Privacy Policy






This Notice of Privacy Practices (Notice) describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment, and/or health care operations and for other purposes that are permitted or required by law. It also describes your rights concerning your PHI.

PHI is information about you, including information that may identify your name, social security number, address, and date of birth; information that relates to your past, present, or future physical or mental health or condition; related health care services you receive; and past, present or future payment for such services. PHI may be in oral, written or electronic form. Examples of PHI include your medical record, claims record, enrollment or disenrollment information, and communications between you and your health care provider about your care.

To promote continuity and consistency of care, we utilize an Electronic Health Record (EHR) system. This means information created in the course of our caring for you will reside in the EHR system and may be available to health care providers involved with your care.  We understand that your health information is personal, and we are committed to protecting health information about you.

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 participate in one or more Health Information Exchanges (HIE) which allows disclosure of your electronic health record via electronic transfer to other facilities and providers for your treatment purposes. Your health information and basic identifying information regarding your visits to our facilities may be shared with the HIEs for the purposes of diagnosis and treatment. This includes health information for your continuing care, as well as, unrelated care you may seek at other locations. Other providers participating in these HIEs may access this information as part of your treatment.

The following categories describe different ways we use and disclose health information.  Not every use or disclosure in a category will be listed.  However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

Treatment: We may use and disclose your PHI to provide you with medical treatment or services.  For example, we may disclose your PHI to doctors, nurses, and other health care personnel or providers to coordinate the different things you need, such as prescriptions, lab work, and X-rays. We may also permit disclosure of your electronic health record via electronic transfer to other facilities and providers for treatment purposes. We also may disclose your PHI to other people who provide services that are part of your care, such as a hospice or home care agency.

Payment: We may use and disclose your PHI to bill and collect payment for your health care services. We may disclose your PHI to other health care providers and organizations involved in your care to assist in their billing and collection efforts.  This may include, for example, disclosures to your health insurance plan about services we recommend for you so your plan can determine eligibility, coverage, or medical necessity or for utilization review activities. We also may disclose your PHI to third parties for collection of payment.

Healthcare Operations: We may call you by name in the waiting areas. We may use your PHI or share it with others involved in your care within the course of operating our facilities. For example, we may use your information to evaluate: the performance of our staff in caring for you; the quality of our services; and effectiveness of various treatments. 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 also may disclose your PHI to third parties and business associates who perform various activities on our behalf, such as accounting, transcription services, data analysis, and risk management.

In addition, 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 participate with selected “accountable care organizations” to better coordinate care, improve the quality of your health care services, and reduce health care costs. We may share your PHI with other health care providers in the accountable care network for these purposes.

Health-Related Benefits and Services: We may communicate to you about a product or service related to your treatment, management or coordination of your care, and recommendations about alternative treatment therapies, providers, or settings of care.

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.

Appointment Reminders: We may use and disclose health information to contact you as a reminder that you have an appointment at our facilities.

Identity Verification: We may photograph you for identification purposes, storing the photo ¡n your medical record. This is for your protection and safety, but you may opt out.


As Required By Law: We will use and disclose your PHI when we are required to do so by federal, state, or local 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. Any disclosure would only be to someone who is likely to help prevent the threat.

For Organ and Tissue Donation: We may disclose your PHI to a designated organ donor program as required or permitted by law.

For National Security: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. If you are a member of the armed forces, we may release your information as required to your military command authorities.

For Legal Proceedings: We may disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone involved in a dispute, but only after efforts have 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, for court orders and other 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 health information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor the health care system, government programs, and compliance with 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 may also release PHI to funeral directors as necessary for them to carry out their duties.

For Workers’ Compensation: We may release health information about you to your employer, your employer’s workers’ compensation insurer and administering government agencies for purposes of compliance with workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

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:

  • Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
  • Notifying people of recalls of medical products they may be using;
  • Reporting births and deaths, birth defects, children at risk, and child abuse or neglect;
  • Preventing or controlling disease, injury, or disability;
  • Reporting reactions to medications or problems with products; and
  • Notifying the appropriate 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 provide your health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

Disaster Relief: We may disclose limited PHI such as your condition, status and location, to disaster relief agencies, such as the Red Cross, for disaster relief purposes.

Individuals Involved in Your Care or Payment for Your Care: We may disclose your health information to a family member, other relative, close personal friend, or any other person you identify as participating in your care or payment for that care.  We may disclose health information that is relevant to that person’s involvement in your care or payment related to your care and that is necessary to notify or assist in notifying those close to you of your location or condition.


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.


You have the right to request restrictions on how we use and disclose your PHI for treatment, payment, or health care operations. We, however, are not required to agree to your 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.

You have a 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 in full.

You have the right to request confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may ask you for information as to how payment will be handled or to specify an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please notify our Registration staff.

You have the right to inspect and obtain a paper or electronic copy of your PHI that our facilities use to make decisions about you for as long as we maintain the PHI. There are a few exceptions. Request to access or receive copies of your PHI shall be in a written request along with your picture identification.  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, facsimile, or other identifying information. Please contact our Privacy Officer if you have questions about access to your health information.

You have the right to request an amendment if you feel the PHI we have about you is incorrect or incomplete.  In certain cases, we may deny your request for an amendment. If we deny your request, you have the right to file a statement of disagreement with us. We may prepare a rebuttal and will provide you with a copy of such rebuttal. Please contact our Privacy Officer if you have questions about the process.

You have the right to find out what disclosures we have made about you to whom, and why. This applies to disclosures made for reasons other than treatment, payment, or our health care operations. It also excludes disclosures we made to you or as authorized by you, for a facility directory, to family members or friends involved in your care, for notification purposes, or as required by law. The right to receive this information is subject to certain exceptions, restrictions, and limitations. Please contact our Privacy Officer for further information.

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

You have the right to file a complaint. If you believe your privacy rights regarding your PHI may have been violated, you may file a complaint to our Privacy Officer at the address below or the Secretary of the Department of Health and Human Services.  You will not be penalized for filing a complaint.


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 we have 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 at our registration desk and in our business offices. You may request a copy of the Notice from these locations. The Notice also will be posted on our website.


For additional information about our privacy practices, please contact our Privacy Officer at Maui Medical Group, 2180 Main St., Wailuku, HI 96793; (808) 242-6464, or via e-mail at


This notice is effective on June 1, 2016