Notice of Privacy Practices

Excel Dermatology of Hawaii

500 Ala Moana Blvd. Bldg 4, Ste 470, Honolulu, HI 96813
PH: 808-495-0906 | F: 808-495-4949

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE READ IT CAREFULLY.

The Privacy Rule under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires us to:

Maintain the privacy of medical information provided to us;
Provide notice of our legal duties and privacy practices; and
Abide by the terms of our Notice of Privacy Practices currently in effect.

Who Will Follow This Notice

This notice describes the practices of our employees and staff and applies to each of these individuals. In addition, these individuals may share medical information with each other for treatment, payment, and health care operation purposes described in this notice.

Information Collected About You

In the ordinary course of receiving treatment and health care services from us, you will be providing us with personal information such as:

Your name, address, and phone number.
Information relating to your medical history.
Your insurance information and coverage.
Information concerning your doctor, nurse, or other medical providers.

In addition, we will gather certain medical information about you and will create a record of the care provided to you. Some information also may be provided to us by other individuals or organizations that are a part of your “circle of care” – such as clinical laboratories, diagnostic testing services, your other doctors, your health plan, and close friends or family members.

How We May Use and Disclose Information About You

We may use and disclose personal and identifiable health information about you for a variety of purposes. All the types of uses and disclosures of information are described below, but not every use or disclosure in a category is listed.

Required Disclosures

We are required to disclose health information about you to the Secretary of Health and Human Services, upon request, to determine our compliance with HIPAA and to you, in accordance with your right to access and right to receive an accounting of disclosures, as described below.

For Treatment

We may use health information about you in your treatment. For example, we may use your medical history, such as a history of skin cancer, to determine and recommend further management recommendations.

For Payment

We may use and disclose health information about you to bill for our services and to collect payment from you or your insurance company. For example, we may need to give payer information about your current medical condition so that it will pay us for the services that we have furnished you. We may also need to inform your payer of the treatment that you are going to receive to obtain prior approval or determine whether the service is covered.

For Healthcare Operations

We may use and disclose information about you for the general operation of our business. For example, we sometimes arrange for accreditation organizations, auditors, or other consultants to review our practices, evaluate our operations, and tell us how to improve our services. Or, we may use and disclose your information to review the quality of services provided to you.

Public Policy Uses and Disclosures

There are several public policy reasons why we may disclose information about you, including:

When required by federal, state, or local law.
For public health reporting activities (e.g., disease prevention/control, injury/disability reporting).
To public health authorities or government authorities for child abuse or neglect reports.
To report adverse events, product defects, or biological product deviations to the FDA.
To notify persons who may have been exposed to communicable diseases or for workplace medical surveillance.
Where we reasonably believe a patient is a victim of abuse, neglect, or domestic violence (with authorization or if required/authorized by law).
For health oversight activities, such as audits, inspections, investigations, and licensure actions.
In response to a warrant, subpoena, or court order, or to assist law enforcement in identifying or locating a suspect, fugitive, witness, or missing person.
To a coroner, medical examiner, or funeral director for identifying a deceased person or determining cause of death.
To organ procurement organizations, transplant centers, and tissue/eye banks, if you are an organ donor.
To worker’s compensation or similar programs for work-related injuries or illnesses.
To prevent a serious threat to your health and safety or that of others.
For certain research purposes, with appropriate privacy protections in place.
For military and national security purposes, or for correctional institutions if you are an inmate.

Our Business Associates

We may share your personal health information with Business Associates, which are third parties that perform certain services for our practice.

Business Associates are required by law to comply with HIPAA privacy and security rules and must enter into a Business Associate Agreement (BAA) with us before accessing personal health information.

We use secure electronic communication methods for personal health information whenever possible, such as encrypted email, secure portals, and HIPAA-compliant messaging services. However, if you request communication via unsecured email or SMS, you must acknowledge that these methods are not fully secure, and you assume the risks associated with such communications.

Disclosures to Persons Assisting in Your Care or Payment

We may disclose information to individuals involved in your care or in the payment for your care, such as your spouse, other doctors, or an aide. We may also use and disclose health information about a patient’s location, general condition, or death. Generally, we will obtain your verbal agreement before using or disclosing health information in this way, but in emergencies, we may proceed without your agreement.

Appointment Reminders

We may use and disclose medical information to contact you as a reminder that you have an appointment or that you should schedule an appointment.

Treatment Alternatives

We may use and disclose your personal health information to tell you about or recommend possible treatment options, alternatives, or health-related services that may be of interest to you.

Other Uses and Disclosures of Personal Information

We are required to obtain written authorization from you for any other uses and disclosures of medical information other than those described above. If you provide us with such permission, you may revoke that permission, in writing, at any time. If you revoke permission, we will no longer use or disclose personal information about you for the reasons covered by your written authorization, except to the extent we have already relied on your permission.

Individual Rights

Right to Request Restrictions: You may ask for restrictions on the ways we use and disclose your information for treatment, payment, and health care operations. We are not required to agree, except where you paid out-of-pocket in full and request that we not disclose that information to your health plan.
Right to Confidential Communications: You may request that we communicate with you by alternative means or at alternative locations (e.g., only at work or by mail).
Right to Inspect and Copy: Except under certain circumstances, you have the right to inspect and copy medical, billing, and other records used to make decisions about you. We may charge a fee for copying and mailing.
Right to Amend: If you believe information in your records is incorrect or incomplete, you may ask us to correct or add missing information. We may deny your request if the information is accurate and complete.
Right to Accounting of Disclosures: You have a right to receive a list of certain instances when we have used or disclosed your medical information. Requests more than once every twelve months may incur a fee.
Right to a Copy of This Notice: You may ask for a copy of this notice at any time.

To exercise any of your rights, please contact us in writing at:
500 Ala Moana Blvd. Bldg 4, Ste 470, Honolulu, HI 96813. Attn: Privacy Officer
When making a request for amendment, you must state a reason for making the request.

Notification of a Breach of Your Information

We take the security of your health information seriously. If a breach of unsecured protected health information occurs, we will notify you in writing no later than 60 days from the date we discover the breach or as required by law.

If fewer than 500 individuals are affected, we will report the breach to the U.S. Department of Health and Human Services (HHS) annually as required by law.

If you have questions about a security incident affecting your health information, please contact our office:

By mail: 500 Ala Moana Blvd. Bldg 4 Ste 470 Honolulu, HI 96813
By phone: 808-495-0906

Changes to This Notice

We reserve the right to make changes to this notice at any time. We reserve the right to make the revised notice effective for personal health information we have about you as well as any information we receive in the future. In the event there is a material change to this notice, the revised notice will be posted. In addition, you may request a copy of the revised notice at any time.

Complaints/Comments

If you have any complaints concerning our privacy practices, you may contact the Secretary of the Department of Health and Human Services at:

200 Independence Avenue, S.W., Room 509F, HHH building, Washington, D.C. 20201
Email: ocrmail@hhs.gov

YOU WILL NOT BE RETALIATED AGAINST OR PENALIZED BY US FOR FILING A COMPLAINT.

To obtain more information concerning this notice, you may contact our clinic:

By mail: 500 Ala Moana Blvd. Bldg 4, Ste 470 Honolulu, HI 96813
By phone: 808-495-0906

This notice is effective as of March 5, 2025.