Kauai Osteopathic Services with doctor of Osteopathy, Lisa R. Chun

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Lisa R. Chun, D.O.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

A. Commitment to your Privacy.

This practice is dedicated to maintaining the privacy of your individually identifiable heath information (IIHI). In conducting business, records are created regarding you and the treatment and services provided to you. The Health Insurance Portability & Accountability Act of 1996 ("HIPPA") is a federal program that requires that all medical records and other individually identifiable health information used of disclosed by this practice in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. As required by law, this practice is providing you with this notice of our legal duties and the privacy practices that are maintained n our practice concerning your IIHI. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at thee time. "HIPPA" provides penalties for covered entities that misuse personal health information.

As required by "HIPPA" we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
How we may use and disclose your IIHI
Your privacy rights in your IIHI
Our obligations concerning the use and disclosure of your IIHI

The terms of this Notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this Notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in the office in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. If you have any questions about this Notice, please contact:
Lisa Chun, DO
Kauai Osteopathic, Inc. (808) 742-1200
P.O. Box 817
Koloa, HI 96756

C. We may use and disclose your individually identifiable health information (IIHI) in the following ways:

The following categories describe the different ways in which we may use and disclose your IIHI. Fro each category we will try to give an example. Not every use or disclosure in a category will be listed.

Standard use:

1. Treatment. Our practice may use your IIHI to provide you with medical treatment or services. WE may disclose your IIHI to doctors, health care personnel or providers in order to coordinate the different things that you need, such as prescriptions, lab work, and x-rays. WE may use the results of such to help reach a diagnosis and treatment management program. Additionally, we may disclose your IIHI to others who may assist in your care, such as your spouse, children, parents, or guardian.

2. Payment. Our practice may use and disclose your IIHI in order to bill and/or collect payment or have you collect payment for the services and items you may receive from us. This may include disclosures to your health insurance plan or other company for services we recommend for you so that they can determine eligibility, coverage, payment, medical necessity or conduct utilization review activities. We may also disclose your IIHI to third parties that may be responsible for such costs, such as family members. Also, we may use your IIHI to bill you and collect payment directly from you for services and items.

3. Health care operations. The practice may use and disclose your IIHI to operate our business and office. For example, these activities may include evaluating the quality of our services or to conduct cost-management and business planning activities and conducting employee performances. We may also use your name in waiting areas.

Use of IIHI with Written Authorization:

1. Education and training. Employees, post-graduate fellows, residents and medical students, and other students of other health care professions may participate in examinations or procedures and in your care as part of an educational program.

2. Appointment reminders. We may use and disclose IIHI to contact you as a reminder that you have an appointment or to provide you information regarding your medical care.

3. Treatment Alternatives. We may use and disclose your IIHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

4. Health related benefits and services. We may use and disclose your IIHI to tell you about health-related benefits and services that may be of interest to you.

D. You will have the opportunity to agree with or object to these uses and disclosures:

1. This practice may disclose to a family member or other relative, or a close personal friend of the individual, or any other person identified by the individual, the confidential information directly relevant to such person's involvement with the individual's care or payment related to the individual's health care, unless that patient has requested specifically in writing that such disclosure not occur and the provider has agreed.

2. If the individual is not present for, or the opportunity to agree or object to the use or disclosure cannot practically be provided because to the individual's incapacity or an emergency circumstance, the practice may, in the exercise of professional judgment, determine whether the disclosure is in the interests of the individual and, if so, disclose only the confidential information that is directly relevant to the person's involvement with the individual's health care.

E. Use and disclosure of your IIHI in certain special circumstances that do not require your authorization.

1. Disclosures required by law. Our practice will use and disclose your IIHI when we are required to do so by federal, state or local law.

2. Public health activities. The practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:
(a) Maintaining vital records, such as birth and deaths
(b) Preventing or controlling disease, injury, or disability
(c) Notifying a person regarding potential exposure to a communicable disease
(d) Notifying a person regarding the potential risk for spreading or contracting a disease or condition
(e) Notifying appropriate government agency (ies) and authority (ies) regarding abuse, neglect or domestic violence
(f) Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

3. Health oversight activities. This practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor governmental programs, compliance with civil rights laws and the health care system in general.

4. Lawsuits and similar proceedings. This practice may use and disclose your IIHI I response to a court or administrative order if you are involved in a lawsuit or similar proceeding. We may also disclose your IIHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested. You are responsible for the cost to obtain this order of protection.

5. Law enforcement. The practice may release IIHI if asked to do so by a law enforcement official:
(a) Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement
(b) Concerning a death we believe has resulted from criminal conduct
(c) Regarding criminal conduct in our office
(d) In response to a warrant, summons, court order, subpoena or similar legal process
(e) To identify/locate a suspect, material witness, fugitive or missing person
(f) In an emergency, to report a crime (including the location of victim(s) of the crime, or the description, identity or location of the perpetrator)

6. To coroners, medical examiners, and funeral directors. We may release your IIHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may also release medical information to funeral directors as necessary for them to carry out their duties related to your or your family's requests.

7. Organ and tissue donation. The practice may release your IIHI to organizations that handle eye, organ or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

8. Research. The practice may use and disclose your IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your IIHI for research purposes except when:
(a) Our use or disclosure was approved by an Institutional Review Board of a Privacy Board;
(b) We obtain the oral or written agreement of the researcher:
(i) The information being sought is necessary for the research study
(ii) The use or disclosure of your IIHI is being used only fro the research and
(iii) The researcher will not remove any of your IIHI from the practice

(c) The IIHI sought by the researcher only related to decedents and the researcher agrees either orally or in writing that the use or disclosure is necessary for the research, and if we request, to provide us with proof of death prior to access to the IIHI of the decedents.

