Privacy Policy
Privacy Notice
All information given by you to members of the Student Health Center staff, either orally or in writing, is privileged and private or protected by law. Personal information obtained by us from you or from other sources of health care about you, and written information entered in your Student Health Center record by you or by Student Health Center staff members, will not ordinarily be revealed or transmitted to anyone in any form, including orally, without your written authorization EXCEPT:
1. Members of the Student Health Center staff may exchange or discuss such information among themselves in the course of providing diagnostic, treatment, counseling, or referral services to you.
2. We may impart information from your record to providers of health care outside the Student Health Center to whom we refer you for diagnosis or treatment, including ambulance attendants and emergency department staff; pharmacy, laboratory, and x-ray personnel; and specialists or consultants. In such instances, only the minimum information necessary for appropriate handling or disposition of your case will be revealed.
3. If you are a student and a member of the University faculty or administration requests confirmation from us that you were disabled by illness or injury from class attendance, performance of assignments, or studying for examinations, we will provide that confirmation when it is clearly in your best interests, but we will not impart any medical information whatsoever. The Student Health Center reserves the right to confirm information when appropriate.
4. If you are a student, charges incurred by you at the Student Health Center for medicines, laboratory tests, x-rays, and certain other services will be reported to the Office of Student Accounts for entry in your account with the University. (NOTE: Only the date of service and the amount of the charge are reported to the Office of Student Accounts. Neither your diagnosis nor the nature of the goods or services provided is revealed. If you do not wish a particular charge to be reported to the Office of Student Accounts, you may arrange to pay that charge directly at the Student Health Center.)
5. If you request that the Student Health Center use your health insurance for laboratory tests sent to outside laboratories, medical procedures such as X-rays or other imaging performed outside of the Student Health Center, approvals or authorizations for prescriptions processed at outside pharmacies, or other testing or treatment not done at the Student Health Center, you then agree to release your medical information needed for processing and/or approval of such tests or treatments, including but not limited to diagnoses, treatments, tests, and pertinent progress notes. The Student Health Center does NOT process insurance for tests, treatments, medications, or miscellaneous supplies rendered at or from the Student Health Center but, on the student’s or employee’s request, will provide an itemized bill for students or employees to submit these charges to their insurance, as applicable.
6. We occasionally may be required or permitted by applicable federal, state, or local laws to reveal information from your health record. Examples include but are not limited to: disclosing to public health authorities and/or school officials in case of certain communicable diseases; in certain emergency situations (if FERPA information); in response to a legally issued subpoena or similar legal processes; for certain federal programs (e.g., Medicare, Medicaid, US military members, or for national security); and/or to confirm compliance with privacy rules.
You have the right to inspect your medical records and to receive copies of part or all of them. You may request that we amend your records. Your request must be in writing and must state the reason why you believe your records should be changed. Your request may be denied but will become a part of your record.
If you have questions or complaints about our privacy practices, please contact Kim Rosenbaum, HIPAA Compliance Officer for the Student Health Center. You may also submit complaints in writing to the U.S. Department of Health and Human Services.
My signature below indicates that I have read and understood the privacy notice above; that if I had any questions about this material they were adequately answered; and that I consent to the release of medical information ONLY as specified above. I understand that if I request release of medical information to a third party (private physician, insurance company, attorney), I will be asked to sign a specific authorization for that release.
Date_______________ Signature ___________________________
7/2020