Patient Privacy Notice



If you have any questions about this Notice, please contact our Privacy Officer listed below.

At SURGICARE OF HAWAI`I (“SOH”), we understand that medical information about you and your health is personal, and we are committed to protecting that information. This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (“PHI”) to carry out treatment, payment and/or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights concerning your PHI, which is information about you, including information that may identify who you are or where you live, that relates to your past, present or future physical or mental health or condition, related healthcare services, and payment for such services.

Who Will Follow This Notice

  • All employees, medical staff members, allied health professionals, and other authorized workforce of SOH who may need access to your information;
  • Any health care professional authorized to enter information into your medical or billing records at SOH;
  • Volunteers we allow to help you at SOH; and
  • All residents, postgraduate fellows, medical students, and students of other health care professions or educational programs at SOH.

Additionally, the independent providers who are providing health care services at SOH, have agreed to follow this Notice when providing services at the SOH facility. These independent providers, however, are legally separate and responsible for their own acts.

Our Legal Duty
We are required by law to:

  • Keep records of the care that we provided to you;
  • Keep your PHI private;
  • Notify you, under certain circumstances, of breaches affecting your PHI;
  • Abide by the terms of the Notice that is currently in effect; and
  • Give you this Notice of our duties and privacy practices with respect to your PHI.

We may change our Notice at any time. We reserve the right to revise or amend this Notice. Any revision or amendment to this Notice will apply to all of your records that SOH created or maintained in the past and for any of your records that we may create or maintain in the future. We will visibly post a copy of our current Notice in our admitting area and business office. You may request a copy of the Notice from these locations or by contacting our Privacy Officer. The Notice also will be posted on our website. Your personal doctor may have separate policies or notices regarding the use and disclosure of PHI that is created in his/her private practice.

We May Use and Disclose Your PHI

We may use or disclose your PHI as described in this section. The following categories describe different ways we may use and disclose PHI. Not every use or disclosure in a category will be listed.

a. Treatment: We may use PHI about you to provide you with medical treatment or services. For example, we may disclose medical information about you to doctors, nurses, technicians, medical students or other personnel who are involved in your care to plan a course of treatment or to coordinate the different things you need, such as prescriptions, lab work, and X-rays. We also may disclose PHI about you to individuals outside of SOH who provide services that are part of your care, such as a hospice or home health agency.

b. Payment: Your PHI will be used, as needed, to obtain payment for your healthcare services. This includes certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you, such as determining eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and undertaking utilization review activities. For example, obtaining approval for a surgery may require that your relevant PHI be disclosed to your health plan. We also may disclose your PHI to third parties for payment collection.

c. Healthcare Operations: We may use or disclose your PHI as needed to support our business activities. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other healthcare operations. This includes combining information we have with information from other health care providers to compare our services and outcomes so we can see where we can make improvements in our care and services. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

We may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may call you by name in the waiting room when your healthcare provider is ready to see you. We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.

We may disclose your PHI for payment activities and certain business operations of another health care provider or health plan as long as they have or had a relationship with you; the information disclosed pertains to that relationship; and the information is used for one of the following health care operations: quality assessment and improvement; case management and care coordination.

We will share your PHI with third party “business associates” who perform various activities on our behalf, such as accounting, transcription services, data analysis, and risk management. Whenever an arrangement between our facility and a business associate involves the use or disclosure of your PHI, we will require the business associate to appropriately safeguard it.

d. Education and Training: We may disclose information to doctors, nurses, technicians, training doctors, medical students, postgraduate fellows and other hospital personnel for review and learning purposes.

These same classes of individuals and other health care professional students may participate in examinations or procedures and in your care as part of our educational programs.

e. Health Related Benefits and Services: We may use and disclose your PHI to tell you about health- related benefits or services that may be of interest to you.

f. Research: Under certain circumstances, we may use and disclose your PHI for research purposes but only as allowed by law or with your permission. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. We may use or allow other researchers to review your PHI for the purpose of preparing a plan for a specific research project but, in that event, none of your identifiable information will be allowed to leave our facilities. We may use your PHI to contact you with information about a research study in which you might be interested in participating. If you choose to participate in a research study, you will be asked to sign a valid authorization to use and disclose your PHI for that study. All research studies must be reviewed and approved by a committee, called an Institutional Review Board (IRB), before subjects may be enrolled. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information.

g. Personal Representatives: We may disclose your PHI to a personal representative who has authority under applicable law to make health care decisions on your behalf.

You Will Have the Opportunity to Agree or Object to the Following Uses and Disclosures

Provided you do not object, we may disclose your PHI in the following situations after we discuss it with you. If, however, you are not able to object, we may disclose your PHI if it is consistent with your known prior expressed wishes and is determined to be in your best interests. As soon as you are able, we will give you the opportunity to object to any further disclosures. In this case, only the PHI that is relevant to your healthcare will be disclosed.

  • Facility Directory: Unless you object, we will use and disclose limited information about you in our facility directory while you are a patient at our facility. This information includes your name, location while you are receiving care, your general condition (fair, stable, discharged, etc.), and your religious affiliation. Except for your religious affiliation, this information may be disclosed to people that ask for you by name. Members of the clergy may be told of your religious affiliation even if they don’t ask for you by name. If you do not want this information listed in the directory, you must notify us when you are being checked in.
  • Individuals Involved in Your Care or Payment for Your Care and Notification: Unless you object, we may disclose to a family member, relative, friend or any other person you identify, your PHI that directly relates to that person’s involvement in your 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. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, about your general condition or death. We also may give information to someone who helps pay for your care. Finally, we may use or disclose your PHI to disaster relief agencies, such as the Red Cross, so that your family can be notified about your condition, status, and location.

