Upon completion of a medical history form, a health record is automatically prepared for you and placed on file in the Health Center. Your medical record is not part of the University record system and is not included in educational records. If you want a copy of your medical records or immunizations that you have received at West Texas A&M University, you must request it. It is strictly confidential. Information from your medical record will not be released without your written permission except in circumstances of danger to yourself or to others unless otherwise provided by law.
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. West Texas A&M University Student Medical Services (SMS) is required by law to maintain the privacy of certain confidential health information known as Protected Health Information, or PHI, and to provide you with a Notice of our legal duties and privacy practices with respect to your PHI. We are required to abide by the terms of this version of this notice most currently in effect.
West Texas A&M University Student Medical Services may use PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission. Examples of our use of your PHI for these purposes are:
We may use and disclose your PHI to anyone involved in your health care, including physicians, nurses, nurse practitioners, athletic trainers, as well as students (nurses, doctors, nurse practitioners and athletic trainers) who are completing training at this facility. We may disclose your PHI when we transfer your care and treatment to outside medical professionals. This includes transfer of PHI via telephone to the hospital or dispatch center as well as providing the hospital with a copy of the written record we create in the course of providing you with treatment and transport. PHI includes such things as verbal and written information that we obtain about you and use pertaining to your medical condition and treatment provided to you by us and other medical personnel including doctors who give orders to allow us to provide treatment to you.
This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including such things as organizing your PHI and submitting bills to insurance companies (either directly or through a third party billing company) management of billed claims for services rendered, placing a medical services hold on your university records, medical necessity determinations and reviews, utilization review, and the collection of outstanding accounts.
This includes quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, and creating reports that do not individually identify you for data collection purposes.
There are some businesses that provide services to our organization, such as laboratory and pharmacy services. These entities may need access to your PHI to perform the service. These businesses are required to safeguard your information at the same level as is required at Student Medical Services.
Other ways in which West Texas A&M University Student Medical Services is permitted to use and/or disclose your PHI are:
We may use or disclose your PHI to the extent that federal, state, or local law requires the use or disclosure. When used in this Notice, "required by law" is defined as it is in the HIPAA Privacy Regulations.
We may use or disclose your PHI for public health activities that are permitted or required by law. For example, we may use or disclose information to a public health authority or its authorized persons to carry out certain activities related to public health including the following:
· To prevent or control disease
· To report disease
· To report child, spouse or elder abuse/neglect
· To report reactions to medications regulated by the Food and Drug Administration
· To locate and notify persons of recalls of products they may be using
· To notify a person who may have been exposed to a communicable disease in order to stop the spread of the disease
We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, civil, administrative, or criminal proceedings or other activities. Oversight agencies seeking this information include government agencies that oversee (1) the healthcare system, (2) government benefit programs, (3) other government regulatory programs, and (4) compliance with civil rights laws.
We may disclose your PHI when required by a court or administrative tribunal order. We may also disclose PHI in response to subpoenas, discovery requests, or other legal proceedings.
Under certain conditions, we also disclose your PHI to law enforcement officials. Some of the reasons for such a disclosure may include, but not limited to: (1) it is required by law or some other legal process (2) it is necessary to locate or identify a suspect, fugitive, material witness, or missing person (3) it is necessary to provide evidence of a crime that occurred on our premises.
We may disclose your PHI to researchers when an institutional review board or privacy board has (1) reviewed the research proposal and established protocols to ensure the privacy of the information and (2) approved the research.
We may disclose PHI to a coroner or medical examiner for purposes of identifying a deceased person, determining a cause of death, or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose, as authorized by law, information to funeral directors so that they may carry out their duties. Further, we may disclose PHI to organizations that handle organ, eye, or tissue donation and transportation.
