WAHIAWA GENERAL HOSPITAL
NOTICE OF PRIVACY PRACTICES
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.
This Notice describes the privacy practices of Wahiawa General Hospital.
Patient Health Information. Under federal law, your patient information is protected and confidential. Patient Information includes information about your symptoms, test results, diagnosis, treatment, and related medical information. Your Protected Health Information also includes payment, billing, and insurance information.
How We Use Your Patient Health Information. We use Health Information about you for treatment, to obtain payment, and for health care operations, including administrative purposes and evaluation of the quality of care that you receive.
Examples of Treatment, Payment, and Health Care Operations:
Treatment : We will use and disclose your Protected Health Information to provide you with medical treatment or services. For example, we may disclose Protected Health Information to doctors, nurses, technicians or other health care providers who are participating in your treatment, to pharmacists who are filling your prescriptions, and to family members who are helping with your care.
Payment : We will use and disclose your Protected Health Information so that we or others may bill and receive payment from you, an insurance company or a third party for treatment and services you received. For example, we may need to obtain authorization from your insurance company before providing certain types of treatment. We will submit bills and maintain records of payments from your health plan.
Health Care Operations : We will use and disclose your Protected Health Information to conduct our standard internal operations. For example, members of the medical staff or the quality improvement committee may use information to assess the care and outcomes of your case.
Other Uses and Disclosures: We may use or disclose identifiable Protected Health Information about you for other reasons. Subject to certain requirements, we are permitted to give out Protected Health Information without your permission for the following purposes:
• Required by Law: We may be required by law to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.
• Public Health Activities: As required by law, we may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.
• Health oversight : We may be required to disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.
• Judicial and administrative proceedings : We may disclose information in response to an appropriate subpoena or court order.
• Law enforcement purposes: Subject to certain restrictions, we may disclose information required by law enforcement officials.
• Deaths: We may report information regarding deaths to coroners, medical examiners, funeral directors, and organ donation agencies.
• Serious threat to health or safety: We may use and disclose information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
• Business Associates: There are some services provided in our organization through contracts with business associates. Examples include physician services in the Emergency Department and Radiology. We may disclose your Protected Health Information to our business associates so that they can perform the job we've asked them to do. To insure your Protected Health Information is protected, however, we require our business associates to appropriately safeguard your information.
• Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation to other people who ask for you by name.
• Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general conditions.
• Communication with Family: Health professionals, using their best judgement, may disclose to a family member, other relative, close personal friend or any other person you identify, Protected Health Information relevant to that person's involvement in your care or payment related to your care.
• Research: We may use or disclose information for approved medical research.
• Workers Compensation: We may release information about you for workers compensation or similar programs providing benefits for work-related injuries or illness.
• Appointment reminders: We may use your information to contact you with appointment reminders.
• Fundraising: W e may contact you as part of a fundraising effort. You have the right to notify us and opt-out of being contacted.
• Food and Drug Administration (FDA): We may disclose to the FDA Protected Health Information relative to adverse event with respect to food, drug, supplements, product and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.
• Military and Special Government Functions : If you are a member of the armed forces, we may release information as required by military command authorities. We may also disclose information to correctional institutions or for national security purposes.
Uses and Disclosures that require us to give you an opportunity to object and op-out:
Individuals involved in your care or payment for your care. Unless you object, we may disclose to a
member of your family, a relative, a close friend or any other person you identify, your Protected Health
Information that directly relates to that person's involvement in your health care. If you are unable to
agree or object to such a disclosure, we may disclose such information as necessary if we determine that
it is in your best interest based on our professional judgment.
Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations that
seek your Protected Health Information to coordinate your care, or notify family and friends of your
location or condition in a disaster. We will provide you with an opportunity to agree or object to such a
disclosure whenever we practically can do so.
Your written authorization is required for other uses and disclosures: The following uses and
disclosures of your Protected Health Information will be made only with your written authorization:
• Uses and disclosures of Protected Health Information containing psychotherapy notes.
• Uses and disclosures of Protected Health Information for marketing purposes.
• Uses and disclosures that constitute a sale of your Protected Health Information.
• Other uses and disclosures of Protected Health Information not covered by this Notice.
If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our
Privacy Officer and we will no longer disclose Protected Health Information under the authorization. But
disclosure that we made in reliance on your authorization before you revoked it will not be affected by the
You have the following rights with regard to your Protected Health Information. Please contact the person listed below to complete the appropriate request forms for exercising these rights.
Request Restrictions : You may request restrictions on certain uses and disclosures of your Protected Health Information for treatment, payment, or healthcare operations. You also have the right to request a limit on the health information we disclose to someone involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of you Protected Health Information to a health plan for payment or healthcare operation purposes and such information you wish to restrict pertains solely to a healthcare item or service for which you have paid us out-of-pocket in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
Confidential Communications : You may ask us to communicate with you by alternative means or at alternative locations.
Inspect and Obtain Copies : In most cases, you have the right to look at or get a copy of your health information. We have up to 30 days to make your Protected Health Information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request.
Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your Protected Health Information in the form or format you request, if it is readily producible in such a form or format. We may charge you a reasonable fee for the labor associated with transmitting the electronic medical record.
Amend Information : If you believe that information in your record is incorrect, or if important information is missing, you have the right to request that we correct the existing information or add the missing information.
Accounting of Disclosures : You may request a list of instances where we have disclosed Protected Health Information about you for reasons other than treatment, payment, or health care operations.
Notification of Breach: You have the right to be notified upon a breach of any of your unsecured Protected Health Information.
Our Legal Duty
We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect.
Changes in Privacy Practices
We may change our policies at any time. Before we make a significant change in our policies, we will change our Notice and post the new Notice in the admissions area. You can also request a copy of our Notice at any time. For more information about our privacy practices, contact the person listed below.
If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about your records, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below will provide you with the appropriate address upon request. You will not be penalized in any way for filing a complaint.
If you have any questions, requests, or complaints, please contact:
128 Lehua St. Wahiawa, HI 96786
Wahiawa General Hospital and the physicians who practice at the hospital are independent contractors and do not hereby assumes any liability for the services or conduct of each other.
Effective Date: The effective date of this Notice is April 14, 2003. Revised September 17, 2013.