NOTICE OF PRIVACY PRACTICES FOR THE HAWAII TOBACCO QUITLINE AND CERTAIN OTHER PROVIDERS

Effective October 3, 2005

SUMMARY
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.

We have a responsibility to protect your health information.

You have certain rights. You may:

• Receive and view a copy of your health records.
• Ask for a change to your health record.
• Ask for a list of certain disclosures of your health information.
• Ask us to contact you in a different way.
• Request limited use of your health information.
• Ask us not to share information with your family members.
• Make complaints related to the privacy of your health information.

 

Following certain rules, we may use and share your health information:

• To perform treatment, obtain payment, or carry out health care related operations.
• To conduct research approved by an Institutional Review Board, a legally authorized committee that protects participants rights and oversees research.
• As otherwise required or allowed by law, or with your written authorization.

 

The law provides extra protection for certain health information:

• Sexually transmitted disease information (including HIV/AIDS).
• Drug and alcohol abuse treatment records.
• Mental health records.

The Hawaii Tobacco Quitline's responsibilities:
The Hawaii Tobacco Quitline is committed to the highest quality services and products. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), we must take steps to protect the privacy of your health information. Health information is material that we have created or received regarding your health and/or payment. This information may include both health information and personal information such as your name, social security number, address, and phone number.

Under federal law, we are required to:

• Protect the privacy of your health information. All employees and associates of Hawaii Tobacco Quitline are required to maintain the confidentiality of health information and receive appropriate privacy training.
• Provide you with this Notice of Privacy Practices explaining our duties and practices regarding your health information.
• Follow the practices and procedures set forth in this Notice.
• One way we will ensure we protect your privacy is to adhere to the standards of privacy and security set out by the Secretary of Human Services. This Notice describes our practices and that of all employees, staff and other members of our workforce.

 

Uses and disclosures that do NOT require your authorization:
Hawaii Tobacco Quitline uses and shares health information in a number of ways connected to your treatment, and our health care operations. Some examples of how we may use or share your health information without your authorization are listed below.

Treatment.

• To our employees or other members of our workforce involved with providing you your health care service.
• To other health care providers in the community treating you who are not on our staff.

 

Health care operations.

• To administer and support our business activities, we give information to organizations that will survey on our behalf for satisfaction, quality, and/or program outcomes, or those of other health care organizations as allowed by law including providers and plans.
• To other individuals such as consultants and attorneys and organizations that help us with our business activities.

 

If we share your health information with other organizations for these purposes, they must agree to protect your privacy.

Research. We may use and share your health information for research projects that have been approved by an Institutional Review Board (IRB), a legally authorized committee that protects participants rights and oversees research. For example:

• When an IRB ensures that the need to use your health information without your authorization is justified and steps are taken to ensure only limited use of such information, we may use and share it for a research project without your authorization.
• When the IRB approves the use and sharing of information, or you authorize the use and sharing of information for a research project, your information may be shared with other institutions.
• In all other cases, we must obtain your authorization to use your information for a research project.

 

Contacting you. Your health information may also be used to contact you. For example, we may contact you to remind that you have an appointment with us. These reminders may be made by postcard, phone, or voicemail.

Other uses and disclosures. We may use or share your health information to enhance health care services, protect safety, safeguard public health, and when otherwise allowed by law. For example, we may provide information to:

• Public health authorities for health surveillance, to investigate or track problems with prescription drugs and medical devices (U.S. Food and Drug Administration).
• Government entities authorized to receive reports when we suspect abuse, neglect, or domestic violence.
• Health care oversight agencies for certain activities such as audits, examinations, investigations, inspections, and licensures.
• Courts when ordered or for lawful subpoena.
• Law enforcement when required or allowed by law.
• Coroners, medical examiners, and funeral directors.
• Correctional facilities, if we are providing health care to you while you are incarcerated.
• Government officials as required for specifically identified government functions, such as national security.

 

Uses and disclosures that you have the right to object:
Disclosure to family and friends. Unless you object, your health care provides will use their professional judgment to provide relevant health information to a family member, friend, or other person you indicate has an active interest in your care.

Uses and disclosures that require your authorization:
Except in the situations listed in the sections above, we will use and share your health information only with your written authorization.

In some situations, federal and state laws provide special protections for specific kinds of health information and require authorization from you before we can share that specially protected health information. In these situations, we will contact you for the necessary authorization.

Your rights regarding your health information:

You have specific rights regarding the use and disclosure of your health information.

Request to receive and inspect copies. In most cases, you have the right to look at or order a copy of your health record by using an Authorization to Release Health Information Form provided by calling us at 1-866-QUIT-NOW (784-8669). You may be charged reasonable fees for copies provided.

Request an amendment. If you believe that information is incorrect or missing, you have the right to request in writing that we correct the existing information or add the missing information. In your request, you must give a reason for the change. We are not required to amend the record, but a copy of your request will be added the record if you direct us to file it.

Request to know about disclosures. You have the right to request in writing a list of certain disclosures of your health information since October 3, 2005. The accounting of disclosures will not include disclosures to those related to providing treatment, payment, health care operations, or when you have authorized the disclosure. You may receive one list per year at no charge. You will be charged a processing fee for each additional request within the same twelve-month period.

Request restricted use. You have the right to ask us in writing to restrict certain uses and disclosures of your health information. We are not required to grant the request but we will comply with any request we grant.

Request how we communicate. You have the right to request in writing that we communicate with you by another means. For example, you may ask us to contact you at work or at a different address. We are not required to grant the request, but we will comply with any request we grant.

Make a complaint. If you think that we may have violated your privacy rights or you disagree with a decision we made about access to your health information, you may file a written complaint with our Privacy Office. You will not be penalized or retaliated against if you file a complaint.

Changes to privacy practices:
The Hawaii Tobacco Quitline may change the terms of this Notice at any time. The revised Notice would apply to all health information that we maintain. We post our current Notice on our web site (www.CallitQuitsHawaii.org) and at our facilities. If you have any questions about this Notice or would like an additional copy, please contact the Privacy Officer at 1-866-QUIT-NOW (784-8669).