NOTICE OF PRIVACY PRACTICES

To our patients: This notice describes how health information about you, as a patient of the Student Health Service, may be used and disclosed, and how you can get access to your health information. This is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Please review this notice carefully. If you would like a copy of this notice, it will be provided at any time. Please request a copy from our front desk.

How the Student Health Service may use and disclose health information about you

You give the Student Health Service consent to use and disclose your health information for the following purposes:

1. For treatment: we may use health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, office staff, pharmacists, or other personnel who are involved in taking care of you and your health. Examples include:

- disclosing your condition to another medical professional to help determine the most appropriate care for you

- sharing information with people who do not work in our office in order to coordinate your care, such as phoning in a prescription or ordering an x-ray

2. For payment: we may use and disclose health information about you so that treatment and services you receive at the Student Health Service may be billed to and payment may be collected from you, an insurance company, or a third party. For example:

- we may need to disclose to your health plan information about a service you received here so your health plan will pay us or reimburse you for the service

- we will submit charges to the Bursar’s office to place on your student account (when charges are placed on your account, the bill will reflect “Student Health Service” and the amount charged. No health information will be entered on the bill.)

3. For healthcare operations: we may use and disclose health information about you in order to run the office and make sure that you and our other patients receive quality care. For example:

- we may use your health information to evaluate the performance of our staff in caring for you

- we may use health information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective

4. Appointment reminders: we may contact you as a reminder that you have an appointment for treatment or medical care at the office

5. Treatment alternatives and other health-related products and services: we may tell you about or recommend possible treatment options or alternatives or other health-related benefits and services that may be of interest to you

6. Business associates: we may contract with business associates to provide certain services and disclose your health information so they can perform the job we have requested. We require the business associate to appropriately safeguard your information. For example:

- sending a lab specimen to an outside laboratory for processing

- having an x-ray reviewed by a radiologist

Please notify the Student Health Service in writing if you do not wish to be contacted for appointment reminders, or if you do not wish to receive communications about treatment alternatives or health-related products and services. You may revoke your consent at any time by giving us written notice. Your revocation will be effective when we receive it, but it will not apply retroactively to uses and disclosures that occurred before that time. If you do revoke your consent, we will not be permitted to use or disclose information for purposes of treatment, payment, or healthcare operations, and we may therefore choose to discontinue providing you with healthcare treatment and services.

Use and disclosure of your health information in special circumstances

The following circumstances may require the Student Health Service to use and disclose your health information without your permission, subject to all applicable legal requirements and limitations.

1. To avert a serious threat to your health and safety or the health and safety of another individual or the public. We will only make disclosures to a person or organization able to help prevent the threat.

2. When required by federal, state, or local law.

3. For research projects that are subject to a special approval process. We will ask you for your permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care at the office.

4. For organ and tissue donation. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye, or tissue transplantation, or to an organ donation bank, as necessary to facilitate such donation and transplantation.

5. Military, Veterans, National Security and Intelligence. If you are or were a member of the US or foreign armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release health information about you.

6. Worker’s Compensation. We may release information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

7. Public Health Risks. We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products.

8. Health Oversight Activities. We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the healthcare system, government programs, and compliance with civil rights laws.

9. Lawsuits and disputes. If you are involved in a lawsuit or dispute, we may disclose health information about you in response to a court or administrative order. Subject to all legal requirements, we may also disclose health information about you in response to a subpoena.

10. Law enforcement. We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons, or similar process, subject to all legal requirements, or if you are an inmate or under the custody of a law enforcement official.

11. Coroners, Medical Examiners, and Funeral Directors. This may be necessary, for example, to identify a deceased person and determine the cause of death.

12. Information not personally identifiable. We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.

13. Family and Friends. We may disclose health information about you to your family and friends if we can infer from the circumstances, based on our professional judgment, that you would not object. For example, we may assume that you agree to our disclosure of your personal health information to your spouse when you bring your spouse with you into the exam room during treatment or while treatment is discussed.

In situations where you are not capable of giving your consent (because you are not present or due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to your family member or friend is in your best interest. In such a situation, we will disclose only health information relevant to the person’s involvement in your care; for example, that we are arranging for transportation to the emergency room as you may be having a heart attack. We may also use our professional judgment and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up, for example, filled prescriptions, medical supplies, or x-rays.

Other uses and disclosures of health information

We will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific written authorization. We must obtain your authorization separate from any consent that we may have obtained from you. If you give us authorization, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose information about you for the reasons covered in your written authorization, but we cannot take back uses or disclosures already made under your authorization.

Your rights regarding health information about you

You have the following rights regarding health information we maintain about you:

1. Communications. You can request that we communicate with you about your health and related issues in a particular manner or at a certain location. For example, you may ask that we contact you at home rather than at work. We will accommodate all reasonable requests.

2. Inspect and copy. You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patient medical records and billing records, but not psychotherapy notes. You must submit a request in writing to the front desk in order to inspect and/or copy your health information. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, and other associated supplies.

3. Amend. You may ask us to amend your health information if you believe it is incorrect or incomplete, and as long as the information is kept by or for the Student Health Service. To request an amendment, your request must be made in writing and submitted to the Director or designee. You must provide us with a reason that supports your request for amendment. We may deny your request if you ask us to amend information that:

- we did not create;

- is not part of the health information we keep;

- you would not be permitted to inspect and copy; and

- is accurate and complete.

4. Accounting of disclosures. You have a right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you for purposes other than treatment, payment, and healthcare operations. To obtain the list, you must submit your request in writing to the front desk. It must state a time period, which may not be longer than six years and may not include dates prior to 4/14/03. Your request should indicate in what form you want the list (i.e., on paper or electronically).

5. Request restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, like a family member. For example, you could ask that we not use or disclose information about a surgery you had. We are not required to agree with your request. If we do agree, we will comply unless the information is needed to provide you with emergency treatment. To request restrictions, you must submit a request in writing to the Director or designee stating the specific restriction requested and to whom you want the restriction to apply.

Changes to this notice

We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post the current notice in the office as well as on our web page with its effective date. You are entitled to a copy of the notice currently in effect.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. To file a complaint, please contact:

- Privacy Officer

Joanne E. Steane, M.D., Director

UW Student Health Service

Dept. Box 3068

1000 E. University Ave.

Laramie, WY 82071

Phone 307-766-2130; fax 307-766-2711

- Region VIII Office for Civil Rights

US Department of Health and Human Services

1961 Stout St.

Room 1185 FOB

Denver CO 80294-3538

Phone 303-844-2024; fax 303-844-2025; TDD 303-844-3439

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