity and care needs. Standard text messaging rates may apply according to your mobile carrier’s plan. [Practice Name] is not responsible for carrier charges.

8. Data Storage & Retention Text communications related to patient care may be documented in the patient’s medical record as required by law. Messages are retained in accordance with our medical record retention policies.

9. Third-Party Messaging Services If we use a third-party messaging platform, we ensure that the vendor signs a Business Associate Agreement (BAA) and complies with HIPAA privacy and security standards.

10. Revocation of Consent Patients may withdraw consent for text messaging at any time. Revocation does not apply to messages already sent prior to the request.

11. Contact Information For questions regarding this policy or to update communication preferences, please contact: TEXAS CENTER FOR ORAL & FACIAL SURGERY 110 DEL RIO COURT, CLEBURNE TX 76033 817-645-1259 [email protected]

Patient Acknowledgment

I acknowledge that I have read and understand the Patient Text Messaging Privacy Policy and consent to receive text messages from TEXAS CENTER FOR ORAL & FACIAL SURGERY as described above.

Patient Name: _________________________________________________

Signature: ____________________________________________________ Date: _________________________________