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Another licensed health care professional chosen by the facility will review your request and the denial. You must make a request in writing to obtain access to your medical information. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all medical information that we maintain, including medical information we created or received before we made the changes. Kona Community Hospital Covid-19 Vaccine Registration Form - Administering Pfizer vaccine Please Print Clearly Legal First Name: Legal Middle Name: Legal Last Name: Date of Birth: Email: Contact Phone Number: Gender (select from list): Ethnicity (select from list): Race (select from list): Street Address (no PO box): City: State: Zipcode: Kona Community Hospital and Kohala Hospital began routing all visitors through a single point of entry starting Saturday, March 7. We will also provide information regarding the COVID-19 vaccine as it becomes available. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. You may obtain a form to request an amendment by using the contact information listed at the end of this notice. Kona Community Hospital Covid-19 Vaccine Registration Form - 75 and Older Please Print Clearly Legal First Name: Legal Middle Name: Legal Last Name: Date of Birth: Email: Contact Phone Number: Gender (select from list): Ethnicity (select from list): Race (select from list): Street Address (no PO box): City: State: Zipcode: Category (select from list): Statement of Non-Discrimination. Kona Community Hospital said Tuesday afternoon technical issues with its COVID-19 vaccine registration phone line have been fixed. This notice takes effect 04/14/2003, and will remain in effect until we replace it. We will provide you with an opportunity to restrict or prohibit some or all disclosures for facility directories unless emergency circumstances prevent your opportunity to object. ... Kona Community Hospital Covid-19 Vaccine Registration Short Form. Unless you object, we may disclose your medical information to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care. We will not be bound to the restrictions unless our agreement is signed by you and the appropriate facility representative. These uses are necessary to make sure that all our patients receive quality care. This notice describes our facility’s practices and those participants listed below in our organized health care arrangement. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the facility. We may not disclose HIV information unless required by law, pursuant to an authorization or the disclosure is to you or your personal representative; to agents or employees of health care providers who participate in the administration or provision of your care or handles or processes specimens of bodily fluids or tissues, and the agent or employee has a need to know such information; to health care providers consulting between themselves or with health care facilities to determine diagnosis and treatment; to the State for public health purposes; to a health care provider who processes, procures, distributes or uses body parts of a deceased person; to health care provider staff committees for the purposes of conducting program monitoring, program evaluation, or service reviews; to pursuant to court order; or, to persons who have been subject to a significant exposure during the course of medical practice or in the performance of professional duties. Kona Community Hospital follows federal guidelines that help protect patient’s health information by limiting the amount of information provided to the public without patient authorization. Learn about Kona Community Hospital culture, salaries, benefits, work-life balance, management, job security, and more. This notice does not imply any joint venture or any other special association or legal relationship between the facility and its medical staff. About Kona Community Hospital: Kona Community Hospital - Kealakekua - Billing is located at Po Box 69 in Kealakekua, HI - Hawaii County and is a business listed in the categories Hospitals and General Medical And Surgical Hospitals. For example: We may use or disclose your medical information to a physician or other health care provider in order to provide treatment to you. The hospital’s next vaccination clinics will take place at the Kona Community Hospital Campus in Kealakekua on May 12th, 21st and 28 th, and at the clinic at the Kona Aquatic Center Gym on May 20. You must make a request in writing to request a listing of disclosures. As such, we may share your medical information and the medical information of others we service with each other as needed for treatment, payment or health care operations relating to our organized health care arrangement. Members of our medical staff and their employees or workforce who provide services or support to the physician at the hospital. To allow for ample processing time, pre-registration must be completed at least 2 business days prior to your scheduled appointment time (Business days are defined as Monday through Friday). For example, you might request that we contact you at work or by mail. Kona Community Hospital registration entryway. Pre-registration form with instructions can be downloaded from the KCH website: https://kch.hhsc.org/wp-content/uploads/Kona-Covid-vaccine-registration-form-inst-III.pdf o Note: First download the form, complete the form and then send it to our vaccine email address. PC: KCH Kona Community Hospital (KCH) currently has the second-highest number of COVID-19 hospitalizations statewide behind … In addition, we may disclose medical information about you to an organization assisting in a disaster relief effort so your family can be notified about your condition and location. Maternity patients can pre-register up to 3 months prior to their expected delivery date. as authorized by state worker’s compensation laws. Our employed physicians and their office staff. If you request copies, we will charge you a fee for copying and postage if you want the copies mailed to you. Contact us using the information listed at the end of this notice for a full explanation of our fee structure. It includes all medical records and other information, which identifies the patient, such as demographic, medical and financial – in any form – electronic, paper or spoken. We may disclose your medical information to another health care provider or entity subject to the federal and state Privacy Rules so they can obtain payment. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information. NOTE: Please submit your online registration at least 2 business days prior to your scheduled visit to ensure ample processing time. The line will be manned by a hospital employee Monday through Friday who will register callers into the CDC’s Vaccine Administration Management System, and then schedule an appointment. You may respond with a statement of disagreement to be attached to the information you wanted amended. For certain types of medical information we may be required to protect your privacy in ways more strict than we have discussed in this notice. We will also use our professional judgment and our experience with common practice to allow a person to pick up filled prescriptions, medical supplies, x-rays or other similar forms of medical information. We may deny your request to inspect and copy in very limited circumstances as allowed by law. You must make your request in writing. By LAURA RUMINSKI West Hawaii Today | Wednesday, March 24, 2021, 12:05 a.m. Kona Community Hospital has begun pre-registering Phase 2 individuals age 50 and older to receive the Pfizer vaccine at its Thursday mega clinics at Kekuaokalani Gymnasium in Kailua-Kona. The facility said it is moving to Tier 1B in alignment with the state Department of Health’s vaccine distribution plan and will begin registering kupuna age 75 and over on Tuesday Jan 19, 2021, to receive the first of two doses of Pfizer’s COVID-19 vaccine…. Included in this project will be: Add 1400 sq. People in that age group can begin the scheduling process by calling Kona Community Hospital’s registration line at (808) 322-4451 between 8 a.m. and noon starting Tuesday. To complete your patient pre-registration and submit it to the hospital, sign your full legal name below and press the Submit button below. We intend to accomplish this by promoting the highest level of quality care with the greatest degree of compassion possible in … The Kona Hospital Foundation values our dedicated team of volunteers because they understand the importance of supporting healthcare in our community. Kona Community Hospital has begun preregistering Phase 2 individuals age 50 and older to receive the Pfizer vaccine at its Thursday mega clinics held at Kekuaokalani Gymnasium in Kailua-Kona. Along with the facility, the following participate in our organized health care arrangement: We use and disclose medical information about you for treatment, payment, and health care operations. If you are denied access to your medical information, you may request that the denial be reviewed. If you have a scheduled appointment for Surgical Services, Radiology/Imaging Service, Maternity Services, or other Outpatient procedure/test; you will be able to take advantage of one of the following options for pre-registration: To allow for ample processing time, pre-registration must be completed at least 2 business days prior to your scheduled appointment time (Business days are defined as Monday through Friday). The Pfizer vaccine will … Please ensure that all of the information you provided is complete and accurate as you will not have the opportunity to change this information prior to your hospital visit. Each has his or her own reason for volunteering, but they all work toward the same goal: to help the Kona Hospital Foundation and Kona Community Hospital raise the level of healthcare in West Hawaii. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We may disclose your medical information to a business associate to assist us in these activities. Other information you would like to include about your facility: Kona Hospital is the first hospital in HHSC to create a HT program. Kona Hospital Foundation offers a grant of $200.00 towards registration fees of HT level in exchange for volunteering doing HT 8 hours a month for a year. We may deny your request if we did not create the information you want amended and the individual who provided the information remains available or for certain other reasons. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your medical information or in response to a request you made to amend or restrict the use or disclosure of your medical information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this notice. The staff of The Kona Ambulatory Surgery Center, LLC is committed to improving the physical and emotional health of the patients and community we serve. Call Patient Access department at (808) 322-5802. To pre-register for an upcoming visit to Kona Community Hospital, please complete the form below. Protected health information is any health information that can be used to identify a patient and relates to health-care services provided to the patient or the payment of those services. We may not disclose DNA information without your specific authorization, except to the following persons: to your physician; or to other persons as may be required by law in your state or required by the Federal government. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request. On Tuesday, Jan. 19, Kona Community Hospital (KCH) will begin registering … We may use and disclose your medical information to obtain payment for services we provide to you. We will disclose this information to members of the clergy and, except for religious affiliation, to other persons who ask for you by name. Pre-registering for your scheduled appointment helps to expedite the admissions process and saves you time. A separate form must be completed for each individual asking to be scheduled for the vaccine. If we deny your request, we will provide you a written explanation. