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NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003
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.
In this notice, we use the terms "we", "us", and
"our" to describe Hale Na`au Pono.
Under the Health Insurance Portability and Accountability Act of 1996
("HIPAA") we are required to maintain the privacy of your protected
health information and provide you with notice of our legal duties and privacy
practices with respect to such protected health information.
We are required to abide by the terms of the notice currently in effect. We
reserve the right to change the terms of our notice at any time and to make the
new notice provisions effective for all protected health information that we
maintain. In the event that we make a material revision to the terms of our
notice, we will post a copy in our office. We will provide a copy to you upon
request.
If you should have any questions or require further information, please
contact our Privacy Officer at (808) 696-4211.

I.
What is “Protected Health Information?”
Your
protected health information (PHI) is health information that contains
identifiers, such as your name, Social Security number, address, or other
information that reveals who you are. For
example, your medical record is PHI because it includes your name and other
identifiers.
If
you are a Hale Na`au Pono client and employee, PHI does not include the health
information in your employment records.
II.
About our responsibility to protect your PHI.
By
law, we must:
1)
Protect the privacy of your PHI.
2)
Inform you about your rights and our legal duties with respect to your
PHI.
3)
Inform you about our privacy practices and follow our notice currently in
effect.
III.
How we may use or disclose your PHI.
The
following describes the purposes for which we are permitted or required by law
to use or disclose your health information without your authorization. Any other
uses or disclosures will be made only with your written authorization and you
may revoke such authorization in writing at any time.
Uses
and disclosures permitted without your written authorization:
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Treatment:
We may use or disclose your PHI to provide you with medical
treatment or services. For example, information obtained by your case
manager may record such information in your record that is related to your
treatment. This information is necessary to determine what treatment you
should receive. |
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Payment:
We may use or disclose your PHI in order to process claims or obtain
payment for covered services from your benefit plan. For example, we may
submit a claim for payment. The claim form will include information that
identifies you, your diagnosis, and treatment or supplies used in the course
of treatment. |
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Health
Care Operations:
We may use or disclose your PHI for health care operations. Health
care operations include, but not limited to, quality assessment and
improvement activities, employee training, management and general
administrative activities. For example, members of our quality improvement
team may use information in your health record to assess the quality of care
that you receive and determine how to continually improve the quality and
effectiveness of the services we provide. We
may use a sign-in sheet at the registration desk. We may also call you by
name in the waiting area when we are ready to perform the necessary
services. We may also contact
you by telephone when necessary to respond to your inquiries or to confirm
information that is required to process a claim for payment from your health
insurance plan. |
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Business
Associates:
There may be instances where services are provided to our
organization through contracts with third party "business
associates". Whenever a business associate arrangement involves the use
or disclosure of your PHI, we will have a written contract that requires the
business associate to maintain the same high standards of safeguarding your
privacy that we require of our own employees. |
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Required
by Law:
We will disclose medical information about you when required to do
so by federal, state or local law. Such
disclosures will be made in compliance with the law and will be limited to
the requirements of the law. There
are stricter requirements for the use and disclosure of some types of PHI.
For example, drug and alcohol abuse client information; HIV, ARC, or
AIDS information; or mental illness and mental health treatment information. |
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Appointment
Reminders:
Your PHI allows us to contact you about appointments for treatment or other
health care you may need. |
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Communication
With Family or Friends When You are Present:
Sometimes a family member or other person involved in your care will
be present when we are discussing your PHI with you.
If you object, please tell us and we won’t discuss your PHI or we
will ask the person to leave the discussion. |
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Communication
With Family or Friends When You are Not Present:
Our service professionals, using their best judgment, may disclose to
a family member, other relative, or any other person you identify, PHI
relevant to that person's involvement in your care or payment related to
your care. Any PHI disclosure will be limited to information that is
directly relevant to that person’s involvement in your health care. For
example, we may allow someone to pick up a prescription for you. |
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Marketing:
We may use or disclose your PHI, as necessary, to provide you with
information about treatment alternatives or other health-related benefits
and services that may be of interest to you. |
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Research:
We may disclose information to researchers when their research has
been approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy of your
PHI. |
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Coroners,
Medical Examiners, Funeral Directors, and Organ Donation:
We may disclose PHI to a coroner or medical examiner. We may also
disclose medical information to funeral directors consistent with applicable
law to carry out their duties. If you are an organ donor, PHI may be
disclosed to authorized organ procurement organizations for the purposes of
facilitating donation of organ, eye, or other tissue. |
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Fund
Raising:
We may contact you as part of a fund-raising effort. |
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Public
Health:
As required by law, we may disclose your PHI to public health or
legal authorities charged with preventing or controlling disease, injury or
disability. This includes, but is not limited to, reporting accidents,
injuries, communicable diseases, reporting quality, safety, or effectiveness
of FDA-regulated products. |
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Workers'
Compensation:
We may disclose PHI to the extent authorized by and to the extent
necessary to comply with laws relating to workers compensation or other
similar programs established by law. |
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To
Avert a Serious Threat to Health or Safety:
Consistent with applicable federal and state laws, we may use and
disclose PHI when necessary to prevent a serious threat to your health and
safety. We may also disclose
PHI in situations which poses an immediate threat to the health of any
individual and which requires immediate medical intervention. |
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Health
Oversight Activities:
We may disclose PHI to a health oversight agency for activities
authorized by law, including audits, investigations, inspections, and
licensure. |
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Court
Orders:
We may disclose PHI in response to court orders that follow strict
procedural protections of your privacy interest. The disclosure will be
limited to the information expressly authorized by the order. |
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Child
Abuse & Neglect:
By law, we may disclose PHI to the appropriate authority to report
suspected child abuse or neglect. The disclosure will be consistent with the
requirements of applicable federal and state laws. |
Uses
and disclosures requiring your written authorization:
Except
for those uses and disclosures described above, we will not use or disclose your
PHI without your written authorization, unless otherwise permitted or required
by law. When your authorization is required and you authorize us to use or
disclose your PHI for some purpose, you may revoke that authorization by
notifying us in writing at any time. Please
note that the revocation will not apply to any authorized use or disclosure of
your PHI that took place before we received your revocation.
