University of Delaware Student Health Services

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/shs/. 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

Authorizations

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.

Your Health Information Rights

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. E.F. Joseph Siebold at 302-831-3699 or by writing: Dr. E.F. Joseph Siebold, 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. E.F. Joseph Siebold , by writing Dr. E.F. Joseph, 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.

Notice of Privacy Practices

Our Responsibilities

Newark, DE 19716-8101

Authorizations

Your Health Information Rights