9. Serious threats to health or safety. The practice may use and disclose your IIHI when necessary to reduce or prevent serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to prevent or reduce the threat.

10. Military. The practice may disclose your IIHI if you are a member of a U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

11. National security. The practice may use and disclose your IIHI for federal officials for intelligence and national security activities authorized by law. We may also disclose your IIHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

12. Regarding inmates or individuals in custody. We may disclose your IIHI to the correctional institution or law enforcement official if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary:
(a) For the institution to provide health care services to you
(b) For the safety and security of the institution, and/or
(c) Protect your health and safety or the health and safety of other individuals or of the correctional institution

13. Worker's Compensation. We may release your IIHI as permitted by worker's compensation laws and other similar legally established programs.

F. Your rights regarding our IIHI

1. If you provide us permission to use or disclose IIHI about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will stop any use or disclosure of your IIHI previously permitted by your written authorization. We are unable to "take back" any disclosures or uses we have already made with your permission.

2. Confidential communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. We may ask you for information as to how payment will be handled or specification of an alternative address or other method of contact.

In order to request a type of confidential communication, you must make a written request to Lisa. R. Chun, D.O. at Kauai Osteopathic, Inc P.O. Box 817, Koloa, HI 96756 (808) 742-1200. Our practice will accommodate reasonable requests. You need not give a reason for your request.

3. Requesting restrictions. You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment, or healthcare operations. Additionally, you have the right to request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment of your care, such as family members and friends. We are
not required to agree with your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to teat you. In order to request a restriction in our use or disclosure of your IIHI, you must make a request in writing to Lisa R. Chun, D.O at Kauai Osteopathic, Inc P.O. Box 817, Koloa, HI 96756 (808) 742-1200.

Your request must describe in clear and concise fashion:
(a) The information you wish to restrict
(b) Whether you are requesting to limit our practice use, disclosure, or both; and
(c) To whom you want the limits to apply.

4. Inspection and copies. You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Lisa. R. Chun, D.O. at Kauai Osteopathic, Inc P.O. Box 817, Koloa, HI 96756 (808) 742-1200 in order to inspect and obtain a copy of your IIHI. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. WE will respond to your written request within thirty days. Our practice may deny your request to inspect and/or copy in certain limited circumstances. If we deny your request to inspect, we will give you our reasons in writing for the denial and explain any right to have the denial reviewed. Another licensed health care professional chosen by us will conduct reviews.

5. Amendment. You may ask us to amend your IIHI if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. WE will respond within sixty days of the receiving your written request. In certain cases, we may deny you request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of such rebuttal. To request an amendment, your request must be made in writing and submitted to Lisa. R. Chun, D.O. at Kauai Osteopathic, Inc P.O. Box 817, Koloa, HI 96756 (808) 742-1200.
You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request and the reason supporting your request in writing. Also, we may deny your request if you ask us to amend information that is in our opinion:

(a) Accurate and complete;
(b) Not part of the IIHI kept by or for the practice;
(c) Not part of the IIHI which you would be permitted to inspect and copy or;
(d) Not created by our practice, unless the individual or entity that created the information is not available to amend the information.

6. Accounting of disclosures. All of our patients have the right to request and accounting of disclosures. An accounting of disclosures is a list of certain non-routine disclosures our practice has made of your IIHI for non-treatment or operations purposes. This applies to disclosures made for reasons other than treatment, payment or our health care operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you or authorized by you, for a facility directory, to family members or friends involved in your care, or for notification purposes. Use of your IIHI as part of routine patient care in our practice is not required to be documented. For example, the doctor shares information with a nurse; or the billing department using your information to file and insurance claim. The right to receive this information is subject to certain exceptions, restrictions and limitations. In order to obtain an accounting of disclosures, you must submit your request in writing to Lisa. R. Chun, D.O. at Kauai Osteopathic, Inc P.O. Box 817, Koloa, HI 96756 (808) 742-1200. All requests for an accounting of disclosures must state a time period, which may not be longer that six years from the date of disclosure and may not include dates before April 14, 2003. The list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

7. Right to a paper copy of this Notice. You are entitled to receive a paper copy of our Notice of Privacy Practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this Notice, pleas contact Lisa. R. Chun, D.O. at Kauai Osteopathic, Inc P.O. Box 817, Koloa, HI 96756 (808) 742-1200.

8. Right to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice's Privacy Officer or with secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Lisa. R. Chun, D.O. at Kauai Osteopathic, Inc P.O. Box 817, Koloa, HI 96756 (808) 742-1200. The U.S. Department of Health and Human Services, Office of Civil Rights, 200 Independence Ave., S.W., Washington, D.C. 20201 (202) 619-0257 toll free 1-877-696-6775. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

9. Right to provide an Authorization for other uses and disclosure. Our practice will obtain your written authorization for uses and disclosures that are not identified by this Notice or permitted by applicable law. Any authorization that you provide to use regarding the use and disclosure of you IIHI may be revoked at any time in writing.

After you have revoked your authorization, we will no longer use or disclose your IIHI for the reasons described in the authorization. Please note: we are required to retain records of your care.

G. Our obligations to you:

We are required to:
1. Maintain the privacy of protected health information
2. Provide you with this Notice of its legal duties and privacy practices with respect to your health information
3. Abide by the terms of this Notice
4. Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed
5. Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations
6. Obtain our written authorization to use or disclose your health information for reasons other than those listed above and permitted by law.

Again, if you have any questions or complaints regarding this Notice or our health information privacy policies, please contact Lisa. R. Chun, D.O. at Kauai Osteopathic, Inc P.O. Box 817, Koloa, HI 96756 (808) 742-1200.

Effective Date of this Notice: April 14, 2003