Universal Men’s Clinic
Notice of Privacy Practices

Universal Men’s Clinic (UMC) is committed to respecting the privacy of our patients and maintaining the confidentiality of their protected health information. When you consent to treatment at Universal Men’s Clinic, you consent to the use of your information as outlined in our Notice of Privacy Practices. If we decide to change our Notice, such changes will be posted on our website. You may visit our website and browse without giving us any personal information.

Notice of Privacy Practices (Effective October 21, 2019)
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.

Our Pledge to You
The health care providers at Universal Men’s Clinic create a detailed record of the care and services you receive at our facilities. By law, we must keep this record private. We must also give you this summary of our legal duties and privacy practices, and follow them. Our policies apply to all of the records of your care that UMC maintains. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

Who Will Follow These Privacy Practices
Universal Men’s Clinic provides health care in partnership with physicians, other healthcare providers and agencies. These privacy practices will be followed by:

  • Any health care provider who treats you at any of our locations
  • All board members, employees, staff and volunteers of our organization
  • All members of our Organized Health Care Arrangement (members of our medical staff and allied health practitioners such as Medical Assistants and Counselors)
  • Any business associate or partner who agrees to maintain your privacy

Some Ways Your Medical Record May Be Used or Shared
We may use or share medical information about you:

  • To conduct, plan and direct your treatment and follow-up among the multiple healthcare providers who may be involved in your treatment directly and indirectly
  • For treatment, such as a referral to a specialist or other health care agency
  • For payment, such as your insurance company, Medicare or Medicaid
  • For health care functions, such as to improve our services
  • For regulatory agencies, such as during an audit or survey of our facilities
  • With those whom you designate to be involved in your care
  • In an emergency or disaster so that your family or friends can be told where you are and how you are
  • When required for public health reports, abuse or neglect reports, funeral arrangements and organ donation
  • When required by law such as a request from law enforcement or a legal order
  • When required by military authorities if you are a member of the military or a veteran
  • For national security and intelligence activities, or for the protection of the President or others

Other Ways That Information About you May Be Used
Unless you tell us not to, we may use information that we have about you:

  • To remind you of an appointment
  • To recommend possible treatment options
  • To tell you about health-related services
  • For research purposes and analyzing data
  • To increase the effectiveness or broaden the scope of the services offered
  • To support business operations

Uses and Disclosures That Require Your Authorization
In any other situation not covered by this notice we will get your written authorization before using or sharing your health information, including release of psychotherapy records. You may revoke any authorization in writing.

Your Rights Regarding Medical Information About You
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to share information with your family, close friends, or others involved in your care. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In most cases, you may review and obtain a copy of your medical record. There may be a fee for the cost to copy and mail it. Your request must specify how or where you wish to receive your medical record. We will honor all reasonable requests.

You may ask us to correct your record if you think that it is incorrect or that key information is missing. You must put your request in writing and state the reason for your request. We cannot revise your record if the information was not created by us; or is not part of the medical record we maintain; or is not part of the record that you can review or copy or if we find out that the record is accurate.

You may get a list of when and whom we gave your medical information. Such a list would not include the permitted disclosures outlined within this notice. Your written request for such a list must state a time period; it must start after April 14, 2003 and be within six years. The first list in a 12-month period is free; other requests will include a fee for our cost to produce the list. We will inform you of the cost before we process your request.

You may ask that we communicate medical information about you in a confidential way, such as sending mail to an address other than your home. We will honor all reasonable requests. Our waiting areas and some of our treatment areas are shared with other patients. Please tell us if you object to this type of waiting or treatment areas. We will do our best to accommodate your request for privacy.

You may ask that we not use or disclose a certain part of your information as allowed by this notice unless you sign a consent form to release the information. By law, we do not have to accept such a request but we will seriously consider it and inform you of our decision. Your request must tell us what specific information you want to limit and to whom the limits apply. You may make any of these requests in writing to the UMC Privacy Officer.

Changes to UMC Privacy Notice
We may change our privacy policies at any time. Changes will apply to prior and new medical information. Before we make major changes in our policies we will change our Notice of Privacy Practice and post the new notice in our facilities and on our website. You can get a copy of the current privacy notice at any time. The effective date is listed just below the title.

Complaints and Appeals
You may contact the UMC Privacy Officer if:

  • You think that your privacy rights may have been violated
  • You disagree with our decision about access to your records
  • You disagree with our decision not to correct your record

We will not punish you in any way for filing a complaint. You may also send a written complaint to the U.S. Department of Health and Human Services’ Office of Civil Rights

Privacy Officer
Universal Men’s Clinic
6600 Kalanianaole Highway, #224
Honolulu, HI 96825
compliance@universalclinic.com
(808)773-7658

Office of Civil Rights
US Department of Health and Human Services
1961 Stout Street #1428
Denver, CO 80294
(Cannot phone)