Notice of Privacy Practices


This notice describes your confidentiality rights as they relate to information from your medical records and explains the circumstances under which information from your medical records may be shared with others. If you do not understand the terms of this notice, please ask for further explanation. This notice is given pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), regarding the protection of patient privacy of health information.

Uses of Your Health Record / Information

Each time you visit the Leeward Community College Student Health Center, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record serves as:

  • A basis for planning your care and treatment;
  • a means for processing and administering claims for (a) payment of physicians, hospitals and others, (b) paying reimbursements, and (c) paying supplement plan benefits and other supplemental benefits, for costs of health care services to you, and any auditing functions thereof;
  • a legal document describing the care you received;
  • a means by which you or a third-party payer can verify that services billed were actually provided;
  • a tool in educating heath professionals;
  • a source of data for medical research;
  • a source of information for public health officials charged with safeguarding and improving health for the public;
  • a source of information for reviewing and evaluating the competence of Leeward Community College health care professionals;
  • a source of data for accreditation, licensing and credentialing activities; and
  • a tool with which we can assess and continually work to improve the quality of care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used will help you to:

  • ensure its accuracy;
  • better understand who, when, where, and why others may access your health information; and
  • make more informed decisions when authorizing disclosure to others.

Your Health Information Rights

Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:

  • receive this notice upon enrollment, when confidentiality practices are substantially amended, and upon request;
  • request a restriction on certain uses and disclosures of your information (45 CFR 164.522)*;
  • inspect and obtain a copy of your health record (for a nominal fee) (45 CFR 164.524);
  • amend your health record (45 CFR 164.528);
  • obtain an accounting of disclosures of your health information within 60 days of your request (45 CFR 164.528);
  • request communications of your health information in a confidential manner by alternative means or at alternative locations; and
  • revoke your authorization to use or disclose health information except to the extent that action has already been taken.

* See "Examples of Disclosures for Treatment, Payment, Health Operations"

Our Responsibilities

This organization is required to:

  • maintain the privacy of your individually identifiable health information;
  • provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you;
  • abide by the terms of this notice;
  • notify you if we are unable to agree to a requested restriction; and
  • accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

Examples of Disclosures for Treatment, Payment, Health Operations

  • We will use your health information for treatment.
    For example: Information obtained by a nurse, physician, or other member of UHSM / Leeward Community College's healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Members of your healthcare team will then record follow-up actions they took and their observations. In that way, each provider accessing your record will know what treatment you have received and how you are responding.
  • We will use your health information for payment.
    For example: A bill may be sent to you or a third-party payer. The information accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
  • We will use your health information for regular health operations.
    For example: Members of the chart review committee, medical staff, the risk-management/quality improvement officer, or other designated quality improvement staff may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
  • External service providers:
    There are some services provided by our organization through contracts outside of UHSM / Leeward Community College. Examples include the physical therapy clinic, referrals, and laboratory. When these services are contracted, we may disclose your health information to these entities so that they can perform the job we have asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require these providers to appropriately safeguard your information.
  • Federal oversight:
    Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
  • Food and Drug Administration (FDA):
    We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
  • Law enforcement:
    We may disclose health information for law enforcement purposes as required by law or in response to a valid judge-ordered subpoena.
  • Notification:
    We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition. If you are a minor, your parent or legal guardian generally has the right to obtain access to your health information.
  • Public health:
    As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
  • Research:
    We may disclose information to researchers when their research has been approved by the University of Hawai'i’s institutional review board. This board reviews research proposals and establishes protocols to ensure the privacy of your health information.
  • Workers compensation:
    We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you've supplied to us.

We will not use or disclose your health information without your authorization, except as described in this notice or as required by law. You may authorize disclosure for other purposes by completing a written authorization that meets the requirements of law. You may revoke such authorization in writing at any time.

Effective Date: [August 28, 2001]

For More Information or to Report a Problem

If you have questions or would like additional information,
you may contact the UHSM Privacy Officer at:

University Health Services Mānoa
University of Hawaiʻi
1710 East West Road
Honolulu, Hawaii 96822
Telephone: (808) 956-8965

If you believe your privacy rights have been violated, you can file a complaint with the director of UHSM (at the above address) or with the secretary of Health and Human Services at:

Office of the Secretary
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775

There will be no retaliation for filing a complaint.

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