Revised Effective Date: 26 October 2017




Guam Seventh-day Adventist Clinic (“Adventist Clinic” for purposes of this Notice) knows that health information about you is personal, and we are committed to protecting the privacy of your information. As a patient of Adventist Clinic, the care and treatment you receive is recorded in a healthcare record. A healthcare record is a collection of health-related information that is maintained by health professionals and official agencies. So that we can best meet your clinical needs, we must share your healthcare record with the health care providers involved in your care. Additionally, we share your health information only to the extent necessary to collect payment for certain services we provide to you, to conduct our business operations, and to comply with the laws that govern health care. We will not use or disclose your health information for any other purpose without your permission.

We are required by law:

  • to make sure that your health information is kept private;
  • to give you this Notice of our legal duties and privacy practices with respect to health information about you; and
  • to follow the terms of the Notice that is currently in effect   


We have a responsibility to safeguard the privacy and integrity of your records. This Notice explains our privacy practices and your rights regarding your health information.



The following parties share Adventist Clinic’s commitment to protect your privacy and will comply with this Notice:

  • Any health care professional authorized to enter information into your healthcare records,
  • All employees, volunteers, trainees, contractors and staff members of  Adventist Clinic


You* have the following rights regarding your health information:


RIGHT TO INSPECT AND OBTAIN A COPY OF YOUR HEALTHCARE RECORD: You have the right to inspect and obtain a copy of the healthcare records that Adventist Clinic uses to make decisions about you and your treatment, subject to certain limited exceptions. This information includes your healthcare and billing records.  A clinical summary will be provided unless you do not agree to a summary. We reserve the right to charge a fee to cover the cost of providing your records to you.



  • Correction: If you believe that the health information that Adventist Clinic has on file about you is incorrect or incomplete, you may ask us to correct the health information in your records. If your health information is accurate and complete, or if the information was not created by Adventist Clinic, we may deny your request; however, if we deny your request, we will provide you with a written explanation of our reasons for doing so.
  • Addendum: In addition, an adult patient of Adventist Clinic who believes that an item or statement in the healthcare record is incorrect or incomplete has the right to provide Adventist Clinic with a written addendum to the record.


RIGHT TO AN ACCOUNTING OF ADVENTIST CLINIC DISCLOSURES OF YOUR HEALTH INFORMATION: You have the right to request an “accounting of disclosures” which is a list describing how we have shared your health information with outside parties. This accounting is a list of the disclosures we made of your health information after April 14, 2003 for purposes other than treatment, payment and health care operations, as those functions are described below in the section of this Notice entitled, “How We May Use and Disclose Health Information About You”.


RIGHT TO REQUEST RESTRICTIONS: You have the right to request restrictions on certain uses or disclosures of your health information. Requests for restrictions must be in writing; the appropriate instructions and forms are available at the clinic registration areas. We are not required to agree to your requested restriction. However, if we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or to comply with the law. If we cannot accept your request, we will explain to you in writing why we cannot do so.


RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS: You have the right to request that we communicate with you about your healthcare in a certain manner or at a certain location. For example, you can ask that we only contact you at work, rather than at your home. You may request confidential communications by changing your contact information for communication at the clinic registration desks. We will not ask you the reason for your request, and we will use our best efforts to accommodate all reasonable requests.


RIGHT TO A COPY OF THIS NOTICE UPON REQUEST: You have the right to a copy of this Notice. It is available in the clinic registration areas or at


* “You” in this Notice means an Adventist Clinic patient or, if applicable, the patient’s personal representative. A personal representative is any person authorized to act on behalf of the patient with respect to his/her health care. For example, a personal representative may include the parent or guardian of a minor (unless the minor has the authority under Guam law to act on his/her own behalf), the guardian or conservator of an adult patient, or the person authorized to act on behalf of a deceased patient.


CONTACT INFORMATION: To obtain information about how to request a copy of your healthcare records, receive an accounting of disclosures of, or correct or add an addendum to your health information:

  • For medical records call (671) 646-8881 ext. 800
  • For dental records call (671) 646-8881 ext. 400
  • For eye records call (671) 646-8881 ext. 440
  • For billing records call (671) 646-8881 ext. 170



The following sections describe different ways that we use and disclose your health information. For each category of uses or disclosures we will provide examples. To respect your privacy, we will try to limit the amount of information that we use or disclose to that which is the “minimum necessary” to accomplish the purpose of the use or disclosure. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.


FOR TREATMENT: We may use health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, residents, nurses, technicians, or other medical and clinical staff who are involved in your care at Adventist Clinic and elsewhere. For example, a doctor treating you for a broken leg needs to know if you have diabetes because diabetes can slow the healing process. Different units of Adventist Clinic also may share health information about you in order to coordinate the different services you need, such as pharmacy, lab work and x-rays.


FOR PAYMENT: We may use and disclose health information about you to bill and receive payment for the treatment and services you receive. For example, we may need to give your health plan information about a physical therapy treatment you received at Adventist Clinic so your health plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.


