Notice of Privacy Practices

Shauna Raboteau, DO, MPH, LLC, doing business as Hui Ola Clinic
2752 Woodlawn Dr, Suite 5-215, Honolulu, HI 96822
Phone: 808-320-4545 · Email: frontdesk@huiolaclinic.com

Effective date: September 1, 2026

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.

Your health information is private, and the law requires us to protect it. This notice explains what we do with your health information, what your rights are, and how to reach us if you have questions or concerns. "Health information" here means any information that identifies you and relates to your health, the care you receive, or payment for that care.

Your rights

You have the following rights regarding your health information. To exercise any of them, contact us at the phone number or email above. Some requests must be made in writing; we will tell you if that applies.

See and get a copy of your record. You can ask to inspect or receive a copy of your medical and billing records. We will usually respond within 30 days and may charge a reasonable, cost-based fee for copies. If you want a copy sent to someone else, tell us who and where.

Ask us to correct your record. If you believe something in your record is wrong or missing, you can ask us to amend it. We may decline, for example if we did not create the information or believe it is accurate, and we will explain why in writing.

Ask for confidential communications. You can ask us to contact you in a specific way (for example, only by cell phone) or at a specific address. We will honor reasonable requests.

Ask us to limit what we use or share. You can ask us not to use or share certain information for treatment, payment, or operations. We are not required to agree, except in one case: if you pay for a service in full out of pocket and ask us not to share information about it with your health insurer, we must honor that request unless the law requires the disclosure.

Get a list of who we have shared your information with. You can ask for an accounting of disclosures covering up to six years before your request. This list will not include disclosures made for treatment, payment, or operations, or disclosures you authorized. The first list in a 12-month period is free.

Get a copy of this notice. You can ask for a paper copy at any time, even if you agreed to receive it electronically.

Choose someone to act for you. If you have given someone medical power of attorney or someone is your legal guardian, that person can exercise your rights and make choices about your information. We will verify their authority before acting.

File a complaint. If you believe your privacy rights have been violated, you can complain to us or to the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint. See the Questions and complaints section below.

Your choices

For some uses of your information, you can tell us what you prefer. If you have a clear preference in any of these situations, let us know.

You can tell us whether or not to:

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

• Share information in a disaster relief situation

If you are unable to tell us your preference, for example if you are unconscious, we may share information if we believe it is in your best interest. We may also share information when needed to reduce a serious and imminent threat to health or safety.

We will never do these things without your written permission:

• Use or share your information for marketing purposes

• Sell your information

• Share your psychotherapy notes, if we keep any

Fundraising: We do not use your information for fundraising. If that ever changes, we will tell you and you can opt out.

Written authorizations. For any use or disclosure not described in this notice, we will ask for your written authorization first. You can revoke an authorization at any time by telling us in writing. Revoking it will not undo anything we already shared while it was in effect.

How we use and share your health information

We typically use or share your health information in the following ways.

To treat you. We use your information to provide your care and may share it with other clinicians, specialists, labs, pharmacies, and facilities involved in treating you. For example, we may send a referral and your relevant records to a specialist, or send a prescription to your pharmacy. Practitioners who work at Hui Ola Clinic may share your information with one another to coordinate your care.

To run our practice. We use your information to manage the clinic, improve the quality of care, train staff, and handle administrative matters. For example, we may review your chart as part of a quality review or use your contact information to send appointment reminders.

To bill for services. We use and share your information to bill and collect payment from you, your health plan, or another responsible party. For example, we may send your health plan information about a visit so it can be paid.

Business associates. We may share your information with companies that do work for us under contract, such as our electronic health record vendor, billing service, or payment processor. These companies are required by law and by contract to protect your information the same way we do.

We are also allowed or required to share your information in other ways, usually for the public good. We must meet legal conditions before doing so.

Public health and safety. We may share information to prevent disease, report adverse reactions to medications, report suspected abuse, neglect, or domestic violence, or prevent a serious threat to anyone's health or safety.

Research. We may use or share your information for research that has been approved through a process that protects your privacy, or with your authorization.

As required by law. We will share information when federal, state, or local law requires it, including with the Department of Health and Human Services if it is reviewing our compliance with privacy law.

Organ and tissue donation, medical examiners, and funeral directors. We may share information with organ procurement organizations and with a coroner, medical examiner, or funeral director when needed.

Workers' compensation, law enforcement, and government requests. We may share information for workers' compensation claims, with law enforcement when permitted by law, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services.

Lawsuits and legal actions. We may share information in response to a court or administrative order, or in some cases a subpoena.

Hawaii law. Hawaii law provides additional protection for certain kinds of information, such as HIV test results and mental health records. Where state law is stricter than federal law, we follow the stricter rule.

Our responsibilities

• We are required by law to keep your health information private and secure.

• We will tell you promptly if a breach occurs that may have compromised the privacy or security of your information.

• We must follow the duties and privacy practices described in this notice and give you a copy of it.

• We will not use or share your information in any way not described here unless you tell us in writing that we may. If you give us permission, you can change your mind at any time by telling us in writing.

Changes to this notice

We may change the terms of this notice at any time. Any changes will apply to all health information we hold, including information we received before the change. The current notice is always available on request at our office, and posted in our office and on our website at huiolaclinic.com. The effective date appears at the top.

Questions and complaints

If you have questions about this notice or want to exercise any of your rights, contact our Privacy Officer:

Shauna Raboteau, DO, MPH, Privacy Officer
Hui Ola Clinic
2752 Woodlawn Dr, Suite 5-215, Honolulu, HI 96822
808-320-4545 · frontdesk@huiolaclinic.com

If you believe your privacy rights have been violated, you may file a complaint with us at the contact above. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by visiting www.hhs.gov/ocr/privacy/hipaa/complaints, calling 1-800-368-1019, or writing to 200 Independence Avenue SW, Washington, DC 20201.

We will not retaliate against you for filing a complaint.

For office use: patients receiving care in person sign a separate Acknowledgment of Receipt of this notice, kept in the chart. The website posting does not require a signature.