Notice of Privacy Practices
Privacy Practice PDF
Our Pledge Regarding Medical Information
The privacy of your medical information is important to us. We understand that your
medical information is personal and we are committed to protecting it. We create a
record of the care and services you receive at our organization. We need this record
to provide you with quality care and to comply with certain legal requirements. This
notice will inform you of the ways we may use and share medical information about
you. We also describe your rights and certain duties we have regarding use and disclosure
of medical information.
Our Legal Duty
Law requires us to:
- Keep your medical information private.
- Give you this notice describing our legal duties, privacy practices, and your rights
regarding your medical information.
- Follow the terms of the current notice.
We have the right to:
- Change our privacy practices and the terms of this notice at any time, provided that
the changes are permitted by law.
- Make the changes in our privacy practices and the new terms of our notice effective
for all medical information that we keep, including information previously created
or received before the changes.
Notice of Change to Privacy Practices:
- Before we make an important change in our privacy practices, we will change this notice
and make the new notice available upon request.
Use and Disclosure of Your Medical Information
The following section describes different ways that we use and disclose medical information.
Not every use or disclosure will be listed. However, we have listed all of the different
ways we are permitted to use and disclose medical information. We will not use or
disclose your medical information for any purpose not listed below, without your specific
written authorization. Any specific written authorization you provide may be revoked
at any time by writing to us.
We may use medical information about you to provide you with medical treatment or
services. We may disclose medical information about you to doctors, nurses, technicians,
medical students, or other people who are taking care of you. We may also share medical
information about you to your other health care providers to assist them in treating
We may use and disclose your medical information for payment purposes. A bill may
be sent to you or a third-party payer. The information on or accompanying the bill
may include your medical information.
For Health Care Operations:
We may use and disclose your medical information for our health care operations. This
might include measuring and improving quality, evaluating the performance of employees,
conducting training programs, and getting the accreditation, certificates, licenses
and credentials we need to serve you.
Additional Uses and Disclosures
In addition to using and disclosing your medical information for treatment, payment,
and health care operations, we may use and disclose medical information for the following
Unless you notify us that you object, the following medical information about you
will be placed in our facility directories: your name; your location in our facility;
your condition described in general terms; your religious affiliation, if any. We
may disclose this information to members of the clergy or, except for your religious
affiliation, to others who contact us and ask for information about you by name.
We may use and disclose medical information to notify or help notify: a family member,
your personal representative or another person responsible for your care. We will
share information about your location, general condition, or death. If you are present,
we will get your permission if possible before we share, or give you the opportunity
to refuse permission. In case of emergency, and if you are not able to give or refuse
permission, we will share only the health information that is directly necessary for
your health care, according to our professional judgment. We will also use our professional
judgment to make decisions in your best interest about allowing someone to pick up
medicine, medical supplies, x-ray or medical information for you.
We may share medical information with a public or private organization or person who
can legally assist in disaster relief efforts.
We may provide medical information to one of our affiliated fundraising foundations
to contact you for fundraising purposes. We will limit our use and sharing to information
that describes you in general, not personal, terms and the dates of your health care.
In any fundraising materials, we will provide you a description of how you may choose
not to receive future fundraising communications.
Research in Limited Circumstances:
We may use medical information for research purposes in limited circumstances where
the research has been approved by a review board that has reviewed the research proposal
and established protocols to ensure the privacy of medical information.
Funeral Director, Coroner, Medical Examiner:
To help them carry out their duties, we may share the medical information of a person
who has died with a coroner, medical examiner, funeral director, or an organ procurement
Specialized Government Functions:
Subject to certain requirements, we may disclose or use health information for military
personnel and veterans, for national security and intelligence activities, for protective
services of the President and others, for medical suitability determinations for the
Department of State, for correctional institutions and other law enforcement custodial
situations, and for government programs providing public benefits.
Court Orders and Judicial and Administrative Proceedings:
We may disclose medical information in response to a court or administrative order,
subpoena, discovery request, or other lawful process, under certain circumstances.
