NOTICE OF PRIVACY PRACTICES
We are required by law to maintain the privacy of your health information (Protected Health Info or PHI) and to provide you with this Notice of our legal duties and privacy practices. When we use or disclose your PHI, we are required to abide by the terms of this Notice.
In certain situations, described below, we must obtain your written authorization in order to use and/or disclose your PHI. We do not need any type of authorization from you for the following:
Use & Disclosures for Treatment, Payment and Health Care Operations. We may use & disclose PHI, in order to treat you, obtain payment for services provided to you and conduct our “health care operations’ as detailed below.
- Treatment. We use and disclose your PHI to provide treatment & other services to you-to diagnose & treat your illness or injury. We may contact you to return to Student Health Service for follow-up, to make a referral, or results of testing.
- Payment. We may use and disclose your PHI to obtain payment for services that we provide to you-disclosures to claim and obtain payment from your health insurer.
- Health Care Operations. We may use and disclose your PHI within our clinic in order to improve quality and cost effectiveness of care. For example, we may use PHI to evaluate quality and competence of our physicians, nurses and other health care workers. We may disclose PHI to our Administrative Director in order to resolve any complaints you may have and ensure that you have a comfortable visit with us. We may disclose PHI to your other health care providers if it is required for them to treat you or receive payment of services.
- Disclosures to Relatives, Close Friends or Other Caregivers. We may use or disclose your PHI to a family member, other relative, a close personal friend or any other person identified by you when you are present for, or otherwise available prior to, the disclosure, if we (1) obtain your agreement; (2) provide you with the opportunity to object to the disclosure and you do not object. We may disclose your PHI in order to notify (or assist in notifying) such persons of your location or general condition.
- Public Health. We may disclose your PHI (1) to report public health issues as required under Louisianan law; (2) to report child abuse to authorities authorized by law to receive reports; (3) to report about products/services under the jurisdiction of the US Food & Drug Administration; (4) to alert a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading disease (5) to your employer as required under laws addressing work-related illness & injuries.
- Victims of Abuse, Neglect or Domestic Violence. If we reasonably believe you are a victim, we may disclose your PHI to a government authority, including the Louisiana Department of Health & Hospitals, Medicaid Fraud Control Unit, a social service or protective agency authorized by law to receive reports.
- Legal Proceedings. We will comply with a legal order (subpoena) or other lawful processes by disclosing your PHI. We will make an attempt to notify you of the subpoena.
- Decedents. We may disclose you PHI to a coroner or medical examiner as authorized by law.
- Health or Safety. We may use or disclose your PHI to prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety as required by Louisiana Law.
- Specialized Government Functions. We may use or disclose your PHI to units of the government, such as US military or US Department of State under certain circumstances.
USE & DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
For any purpose other than the ones described above, we only may use or disclose your PHI when you grant us your written authorization on our authorization form. For example, you will need to sign an authorization form before we can send your PHI to your life insurance company or to any attorney representing the other party in litigation in which you are involved.
- We may not disclose your PHI to another college or university without your written authorization.
- We may not disclose certain “Highly Confidential Information” such as HIV/AIDS testing, diagnosis, or treatment; generic testing for purpose other than a death or crime, determining paternity, determining the identity of a deceased person, mental health and developmental disabilities without your written consent.
- We will not fax your PHI to another physician unless you grant us your written authorization on our authorization form. Once written authorization is provided by the patient, Student Health Service will confirm the fax number to be used is in fact the correct one for the other physician's office. We may receive a facsimile of your immunization/health records from your physician/health clinic. These will be placed in your medical record file and maintained in the department. The fascimile machine is placed in a secure location (Business Manager's private office) to prevent unauthorized access to information.
COMPLAINTS & FURTHER INFORMATION
You may file a written complaint or request for further information with the Administrative Director for Student Health Service. You will receive a response in accordance with the policy on complaints outlined in the Student Handbook.
- You may request additional restrictions on our use and disclosure of your PHI (1) for treatment, payment and health care operations: (2) to individuals (such as family members, close personal friend or any other person identified by you, or (3) to notify or assist in our notification of your location and general condition. This request must be made in writing to the Administrative Director. We are not required to agree to a requested restriction. We will send you a written response within 10 business days.
- Right to Revoke Your Authorization. You may revoke your Authorization obtained in connection with your Highly Confidential Information, except to the extent that we have taken action in reliance upon it, by delivering a written revocation statement to Student Health Service.
- Right to Inspect & Copy Your Health Information. You may request access to your medical record file maintained by us in order to inspect and request copies of the records. Under limited circumstances, we may deny you access to a portion of your records. If you desire access to your records, please complete the record request form in Student Health Service. If you require copies, we will charge as follows: 1-5 pages-$5.00; 6-10 pages-$10.00 and over 10 pages-$1.00 per page for 25 pages. We will charge for postage costs if you request that we mail copies for you.
- Right to Amend Your Records. You have the right to request that we amend the Protected Health Information maintained in your medical record file. If you desire to amend your records, please put that request in writing and submit to the Student Health Service. We will comply wit your request unless we believe that the information that would be amended is accurate and complete or other special circumstances apply.
- Right to Receive An Accounting of Disclosures. Upon written request, you may obtain a summary of certain disclosures of your Phi made by Student Health Service.
- Right to Receive Paper Copy of this Notice. You have the right to obtain a paper copy of this Notice, even if you have received such notice electronically.
We may change the terms of this Notice at any time. If we change this Notice, we will post the new Notice in the patient waiting area of Student Health Service. You may obtain a paper copy of the new Notice upon request.
Revised June 2004
