Privacy and non-discrimination Policy

If you are vision-impaired or have some other impairment covered by the Americans with Disabilities Act or a similar law, and you wish to discuss potential accommodations related to using this website, please contact us at (808) 989-6828.

You have the right to inspect and copy your Protected Health Information (reasonable fees may

apply): Pursuant to your written request, you have the right to inspect and copy your Protected

Health Information in paper or electronic format. Under federal law, you may not inspect or copy

the following types of records: psychotherapy notes, information compiled as it relates to civil,

criminal, or administrative action or proceeding; information restricted by law; information related

to medical research in which you have agreed to participate; information obtained under a

promise of confidentiality; and information whose disclosure may result in harm or injury to

yourself or others. We have up to 30 days to provide the Protected Health Information and may

charge a fee for the associated costs.

You have a right to a summary or explanation of your Protected Health Information: You have

the right to request only a summary of your Protected Health Information if you do not desire to

obtain a copy of your entire record. You also have the option to request an explanation of the

information when you request your entire record.

You have the right to obtain an electronic copy of medical records: You have the right to request

an electronic copy of your medical record for yourself or to be sent to another individual or

organization when your Protected Health Information is maintained in an electronic format. We

will make every attempt to provide the records in the format you request; however, in the case

that the information is not readily accessible or producible in the format you request, we will

provide the record in a standard electronic format or a legible hard copy form. Record requests

may be subject to a reasonable, cost-based fee for the work required in transmitting the

electronic medical records.

You have the right to receive a notice of breach: In the event of a breach of your unsecured

Protected Health Information, you have the right to be notified of such breach.

You have the right to request Amendments: At any time if you believe the Protected Health

Information we have on file for you is inaccurate or incomplete, you may request that we amend

the information. Your request for an amendment must be submitted in writing and detail what

information is inaccurate and why. Please note that a request for an amendment does not

necessarily indicate the information will be amended.

You have a right to receive an accounting of certain disclosures: You have the right to receive an

accounting of disclosures of your Protected Health Information. An “accounting” being a list of

the disclosures that we have made of your information. The request can be made for paper

and/or electronic disclosures and will not include disclosures made for the purposes of:

treatment; payment; health care operations; notification and communication with family and/or

friends; and those required by law.

You have the right to request restrictions of your Protected Health Information: You have a right

to restrict and/or limit the information we disclose to others, such as family members, friends,

and individuals involved in your care or payment for your care. You also have the right to limit or

restrict the information we use or disclose for treatment, payment, and/or health care

operations. Your request must be submitted in writing and include the specific restriction

requested, whom you want the restriction to apply, and why you would like to impose the

restriction. Please note that our practice/your physician is not required to agree to your request

for restriction with the exception of a restriction requested to not disclose information to your

health plan for care and services in which you have paid in full out-of-pocket.

You have a right to request to receive confidential communications: You have a right to request

confidential communications from us by alternative means or at an alternative location. For

example, you may designate we send mail only to an address specified by you which may or

may not be your home address. You may indicate we should only call you on your work phone

or specify which telephone numbers we are allowed or not allowed to leave messages on. You

do not have to disclose the reason for your request; however, you must submit a request with

specific instructions in writing.

CHANGES TO THIS NOTICE

We reserve the right to change the terms of this notice and will notify you of such changes. We

will also make copies available of our new notice if you wish to obtain one. We will not retaliate

against you for filing a complaint.

COMPLAINTS

If at any time you believe your privacy rights have been violated and you would like to register a

complaint, you may do so with us or with the Secretary of the United States Department of

Health and Human Services.

If you wish to file a complaint with us, please submit it in writing to our Privacy/Compliance

Officer to the address listed on our website.

If you wish to file a complaint with the Secretary of the United States Department of Health and

Human Services, please go to the website of the Office for Civil Rights

(www.hhs.gov/ocr/hipaa/), call 202-619-0257 (toll free 877-696-6775), or mail to:

Secretary of the US – Department of Health and Human Services

200 Independence Ave S.W.

Washington, D.C. 20201

To file a complaint with the practice, submit your complaint in writing to Yun Sun Lee, M.D. All

complaints shall be investigated without repercussion to you. You will not be penalized for filing

a complaint.