Under limited circumstances, such as a court order warrant, or grand jury subpoena,
we may share your medical information with law enforcement officials. We may share
limited information with a law enforcement official concerning the medical information
of a suspect, fugitive material witness, crime victim or missing person. We may share
the medical information of an inmate or other person in lawful custody with a law
enforcement official or correctional institution under certain circumstances.
Public Health Activities:
As required by law, we may disclose your medical information to public health or legal
authorities charged with preventing or controlling disease, injury or disability,
including child abuse or neglect. We may also disclose your medical information to
persons subject to jurisdiction of the Food and Drug Administration for purposes of
reporting adverse events associated with product defects or problems, to enable product
recalls, repairs or replacements, to track products, or to conduct activities required
by the Food and Drug Administration. We may also, when we are authorized by law to
do so, 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.
Victims of Abuse, Neglect, or Domestic Violence:
We may use and disclose medical information to appropriate authorities if we reasonably
believe that you are a possible victim of abuse, neglect, or domestic violence, or
the possible victim of other crimes. We may share your medical information if it is
necessary to prevent a serious threat to your health and/or safety or the health and/or
safety of others. We may share medical information when necessary to help law enforcement
officials capture a person who has admitted to being part of a crime or has escaped
from legal custody.
We may disclose health information when authorized or necessary to comply with laws
relating to workers compensation or other similar programs.
Health Oversight Activities:
We may disclose medical information to an agency providing health oversight for activities
authorized by law. This would include audits, civil, administrative, or criminal investigations
or proceedings, inspections, licensure or disciplinary actions, or other authorized
Under certain circumstances, we may disclose health information to law enforcement
officials. These circumstances include reporting required by certain laws (such as
reporting of certain types of wounds), pursuant to certain subpoenas or court orders,
reporting limited information concerning identification and location at the request
of a law enforcement official, reports regarding suspected victims of crimes at the
request of a law enforcement official, reporting death, crimes on our premises, and
crimes in emergencies.
Alternative and Additional Medical Services:
We may use and disclose medical information to furnish you with information about
health-related benefits and services that may be of interest to you, and to describe
or recommend treatment alternatives.
Your Individual Rights
You Have a Right to:
- Look at or get copies of certain parts of your medical information. You may request
that we provide copies in a format other than photocopies. We will use the format
you request unless it is not practical for us to do so. You must make your request
in writing. You may ask the Student Health Services receptionist for the form needed
to request access. You may contact the receptionist in person at the Student Health
Clinic during hours of operation or by calling 972.721.5322. There may be charges
for copying and for postage if you want the copies mailed to you. Ask the Student
Health Services receptionist about our fee structure.
- Receive a list of all the times we or our business associates shared your medical
information for purposes other than treatment, payment, health care operations and
other specified exceptions.
- Request that we place additional restrictions on our use or disclosure of your medical
information. We are not required to agree to these additional restrictions, but if
we do, we will abide by our agreement (except in the case of an emergency).
- Request that we communicate with you about your medical information by different means
or to different locations. Your request that we communicate your medical information
to you by different means or at different locations must be made in writing to our
Director of Student Health Services .
- Request that we change certain parts of your medical information. We may deny your
request if we did not create the information you want changed or for certain other
reasons. If we deny your request, we will provide you with a written explanation.
You may respond with a statement of disagreement that will be added to the information
you wanted changed. If we accept your request to change the information, we will make
reasonable efforts to tell others, including people you name, of the change and to
include the changes in any future sharing of that information.
- If you wish to receive a paper copy of this privacy notice, then you have the right
to obtain a paper copy by making a request in writing to our Director of Student Health
Questions and Complaints
If you have any questions about this notice, please ask a Student Health Services
Receptionist to speak to our Director of Student Health Services. If you think that
we may have violated your privacy rights, you may speak to our Director of Student
Health Services and submit a written complaint. To take either action, please inform
the Student Health Services Receptionist that you wish to contact the Director of
Student Health Services or request a complaint form. You may submit a written complaint
to the U.S. Department of Health and Human Services; we will provide you with the
address to file you complaint. We will not retaliate in any way if you choose to file