282 The
Green, Laurel Hall
Phone:
302-831-2226
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective as of
(Modified as of
(Privacy Officer updated May 6, 2013)
We
understand that information about you and your health is personal.
This notice will describe your rights and certain obligations we have
regarding the use and disclosure of your health information.
This notice applies to all records of your care created or received
at:
University of
Delaware
Student Health
Services
Laurel
Hall
University of
Delaware
Sports Medicine
Clinic
140 Bob
Carpenter Center
Newark, DE
19716-8101
For
purposes of this notice, these places will be referred to as “Facilities”. This notice also covers those
physicians, healthcare providers, and independent contractors that
provide healthcare services at the locations listed above, and those parts of
the University of Delaware that provide services to our Facilities, such as our
Department of Occupational Health and Safety, Office of Real Estate and Risk
Management, Office of Billing and Collection, Information Technologies,
University Executive Officers, Internal Audit Department, University Archives,
Center for Counseling and Student Development and the Physical Therapy
Clinic. These departments and
individuals will follow the terms of this notice and may share health
information with each other for treatment, payment, or healthcare operations as
described in this notice.
It is our responsibility to safeguard your
health information. We are
required by state and federal law to maintain the privacy of your health
information. We must also give you
this notice of our legal duties and our privacy practices, and we must follow
the terms of the notice that is currently in effect.
We reserve the right to change this notice
and to make the new provisions effective for all health information we maintain
as well as any health information we receive in the future.
We will post a copy of the current notice at our Facilities, and it will
also be available on our website at http://www.udel.edu/studenthealth/.
A copy of the current notice in effect will be available at the
registration desk of our Facilities.
Please
note, if you are a student at the University of Delaware, this notice does not
apply to you.
Permitted Uses and Disclosures
The following categories describe different ways that
we may use and disclose your health information. We have not listed every use or
disclosure within the categories, but describe some of the types of uses and
disclosures we may make.
Treatment –
We may use and disclose your health information to provide you with medical
treatment and services. For
example, your information may be disclosed to other healthcare providers who
perform lab work, read x-rays, interpret EKG’s and provide medications to our
dispensary (if they are involved in your care).
Payment – We
may use and disclose your health information so that the treatment and services
you receive may be billed to and payment collected from you, an insurance
company, or a third party. We may
also use and disclosure your health information in order to determine your
benefits, eligibility, and authorization to receive treatment from us. For example, your health information
may be shared with your insurance company and/or prescription payment plan so
that any appropriate costs can be charged/reimbursed to you. In addition,
information may be shared with the University of Delaware billing office so that
your account can be appropriately assessed.
Health Care
Operations – We may use and disclose
your health information for our healthcare operations.
For example, we may use your health information for the purposes of
reviewing and improving the quality of care/service, meeting accreditation
requirements, compiling statistics, and assuring compliance with
university/departmental regulations regarding immunization/TB testing
status.
Business Associates
– There are some services we provide through contracts with business
associates. For example, we
may disclose your health information to a collection agency in certain
situations when your account has become severely delinquent in an attempt to
collect payment for our services.
To protect your health information, we require our business associates to
sign written agreements which state that they will protect the privacy of your
information.
Appointment
Reminders and Alternative Treatments
– We may contact you to provide appointment reminders or information about
treatment alternatives or other health-related benefits and services that may
be of interest to you.
Individuals
Involved in Your Care or Payment for Your Care
– We may disclose your health information that is relevant to your medical care
or payment for your medical care to your friends, family members, or any person
you identify unless you tell us in advance not to do so.
We may also use or disclose your health information to notify (or assist
in notifying) your family members, personal representatives, or another person
involved in your care of your condition, status, or location.
In addition, we may disclose health information about you to an entity
assisting in a disaster relief effort (such as the Red Cross) so that your
family members, personal representatives, or another person involved in your
care can be notified about your condition, status, or
location.
Specifically
Approved Research – We may disclose
your health information to researchers when an Institutional Review Board (IRB)
or Privacy Board has reviewed the research proposal, has established certain
procedures to ensure the privacy of your health information, and has approved
the research.
We may also use or disclose your health information for
the following purposes in accordance with applicable law:
·
For public
health activities or legal authorities charged with preventing or controlling
disease, injury, or disability
·
To report
abuse, neglect, or domestic violence
·
To health
oversight agencies
·
For judicial
and administrative proceedings (in response to a subpoena or court
order)
·
For law
enforcement purposes, for example to identify a suspect, to provide information
about the victim of a crime, or to report criminal
conduct
·
To provide
information regarding decedents, for example, to coroners, medical examiners,
and funeral homes
·
For cadaveric
organ, eye or tissue donation
·
To avert a
serious threat to health or safety
·
For
specialized government functions, for example, national security and
intelligence activities, or to the military if you are a member of the armed
forces
·
To comply with
worker’s compensation laws
·
As required or
permitted by law
Other uses or disclosures of your health information
will only be made with your written permission called an authorization under
federal law and/or your consent under state law.
