By law, we are required to inform you on how your medical information may be disclosed or accessed, as well as describe your rights of privacy. Please review it carefully.
Protected Health Information
Protected Health Information – is any information about you that we have in your records, including demographic information, social security number, and the medical contents of your chart.
How We May Use and Disclose Health Information About You
The following are the ways we normally use and disclose your protected health information on a routine basis without getting any special permission from you, in order to treat you, to obtain payment for services provided, and to conduct our health care operations. This does not apply to how we use and disclose your highly confidential information, which requires a separate authorization. In the routine cases below, we would disclose only the minimum necessary information to accomplish the specific task at hand.
For Treatment. We may disclose health information about you to provide you with medical treatment or services. This normally involves disclosing the information to doctors, nurses, technicians, office staff or other personnel who are involved in taking care of your health. For example, we may forward test results, specialist consultation notes, medical summaries, and other information to other doctors or healthcare personnel, as we deem appropriate for your medical care.
For Healthcare Operations. We may use and disclose protected health information about you in order to run the business activities of our office. We may use a sign-in sheet and leave messages on your email or answering machine about appointments or test results. During the normal course of operations, every effort is made to respect patient privacy.
Family. We may disclose health information about you to your family if we obtain your written agreement to do so. The student must complete an authorization for the Release of Confidential Information Form in the company of a Student Health Service employee who will act as a witness.
Other Uses and Disclosure of Protected Health Information
We will not use or disclose your health information for any purposes other than those identified in the previous section without a specific, separate, written authorization from you.
Highly Confidential Information (Information about HIV, substance abuse, and psychotherapy notes) requires a special authorization from you, even for purposes of treatment, payment, and business operations.
If you give us the authorization to disclose information about you, you may revoke that authorization by written notice at any time, but we cannot take back any disclosure already made with your permission up to that time.
Your Rights Regarding Health Information About You
You have the following rights regarding your health information we maintain on you:
You have a right to a copy of your records, but not to take the originals. We reserve the right to charge a nominal copying fee for this service. All you have to do is give us a written request for this.
You can request the record be amended if you believe there is an error. All you have to do is write a written request to your health care provider, who will review this and make the change only if the health care provider agrees. The health care provider does not have to make the change if the health care provider disagrees with the request.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that we only contact you at work. You may also request that your information not be disclosed to certain family members. Please make such requests specific, and in writing.
You certainly have the right to request that your information not be disclosed to anyone; but if the health care provider believes this would interfere with treatment, the health care provider is not required to agree to this since it would make it impossible to treat you. You have the right to transfer your care to another health care provider. If the healthcare provider does agree to such restrictions, your information may still be disclosed if needed in an emergency situation.
Questions or Concerns
If you believe your privacy rights have been violated, you may file a complaint with our office by contacting Theresa Smith, CRNP, Director of Student Health Services. You may do this by calling 215-572-2966 or by sending a written letter outlining the specifics of your complaint to our office. If you are not satisfied, you may also contact the Secretary of the Department of Health and Human Services, Office of Civil Rights. You will not be penalized for filing a complaint.