Your Information. Your Rights. Our Responsibilities.

This Notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

Effective Date: June 22, 2026

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When it comes to your health information, you have certain rights.

You have the right to:

• Obtain a copy of your paper or electronic medical record

• Request a correction to your medical record

• Request confidential communications

• Ask us to limit certain uses or disclosures

• Receive a list of certain disclosures of your information

• Obtain a copy of this Notice

• Choose someone to act on your behalf

• File a complaint if you believe your privacy rights have been violated

Get a Copy of Your Medical Record

You may request an electronic or paper copy of your medical record and other health information we maintain about you.  We will generally provide a copy or summary within 30 days of your request. A reasonable, cost-based fee may apply.

Request a Correction

You may ask us to correct health information you believe is inaccurate or incomplete.

We may deny your request, but if we do, we will provide a written explanation within 60 days.

Request Confidential Communications

You may request that we contact you in a specific way (for example, by cell phone, email, or mail) or at a specific address.  We will accommodate all reasonable requests.

Request Restrictions

You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations.  We are not required to agree to every request if doing so could affect your care.  If you pay for a service in full out-of-pocket, you may request that we not disclose information about that service to your health insurer for payment or healthcare operations purposes. We will honor such requests unless disclosure is required by law.

Please note: A patient's right to request restrictions on disclosures to a health plan does not alter any legal or contractual billing obligations that may apply to certain insurance programs. Some health plans, including Medicare, may require participating providers to submit claims for covered services. Please contact our office regarding your specific coverage and billing options.

Receive an Accounting of Disclosures

You may request a list of certain disclosures of your health information that we are required by law to track. This does not include routine disclosures made for treatment, payment, healthcare operations, or disclosures you authorized. The first request in a 12-month period is free; additional requests may be subject to a reasonable fee.

Obtain a Copy of This Notice

You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

Choose Someone to Act for You

If you have granted another person medical power of attorney or if someone is your legal guardian or personal representative, that individual may exercise your rights and make decisions regarding your health information.  We will verify the individual's authority before honoring such requests.

File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights.

You will not be penalized or retaliated against for filing a complaint.

For certain health information, you have choices about how we use and share information.

You may tell us whether to:

• Share information with family members, close friends, or others involved in your care

• Share information with individuals involved in payment for your care

• If you are unable to communicate your wishes, we may share information when we believe it is in your best interest or when necessary to prevent a serious threat to health or safety.

Authorization Required

We will not use or disclose your health information for the following purposes without your written authorization:

• Marketing purposes (when authorization is required by law)

• Sale of your health information - Elam Sports Oʻahu does not sell patient information and does not share patient information for marketing purposes without your authorization.

Treatment

We may use and disclose your health information to provide, coordinate, and manage your healthcare.  We may share information with physicians, surgeons, therapists, healthcare providers, and other members of your healthcare team involved in your care.

Examples include:

• Coordinating care with your physician or surgeon

• Obtaining referrals, prescriptions, or authorizations

• Consulting with other healthcare professionals involved in your treatment

• Supporting continuity of care

Payment

We may use and disclose your health information to bill and obtain payment from health plans, insurance companies, government programs, or other responsible parties.

Example:  We may provide information to your health insurance plan so it can determine eligibility, authorize services, and process payment.

Healthcare Operations

We may use and disclose your health information to operate and improve our practice, evaluate quality of care, conduct training, maintain licensure, perform audits, and carry out other healthcare operations.  We may also contact you regarding your care, appointments, treatment follow-up, or administrative matters.

Physical Therapy Services

As a physical therapy practice, we may communicate and exchange information with referring providers, consulting providers, imaging facilities, healthcare organizations, case managers, payers, and other authorized parties involved in your treatment, payment, or healthcare operations as permitted by law.

Workers' Compensation, Auto Claims, and Government Programs

When permitted or required by law, we may disclose information necessary to:

• Process workers' compensation claims

• Process motor vehicle accident, no-fault, personal injury protection (PIP), liability, or related insurance claims

• Coordinate care and benefits through the U.S. Department of Veterans Affairs (VA), TRICARE, or other government-sponsored healthcare programs

We may use or disclose your health information as permitted or required by law for the following purposes:

Public Health and Safety

• Preventing disease

• Reporting adverse reactions to medications

• Reporting suspected abuse, neglect, or domestic violence

• Preventing or reducing serious threats to health or safety

• Assisting with product recalls

Research

We may use or disclose health information for approved research purposes when permitted by law.

Compliance with Law

We will disclose information when required by federal, state, or local law.

Medical Examiners and Funeral Directors

We may disclose health information to coroners, medical examiners, or funeral directors as authorized by law.

Health Oversight Activities

We may disclose information to agencies responsible for oversight activities authorized by law, including audits, investigations, inspections, and licensure reviews.

Law Enforcement and Government Requests

We may disclose health information:

• For law enforcement purposes

• For national security purposes

• For military activities

• For other government functions authorized by law

Lawsuits and Legal Proceedings

We may disclose health information in response to court orders, subpoenas, or other lawful legal processes.

Elam Sports Oʻahu utilizes secure electronic systems, including electronic health records, WebPT® Reach, digital intake forms, patient engagement tools, and other healthcare technologies to support scheduling, communication, documentation, billing, and patient care.

We may use these systems to:

• Send appointment reminders and scheduling notifications

• Deliver registration and intake forms electronically

• Communicate regarding your treatment or administrative matters

• Collect and maintain information necessary for your care

• Facilitate secure communication between you and your healthcare team

We may also utilize secure technology tools, including artificial intelligence (AI)-assisted documentation systems, to assist with clinical documentation. These tools support our providers but do not replace professional judgment. All clinical documentation is reviewed and approved by the treating provider.  Electronic communications may be delivered through email, text message, patient engagement platforms, or other secure electronic systems based on your communication preferences.  If you prefer not to receive electronic communications, please notify our office.

We are required by law to:

• Maintain the privacy and security of your protected health information

• Notify you if a breach occurs that may compromise the privacy or security of your information

• Follow the duties and privacy practices described in this Notice

• Provide you with a copy of this Notice

We will not use or disclose your information other than as described in this Notice unless you authorize us to do so in writing.  You may revoke your authorization at any time in writing, except to the extent we have already acted upon it.

We reserve the right to change this Notice and make the revised Notice effective for all protected health information we maintain.  Updated Notices will be available upon request, in our office, and on our website.

If you have questions about this Notice or wish to file a privacy complaint, please contact:

Privacy Officer
Elam Sports Oʻahu
91-1027 Shangrila St., Building 1867
Kapolei, HI 96707
Phone: 808.674.9595

kap@elamsportsoahu.com

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.  We will not retaliate against you for filing a complaint.