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. If you want more information about our privacy practices or have questions or concerns, please contact us using the information listed at the end of this notice. Kona Community Hospital said Tuesday afternoon technical issues with its COVID-19 vaccine registration phone line have been fixed. The vaccine registration form can be downloaded here •KCH COVID19 Vaccine Registration & Scheduling o Register with KCH COVID Call Center (808) 322-4451 or by email (voicemails will not be returned) o Pre-registration form with instructions can be downloaded from the KCH website (updated 3/11/2021):https://kch.hhsc.org/wp-content/uploads/Kona-Covid-vaccine-registration-form-V3.11.2021.pdf for public health activities, including disease and vital statistic reporting, child abuse reporting, FDA oversight, and to employers regarding work-related illness or injury; to report adult abuse, neglect, or domestic violence; In response to court and administrative orders and other lawful processes; to law enforcement officials after receiving subpoenas and other lawful processes, concerning crime victims, suspicious deaths, crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person; to coroners, medical examiners, and funeral directors; to avert a serious threat to health or safety; in connection with certain research activities; to the military and to federal officials for lawful intelligence, counterintelligence, and national security activities; to correctional institutions regarding inmates; and. Thank you for choosing Kona Community Hospital for your healthcare needs. We will comply with the outcome of the review. NOTE: Please submit your online registration at least 2 business days prior to your scheduled visit to ensure ample processing time. We must follow the privacy practices that are described in this notice while it is in effect. The person conducting the review will not be the person who denied your request. Reports of issues […] You may obtain a form to request the accounting by using the contact information at the end of this notice. Kona Community Hospital says it is accepting vaccine pre-registration for individuals 50+ years of age. Pre-registering for your procedure shortens the admissions process and saves you time. Register Online Pre-registering for your procedure shortens the admissions process and saves you time. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your medical information. Reviews from Kona Community Hospital employees about working as a Registered Nurse at Kona Community Hospital. We may use and disclose your medical information in connection with our health care operations. To pre-register for an upcoming visit to Kona Community Hospital, please complete the form below. More information at this link. You may obtain a form to request alternative communications by using the contact information listed at the end of this notice. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Kona Community Hospital will expand vaccinations to community members age 75 and over…. However, online inventory may be limited. For kupuna registration at Hilo Medical Center, visit hilomedicalcenter.org or call 932-3000 and press 8 on weekdays during business hours for assistance; at Kona Community Hospital, call … The hospital’s next vaccination clinics will take place at the Kona Community Hospital Campus in Kealakekua on May 12th, 21st and 28 th, and at the clinic at the Kona Aquatic Center Gym on May 20. Kona Community Hospital (click link) For registration and appointments, call (808) 322-4451, Mon. If you are not present, or in the event of your incapacity or an emergency, we will disclose your medical information based on our professional judgment of whether the disclosure would be in your best interest. April 23, 2021 (click here) We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. By next week, kūpuna will be able to register for coronavirus vaccination across the Big Island. We must accommodate your request if it is reasonable, specifies the alternative means or location, and provides satisfactory explanation how payments will be handled under the alternative means or location you request. ... KCH’s pre-registration … Kona Community Hospital is dedicated to providing excellent care delivered by a highly trained team of healthcare providers. You also may submit a written complaint to the U.S. Department of Health and Human Services. However, the … We may use or disclose your medical information as authorized by law for the following purposes deemed to be in the public interest or benefit: We may use your medical information to contact you with information about health-related benefits and services or about treatment alternatives that may be of interest to you. You have the right to receive a list of instances in which we or our business associates disclosed your medical information for purposes other than treatment, payment, health care operations, as authorized by you, and for certain other activities, since April 14, 2003. We support your right to the privacy of your medical information. A Like Hilo Medical Center, Kona Community Hospital is accepting pre-registration for the COVID-19 vaccine for children ages 12 to 15. Kona Community Hospital Cancer Center Our current focus is the expansion and upgrade to the hospital cancer center. ft. to Cancer Center Dedicated Chemo Patient Restroom New Central Nurse Station Isolation Room with Bathroom If you receive this notice on our web site or by electronic mail (e-mail), you are entitled to receive this notice in written form. You have the right to look at or get copies of your medical information, with limited exceptions. The vaccine registration form can be downloaded here You may obtain a form to request additional restrictions on the use or disclosure of your medical information by using the contact information listed at the end of this notice. o Submit registration form via email to KCHCOVIDvaccine@hhsc.org “Because of our population, we have moved through our kupuna age 65 and up,” said Judy Donovan, KCH marketing … For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice. Contact us using the information listed at the end of this notice for a full explanation of our fee structure. – Fri., 8 a.m. – 12 p.m. Queen’s North Hawai‘i Community Hospital Call (808) 881-4668 or email [email protected] for scheduling

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