Consistent with federal and state laws, we may disclose your PHI if we believe that the disclosure is necessary to prevent or lessen a serious and imminent threat to health or safety of a person or the public. We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security, Protective Services - Under certain conditions, we may disclose your PHI for certain military and veteran activities, including determination of eligibility for veteran's benefits and where deemed necessary by appropriate military command authorities. If you are a member of foreign military service, we may disclose your information to the foreign military authority. We also may disclose your PHI to authorized federal officials for conducting national security and intelligence activities, and for the protection of the President, other authorized persons, or heads of state.
If you are an inmate of a correctional institution, we may disclose your PHI to the correctional institution or to a law enforcement official for (1) the institution to provide health care to you (2) your health and safety and the health and safety of others, or (3) the safety and security of the correctional institution.
We may disclose your PHI to comply with worker's compensation laws and other similar programs that provide benefits for work related injuries or illnesses.
Unless you object in writing we may disclose your PHI to a friend or family member that you have identified as being involved with your health care. We also may disclose your information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. If you are not present or able to agree to these disclosures of your PHI, then we may, using our professional judgment, determine whether the disclosure is in your best interest.
The following is a description of the disclosures that we are required by law to make.
We are required to disclose your PHI when the Secretary is investigating or determining our compliance with HIPAA Privacy Regulations.
We are required to disclose to you most of your PHI in a "designated record set" when you request access to this information. Generally a "designated record set" contains medical and billing records as well as other records that are used to make decisions about your health care benefits. We are also required to provide, upon your request, an accounting of most disclosures of your PHI that are for reasons other than treatment, payment, and health care operations.
Other uses and disclosures of your PHI that are not described above will be made only with your written authorization. If you provide us with such an authorization, you may revoke the authorization in writing, and this revocation will be effective for future disclosures of PHI. However, the revocation will not be effective for information that we have used or disclosed relying on the authorization.
The following is a description of your rights with respect to your protected health information.
You have the right to request a restriction on the PHI we use or disclose about you for treatment, payment or health care operations. We are not required to agree to any restriction that you may request. If we do agree to the restriction, we will comply with the restriction unless the information is needed to provide emergency treatment to you.
If you believe that a disclosure of all or part of your PHI may endanger you, you may request that we communicate with you regarding your information in an alternative manner or at an alternative location. For example, you may request that we contact you only at your work.
You have the right to inspect and copy your PHI that is contained in the "designated record set." However, you may not inspect or copy psychotherapy notes or certain other information. We may deny your request to inspect and copy your PHI in certain limited circumstances. If you are denied access to your information, you may request that the denial be reviewed. A licensed health care professional chosen by us will review your request and the denial. The person performing the review will not be the same one who denied your initial request. Under certain conditions our denial will not be reviewable. If this event occurs, we will inform you in our denial that the decision is not reviewable.
If you believe that your PHI is incorrect or incomplete, you may request that we amend your information. In certain cases, we may deny your request for amendment. If we deny your request, you have the right to file a statement of disagreement with us. This statement will be linked with the disputed information and all future disclosures of the disputed information will include your statement of disagreement.
You have a right to an accounting of most disclosures of your PHI that are for reasons other than treatment, payment, or health care operations. An accounting will include the date(s) of disclosure, to whom we made the disclosure, a brief description of the information disclosed, and the purpose of the disclosure. Your request may be for disclosures made up to six years before the date of your request, but in no event, for disclosures made before April 14, 2003.
You have the right to a paper copy of this Notice, even if you have agreed to accept this notice electronically.
You also have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments, or complaints you may direct all inquiries to the privacy officer listed at the end of this notice.
West Texas A&M University Student Medical Services reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all protected health information that we maintain. Any material changes to the Notice will be promptly posted in our facilities and posted on our web site, if we maintain one. You can get a copy of the latest version of this notice by contacting the Privacy Officer as listed at the end of this notice.
If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact: LuAnne Rickwartz, Privacy Officer, West Texas A&M University Student Medical Services, Virgil Henson Activities Center, Room 104 in person, WT Box 61401, Canyon, TX 79016 in writing, or 806-651-3287 by phone.
To request a copy of medical records, please download the following form: Authorization to Release Medical Records, complete and sign the document then fax to 806-651-3289.
updated March 6, 2015