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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:

      1. 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.
      2. 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.
      3. 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.
      4. Business Associates: There may be instances where services are provided to our organization through contracts with third party "business associates" sometimes also referred to as a Qualified Service Organization. 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.
      5. 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. When client circumstance require the applicability of the stricter law, we will apply the stricter rule protecting information as opposed to the more liberal rule of disclosure.
      6. Appointment Reminders: Your PHI allows us to contact you about appointments for treatment or other health care you may need.
      7. 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.
      8. 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.
      9. 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.
      10. 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.
      11. 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.
      12. Fund Raising: We may contact you as part of a fund-raising effort.
      13. 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.
      14. 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.
      15. 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.
      16. Health Oversight Activities: We may disclose PHI to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure.
      17. 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.
      18. 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:

    1. 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.
    2. 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.
    3. 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
    4. 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.
    5. 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.
    6. 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.