Po'ailani | Dual Diagnosis Treatment

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.

Understanding Your Health Record/Information:

As a client of the Po'ailani Inc., a record is created that contains your symptoms, assessment and test results, diagnoses, treatment plan, and a plan for future care or treatment. This record describes the care that you receive at PO'AILANI INC., and is protected information by federal law. This information is used to:

Plan your care and treatment;
Communicate with other health professionals who contribute to your care;
Provide you or a third party payer with verification that services billed were actually provided;
A source of information for public health officials charged with improving the health of the nation;

Information that does not identify you is used for:
Research purposes;
A source of data for planning at PO'AILANI INC., and improving treatment and services

Knowing what is in your record helps you to ask questions about how information will be used when you give permission for information from your record to go to others and to assure that the information is accurate.

Your Health Information Rights:

Although your treatment record is the physical property of PO'AILANI INC.,, the information belongs to you. You have the right to review your treatment record. You have the right to:

Inspect and copy your health record as the law provides;
Amend your health record as the law provides;
Be informed of any disclosures of your treatment information;
Request communications of your health information by alternative means or at alternative locations;
Revoke your authorization to use or disclose treatment information except to the extent that action has already been used;
Limit the use and/or disclosure of your treatment information. However, PO'AILANI INC., is not required to agree to a requested restriction.

You also have the right to give permission for most uses of your treatment information.

Our Responsibilities:

PO'AILANI INC., is required to:

Maintain the privacy of your treatment information;
Notify you about our legal duties and privacy practices with respect to information we collect and maintain about you;
Abide by the terms of this notice;
Accommodate any reasonable requests you may have to communicate treatment information by alternative means or at alternative locations

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 you upon your request. PO'AILANI INC., will not use or disclose your treatment information without your permission except as described in this notice or required by law.

Examples of Disclosures for Treatment, Payment and Health Operations:

PO'AILANI INC., will use your information for treatment purposes.

For example: PO'AILANI INC., staff will record your treatment plan and progress in your treatment record. This plan and progress will be reviewed by your treatment team regularly to ensure that you are receiving the proper treatment services.

PO'AILANI INC., will use your information for payment purposes.

For example: PO'AILANI INC., will send a bill to your insurance company, or the state agency that is funding your treatment that may contain information that identifies you, as well as your diagnosis and treatment. Your insurance company will then use this information to pay PO'AILANI INC.,.

PO'AILANI INC., may use your treatment information for day-to-day treatment program operations:

For example: PO'AILANI INC., staff may use information in your treatment record to assess the care and outcomes of your treatment at PO'AILANI INC., and to justify funding from the state and federal government. This information will then be used to continually improve the quality and effectiveness of the treatment and service that PO'AILANI INC., provides.

Other Uses and Disclosures Not Requiring Your Permission:

Business Associates:
There are some services provided to PO'AILANI INC., through contracts with business associates. Examples include an auditor who reviews PO'AILANI INC., records for financial accountability.

Research:
PO'AILANI INC., may give information to researchers when their research has been approved by an Institutional Review Board (IRB) that has reviewed a research proposal and established procedures to ensure the privacy of your treatment information.

Public Health:
As required by law, we may disclose your health information to public health or legal authorities preventing or controlling disease, injury or disability.

Health Oversight:
Federal and State law allow for your treatment information to be released in order to investigate fraud and abuse, for licensing and for program quality.