IV.
Your rights regarding your PHI.
You
have the following rights with respect to your PHI.
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Right
to See and Receive Copies of Your PHI:
In general, you have a right to see and receive copies of
your PHI that is maintained by our office.
If you would like to see or receive a copy of your PHI, we require
that a written request be sent to our Privacy Officer at: Privacy
Officer, Hale Na`au Pono, 86-226 Farrington Highway, Waianae, HI 96792-3128.
After we receive your written request, we will let you know when and
how you can see or obtain a copy of your PHI.
If you agree, we will give you a summary or explanation of your PHI
instead of providing copies.
We may charge you a fee for the copies, summary, or explanation.
Under federal law, however, you may not inspect or copy the following
records; psychotherapy notes; information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative action or
proceeding, and protected health information that is subject to law that
prohibits access to protected health information. We may deny some or all of
your request to see or receive copies of your PHI, but if we do, we will
inform you in writing and explain you right, if any, to have our denial
reviewed. Please contact our Privacy Contact if you have questions about
access to your medical record. |
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Right
to Request Restrictions:
You have the right to request that we restrict uses or disclosures of
your PHI to carry out treatment, payment, health care operations, or
communications with family or friends. By law, we are not required to agree
to a restriction. |
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Right
to Receive Confidential Communication:
You have the right to request that we send communications that
contain your PHI by alternative means (e.g. facsimile) or to alternative
locations (e.g. different address). When we can reasonably and lawfully
abide by your request, we will.
However, we are permitted to charge you for any additional cost of
sending your PHI to alternative |
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Right
to Amend:
You have the right to have us amend your PHI for as long as we
maintain such information. Your written request must include the reason or
reasons that support your request and sent to our Privacy Officer at: Privacy
Officer, Hale Na`au Pono, 86-226 Farrington Highway, Waianae, HI 96792-3128.
After we receive your written request, we will respond to your
request. If we approve your request, we will make the amendment to your PHI.
We may deny your request for an amendment if we determine that the record
that is the subject of the request was not created by us, is not available
for inspection as specified by law, or is accurate and complete. If we deny
your request, we will tell you why and explain your right to file a written
statement of disagreement. |
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Right
to Receive an Accounting of Disclosures:
You have the right to receive an accounting of disclosures of your
PHI made by us up to six years prior to the date the accounting is requested
(or shorter period as requested). This does not include disclosures made to
carry out treatment, payment and health care operations; disclosures made to
you; other disclosures not requiring your authorization; or disclosures made
prior to the HIPAA compliance date of April 14, 2003. Your first request for
accounting in any 12-month period shall be provided without charge. A
reasonable, cost-based fee shall be imposed for each subsequent request for
accounting within the same 12-month period. |
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Right
to Obtain a Paper Copy:
You have the right to obtain a paper copy of this Notice of Privacy
Practices at any time. |
V.
How to File a Complaint if You Believe Your Privacy Rights Have Been
Violated.
If
you believe that your privacy rights have been violated, please submit your
complaint in writing to:
Hale
Na`au Pono
Attn: Privacy Officer
86-226 Farrington Highway
Waianae, HI 96792-3128
You
may also file a complaint with the Secretary of the Department of Health and
Human Services.
You
will not be retaliated against for filing a complaint.
VI.
Governing Laws & Regulations.
Various
laws apply to the rules of confidentiality to protect your privacy.
These laws include State & Federal laws, court cases, and rules &
regulations. Of significance are 42
USC Sec. §290dd-2, 42 CFR Part 2 Confidentiality of Alcohol and Drug Abuse
Patient Records, and 42 USC §§1320d-2 and 1320-4, 45 CFR §164.500 et seq.
VII.
Effective date of this notice.
This
notice is effective April 14, 2003.
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