FOR HEALTH CARE OPERATIONS: We may use and disclose health information about you for functions that are necessary to run Adventist Clinic and assure that all of our patients receive quality care. We may also share your health information with affiliated health care providers so that they may jointly perform certain business operations. For example, we may use health information to review our treatment and services and evaluate the performance of our staff in caring for you. We may combine health information about many of our patients to decide what additional services Adventist Clinic should offer, and what services are not needed. We may share information with doctors, residents, nurses, technicians, and other medical and clinical staff for quality assurance and educational purposes.


BUSINESS ASSOCIATES: Adventist Clinic contracts with outside companies that perform business services for us, such as information technology specialists who help maintain the clinic’s electronic health records. In certain circumstances, we may need to share your health information with a business associate so that a service can be performed on our behalf. Adventist Clinic will limit the disclosure of your information to a business associate to the amount of information that is the “minimum necessary” for the company to perform services for Adventist Clinic. In addition, we will have a written contract in place with the business associate requiring it to protect the privacy of your health information.


APPOINTMENT REMINDERS: We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or medical care at Adventist Clinic.

TREATMENT ALTERNATIVES: We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

HEALTH-RELATED BENEFITS AND SERVICES: We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.


INDIVIDUALS INVOLVED IN YOUR CARE: Unless there is a specific written request from you to the contrary, we may release minimum necessary health information about you to a family member or friend who is involved in your care, give information to someone who helps pay for your care, and notify a family member, personal representative or another person responsible for your care about your location and general condition. In addition, we may disclose health information about you to an organization assisting in a disaster relief effort (such as the Red Cross) so that your family can be notified about your condition, status and location.


RESEARCH: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.


FUNDRAISINGWe may contact you as part of a fund-raising effort.


TO PREVENT A SERIOUS THREAT TO HEALTH OR SAFETY: We may use and disclose certain information about you when necessary to prevent a serious threat to your health and safety or the health and safety of others. However, any such disclosure will only be to someone able to help prevent the threat, such as law enforcement, or to a potential victim. For example, we may need to disclose information to police if you have stated that you intend to harm yourself or someone else.



WORKERS’ COMPENSATION: We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.


PUBLIC HEALTH ACTIVITIES: We may disclose health information about you for public health activities. These activities include, but are not limited to the following:


  • to prevent or control disease, injury or disability;
  • to report the abuse or neglect of children, elders and dependent adults;
  • to report reactions to medications or problems with products;
  • to notify you of the recall of products you may be using;
  • to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
  • to notify the appropriate government authority if we believe you have been the victim of abuse, neglect or domestic violence, but only when required or authorized by law; and
  • to notify the appropriate registries, such as a Cancer Center or the Emergency Medical Services Authority, when you seek treatment at Adventist Clinic for certain diseases or conditions.        


HEALTH OVERSIGHT ACTIVITIES: We may disclose health information to a health oversight agency, such as the Department of Health Services or the Center for Medicare and Medicaid Services or Medical Indigent Program, for activities authorized by law. These oversight activities include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.


LAWSUITS AND DISPUTES: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, legally enforceable discovery request, or other lawful process by someone else involved in the dispute.


LAW ENFORCEMENT: We may release health information if asked to do so by law enforcement officials in the following limited circumstances:


  • In response to a court order, subpoena, warrant, summons or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain limited circumstances, the victim is unable to consent;
  • About a death we believe may be the result of criminal conduct;
  • About criminal conduct at Adventist Clinic; and
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime. 


CORRECTIONAL INSTITUTION:  Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.


CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS: We may release health information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also release health information about patients of Adventist Clinic to funeral directors as necessary to carry out their duties with respect to the deceased.


MILITARY AND VETERANS: If you are a member of the armed forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.


NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES: Upon receipt of a request, we may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. We will only provide this information after the Privacy Officer has verified the validity of the request and reviewed and approved our response.


OTHER USES OR DISCLOSURES REQUIRED BY LAW: We will also disclose health information about you when required to do so by federal or local laws that are not specifically mentioned in this Notice.



We reserve the right to change our privacy practices and update this Notice accordingly. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We post copies of the current Notice in the clinic public areas and at If the Notice is changed, we will post the new Notice in the same locations and provide it to you upon request. The Notice contains the effective date at the top of the first page.



We welcome your comments about our Notice and our privacy practices. If you believe your privacy rights have been violated, you may file a complaint with Adventist Clinic or with the Secretary of the Department of Health and Human Services (200 Independence Avenue, S.W., Washington, D.C. 20201). To register a comment or file a complaint with Adventist Clinic, please contact:



Guam Seventh-Day Adventist Clinic

388 Ypao Road

Tamuning, Guam 96913

Phone: (671) 646-8881 ext. 101


Please be assured that no one will retaliate or take action against you for filing a complaint.



Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health information about you for the activities covered by the authorization, except if we have already acted in reliance on your permission. We are unable to take back any disclosures we have already made with your authorization.