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
Uses and disclosures – we will use and disclose elements of your protected health information (PHI) in the following ways.
Without your signed authorization:
- Treatment: Your health information may be used by
staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosis and treatment. For example, results of tests and procedures will be available in
your medical record to all health professionals who may provide treatment or testing.
- Payment: Your health information may be used to
seek payment from your health plan or other coverage that may apply.
- Health care operations: Your health information may
be used as necessary to support day to day activities and management of Hawaii Pain Specialists. For example, information on the type of service you received may be used to support budgeting and
- When release is required by law including judicial settings and to health oversight regulatory agencies and law enforcement.
- In emergency situations or to avert serious health/safety situations.
- To contact you about appointment reminders, treatment alternatives and other health-related benefits and services.
Disclosure of your health information or its uses for any purpose other than
those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the
authorization. However, your decision to revoke the authorization will not affect or undo any use of disclosure of information that occurred before you notified us of your decision to revoke your
Your rights – you
have the following rights concerning PHI:
- Restrictions: You have the right to request
restrictions on the use and disclosure of your PHI. To do this, restrictions are to be made by a formal written request to Hawaii Pain Specialists at the address above. We are not required to grant
- Confidential Communications: You have the right to
receive confidential communication concerning your medical condition and treatment.
- Access: You may generally inspect or receive copies
of the PHI that we maintain. As permitted by federal regulation, we require that request to inspect or copy PHI be submitted in writing. You may obtain a form to request your records by contacting
the front desk receptionist. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny.
- Amendments: To request changes be made to your PHI,
you must submit a formal request to Hawaii Pain Specialists at the address above. It is not the right to obliterate or totally remove documentation from a medical record. Rather it is to “append” a
statement of counter opinion to the record. Upon review of your request we will send you the “corrective” information or send a counter reason as to why we cannot make the “corrective”
- Accounting: To receive an accounting of the
disclosures by us of your PHI in the six years prior to your request, please submit a formal written request to Hawaii Pain Specialists at the address listed above. We are not required, however, to record disclosures we make pursuant to a signed consent or authorization.
- This notice: You have the right to receive a
printed copy of this notice.
- Complaints: If you would like to submit a comment
or complaint about our privacy practices, you can do so by sending a letter outlining your concerns. If you believe that your privacy rights have been violated, you should call the matter to our
attention by sending a letter describing the cause of your concern to the address above.
Our duties: We are
required by law to maintain the privacy of your PHI. We must abide by the terms of this notice.
Privacy Contact: For
more information about our privacy practices please contact us per the above information.