You may always refuse to sign an authorization or consent.
Please be aware that once your information has been disclosed, we have no
control over any re-disclosure by the recipient. You may always revoke an
authorization in writing. Except to the extent that the information has already
been used or disclosed, we will abide by your request to revoke your
authorization. Some typical
disclosures that require your authorization or consent are as
follows:
Treatment of Minors for STDs
– We will disclose information regarding the consultation, examination, and
treatment of a minor for sexually transmitted diseases (STDs) only in accordance
with state law. Generally, state
law requires that such information remain strictly confidential and may only be
released to the minor or those providing consent for the minor, and as necessary
to comply with laws relating to child abuse investigations or the control and
treatment of STDs.
HIV-Related Information
– We will disclose confidential HIV-related information only in accordance with
state law. Generally, state law
requires that confidential HIV-related information may only be disclosed to
those individuals you specify in a legally effective release or to those persons
specified by state law who may receive the information without your
consent.
Genetic Information
– We will use and disclose genetic information only in accordance with state
law. Generally, genetic
information may not be retained without first obtaining an informed consent
from the individual unless retention of the genetic information is specifically
permitted under state law.
Additionally, all samples of an individual from which genetic information
has been obtained will be destroyed promptly unless one of the exceptions to
retention under state law applies.
Genetic information will only be disclosed as permitted by
law.
Research –
Unless we receive specific approval from an Institutional Review Board (IRB) or
Privacy Board, we may disclose your health information to researchers only
after you have signed a specific written authorization.
You do not have to sign the authorization in order to get treatment, but
if you do refuse to sign the authorization, you cannot be part of the research
study.
The following describes your rights concerning your
health information. You may contact us using the information at the end of this
notice to exercise your rights, obtain the forms described here, get an
explanation on how to submit a request, or receive other additional
information.
Right
to Access - You have the right to
inspect and get copies of or receive a summary of certain portions of your
health record. You must make a request in writing, and may obtain a request
form from us. You may be charged a fee for the costs of copying, mailing, or
other supplies associated with your request. Under limited circumstances, we can deny
you the right to your medical records.
Right
to Amend - You have the right, with
limited exceptions, to request that we amend your health record. Your request
must be in writing, and it must explain why the information should be amended.
We may deny the request if your request is not in writing, if it does not
provide a reason for the amendment, if your health information was not created
by us or is not part of the information maintained by us, if the amendment
pertains to information you are not permitted to copy and inspect under
applicable law, or if the information in your medical record is complete and
accurate. If we deny your request
for an amendment, you may file a statement of disagreement with us, which we
have the right to rebut.
Right
to an Accounting -
You have the right to receive a list of instances since April 14, 2003 in
which we disclosed your health information except for those disclosures exempted
by law, for example, those for treatment, payment, or healthcare operations
purposes, and those authorized by you or your representative.
Your request must state a time period which may not be longer than six
(6) years (you may request a shorter time period) and may not be for disclosures
before April 14, 2003. If you
request this accounting more than once in a 12 month period, we may charge a
reasonable fee for responding to these additional
requests.
Right
to Request Restrictions - You have
the right to request that we place additional restrictions on our use or
disclosure of your health information. We are not required to agree to these
restrictions, but if we do, we will abide by our agreement (except in an
emergency). You must make your request in writing.
Any agreement we may make to your request for additional restrictions
must be in writing signed by a person authorized to make such an agreement on
our behalf. We will not be
bound unless our agreement is in writing.
Right
to Confidential Communications - You
have the right to request that we communicate with you about your health
information by alternative means or to alternative locations. You do not have
to explain the basis for your request. You must make this request in writing
and specify how or where you wish to be contacted and we will accommodate all
reasonable requests.
Right
to a Paper Copy – You have the right
to obtain a paper copy of this notice of privacy practices upon request, even
if you have agreed to accept this notice electronically.
Please let us know in person or contact our Privacy Officer and we will
provide you with a paper copy.
Right
to Revoke – You have the right to
revoke your authorization or consent to use or disclose health information
except to the extent that we or others have relied on your prior authorization
or consent.
For More
Information or to Report a Problem
If
you would like more information about our privacy practices or if you have
questions or concerns, please contact our Privacy Officer, Dr. Timothy Dowling
at 302-831-3699 or by writing: Dr.
Timothy Dowling, University of Delaware, Student Health Services, Laurel Hall,
Newark, DE
19716-8101.
If
you believe your privacy rights have been violated, you also have the right to
file a complaint with our Privacy Officer, Dr. Timothy Dowling, by writing: Dr.
Timothy Dowling, University of Delaware, Student Health Services, Laurel Hall,
Newark, DE 19716-8101. All
complaints must be in writing and you will not be penalized in any way for
making a complaint. You may also
submit a written complaint to the U.S. Department of Health and Human
Services.