We May Make the Following Uses and Disclosures without Your Authorization

  • When Required By Law: We will use and disclose your PHI when we are required to do so by federal, state, or local law. The use or disclosure will comply with the law and will be limited to the relevant requirements of the law.
  • To Avert a Serious Threat to Health or Safety: We may use and disclose your PHI to prevent a serious threat to your health and safety or the health and safety of others.
  • For Organ and Tissue Donation: We may disclose you PHI to a designated organ donor program as required or permitted by law.
  • For Military Activity and National Security: When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities, (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your PHI to federal officials for national security and intelligence activities, including for the provision of protective services to the President of the United States or other officials.
  • For Legal Proceedings: We may disclose PHI in response to a court or administrative order. We may also disclose PHI in response to a subpoena, discovery request, or other lawful process, but only if a reasonable effort has been made to tell you about the request or to obtain an order protecting the PHI requested.
  • For Law Enforcement: We may use or disclose your PHI for law enforcement purposes, such as legal processes, limited information requests for identification and location purposes, information pertaining to victims of a crime, suspicion that death has occurred as a result of criminal conduct, a crime occurring on our premises, and certain medical emergencies (not on the premises).
  • For Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws.
  • To Coroners, Medical Examiners and Funeral Directors: We may disclose your PHI 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 also may disclose PHI to funeral directors as necessary for them to carry out their duties.
  • For Workers’ Compensation. We may disclose your PHI as permitted by workers’ compensation laws and other similar programs.
  • For Public Health: We will disclose PHI to public health authorities for public health activities, investigations, or interventions as required by law. Public health activities generally include:
    • Reporting births and deaths, birth defects, children at risk, and child abuse or neglect;
    • Preventing or controlling disease, injury, or disability;
    • Notifying people of recalls of medical products they may be using;
    • Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
    • Reporting reactions to medications or problems with products; and
    • Notifying the appropriate government authority if we believe a patient has been the victim of abuse or neglect.
  • Regarding Inmates or Individuals in Custody: If you are in legal custody, we may disclose your PHI to a correctional institution or law enforcement official. PHI may be disclosed to treat you, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

Other Uses and Disclosures of Your PHI

Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us permission to use or disclose your PHI, you may revoke that permission, in writing, at any time. If you revoke your permission, we will stop any use or disclosure of PHI previously permitted by your written authorization. We are unable to “take back” any disclosures we have already made with your permission. We generally will not sell your PHI, use or disclose your PHI for marketing, or use or disclose any PHI contained in psychotherapy notes without your authorization.

Your Rights Regarding Your PHI

The following is a statement of your rights with respect to your PHI and describes how you may exercise these rights. We have the right to deny your request in certain circumstances. We will inform you if your request is denied.

a. You have the right to request restrictions on the use or disclosure of your PHI for treatment, payment, or health care operations. We, however, are not required to agree to this request except as indicated below. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request a restriction, your request must be in writing to our Privacy Officer and must describe:

    • The information you wish restricted;
    • Whether you are requesting to limit our use, disclosures, or both; and
    • To whom you want the limitation to apply.

b. You have the right to request, and we are required to agree to, a restriction on the information disclosed to your health plan if you make arrangements to pay for the related services out-of-pocket in full. SOH is not responsible for notifying subsequent health care providers of this request for restrictions on disclosures to your health plan for those items and services, so you will need to notify other providers if you want them to abide by the same restriction.

c. You have the right to request confidential communications from us by alternative means or at an alternative location. We will attempt to accommodate reasonable requests. We will not request an explanation from you as to the basis for the request. Please submit your request in writing to our Admitting/Registration staff.

d. You have the right to inspect and obtain a paper or electronic copy of your PHI that SOH uses to make decisions about you for as long as SOH maintains the PHI. There are a few exceptions. If we deny your request to inspect your PHI, we will give you reasons in writing for the denial and explain any right to have the denial reviewed. If you want copies of your PHI, a charge for copying may be imposed. You may direct that the copy be transmitted directly to an entity or person designated by you, provided that any such designation is clear, conspicuous, and specific with complete name and mailing address or other identifying information. Please contact our Medical Records Department if you have questions about access to your health information.Your records remain the property of SOH.

e. You have the right to request an amendment if you think that the PHI we have about you is wrong or incomplete. In certain cases, we may deny your request for an amendment. If we deny your amendment request, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Medical Records Department if you have a question about amending your medical record.

f. You have the right to request a list of our disclosures of your PHI, subject to several exceptions and limitations. For example, this right does not apply to disclosures for purposes other than treatment, payment or healthcare operations, and it excludes disclosures we may have made to you, to family members or friends involved in your care, for notification purposes, or as required by law. You have the right to receive specific information regarding these disclosures. To request this list or accounting of disclosures, you must submit your request in writing to our Privacy Officer. Your request must state a time period that may not be longer than six years prior to the request date and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists during the same 12-month period, we may charge you for the cost of providing the list. We will notify you of the cost Involved and you may choose to withdraw or modify your request at the time before any costs are incurred.

g. You have the right to obtain a paper copy of this Notice, even if you agreed to receive such notice electronically. You may ask us to give you a copy of this notice at any time. To request a copy of this Notice, please contact our Privacy Officer.

h. You have the right to file a complaint if you believe your privacy rights regarding your PHI may have been violated. If you have questions about this Notice or wish to file a complaint, please contact our Privacy Officer. You may file a complaint with the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by us. We will not retaliate against you for filing a complaint.

For additional information about our privacy practices, please contact our Privacy Officer at 55 Merchant St., 26th Floor, Honolulu, HI 96813 (808) 535-7310, 535-7314 or via E-mail at [email protected]

Nondiscrimination: SURGICARE of Hawaii complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.