Health Services

Notice of Privacy Practices

Health Services is committed to protecting Personal Health Information (PHI) in accordance with Federal Law. The notice of privacy practices became effective April 14, 2003.

Notice of Privacy Practices

Effective Date 4/14/03

Revised January, 2011

Our Pledge Regarding Medical Information:

The Office of Health Services understands that Health Information and your health are personal. We are committed to protecting your Personal Health Information (PHI) in accordance with the federal law.  We value the trust you have placed in the Office of Health Services to provide health care for you, and give our commitment to treat all of the information you give us responsibly.

The Law requires us to:

  • Make sure that medical information that identifies you is kept private.
  • Give you this notice of our legal duties and privacy practices with respect to PHI
  • Follow the terms of the notice that are currently in effect.

How We May Use and Disclose Health Information:

The following are the many ways different ways that we are permitted to use and disclose medical information. We will not use or disclose your PHI for any purpose not listed below without your specific written authorization. You may revoke such permission anytime by writing to the Director of Health Services, Anna M. Stacey,R.N.

Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical treatment about you to doctors, nurses, technicians, medical students, or other personnel, including people outside of Health Services, who are involved in your medical care and require the proper information to treat you.

Health Care Operations:  We may use and disclose health information for health care operation purposes. These uses and disclosures are necessary to run the Office of Health Services and make sure that all our patients receive quality medical care. For example, we may use medical information to review our treatment and services, combine this with information we have from other health care providers and make any improvements, if necessary, in the care and services we provide.

Notification: We will share information about your location, general condition or death with a family member., your personal representative or any person resposible for your medical care.  If you are present we will get your permission, or refusal of permission, to release this information.  In case of emergency, or if you are unable to give or refuse permission, we will use professional judgement and share only the health information that is directly necessary for your health care.

Public Health Activities: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. We may also disclose your health information to persons subject to jurisdiction of the Food and Drug Administration for purposes of reporting adverse events associated with product defects or activities required by the FDA.   When authorized by law, we may also notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition.

To Avert a Serious Threat to Health or Safety: We may use and disclose health information when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person.

As Required By Law: We will disclose health information about you when required to do so by federal, state or local law.

Special Situations:

Law Enforcement: We may release health information if requested to do so by a law enforcement official by: 1) a court order, subpoena, warrant, summons or similar process. 2) to identify or locate a suspect, fugitive, material witness, or missing person. 3) if the victim of a crime or, if under certain limited circumstances, we are unable to obtain the persons agreement.4)  a death we believe may be the result of criminal conduct. 5) about criminal conduct on our premises, and 6) in emergency circumstances to report a crime, the location of a crime or victims: or the identity, description, or location of the person who committed the crime.

Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information in response to a court or administrative order. We may also disclose health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Worker’s Compensation: We may release health information for worker’s compensation or similar programs. These programs provide benefits for work related injuries or illness.

Your individual rights regarding your health information:

  • Right to Inspect and Copy
  • Right to Amend
  • Right to an Accounting of Disclosures
  • Right to Request Restrictions
  • Right to Request Confidential Communications
  • Right to a Paper Copy of This Notice

All requests pertaining to your rights must be written and submitted to the Office of Health Services

*Detailed explanations of your individual “Bill of Rights” is available at the Office of Health Services.

Changes to this notice:

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for current medical information, as well as any new information we receive from you. We will post a copy of the current notice, with the effective date, in our office reception area.  You will be offered a copy of any current notice each time you register for treatment.


If you believe your privacy rights have been violated,  you may file a complaint, in writing,  with the Dean of Students in the Office of Student Affairs.

Other uses of medical information:

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 permission. If you provide us permission to use or disclose health information, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided you.