177 B State St
Boston, MA 02109
(617) 523 4444
(617) 367 2092
Notice of Privacy Practices version 2-27-03
(Effective April 14, 2003)
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND
DISCLOSED BY THE STUDENT HEALTH CENTER AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
UNDERSTANDING YOUR PROTECTED HEALTH INFORMATION (PHI):
Understanding what is in your health record and how your health information is used will help you
to ensure its accuracy, allow you to better understand who, what, when, where and why others may
access your health information, and assist you in making more informed decisions when authorizing
disclosure to others. When you visit us, we keep a record of your symptoms, examination, test
results, diagnoses, treatment plan, and other medical information. We also may obtain health
records from other providers. In using and disclosing this protected health information (PHI),
it is our objective to follow the Privacy Standards of the federal Health Insurance Portability
and Accountability Act, 45 CFR Part 464, even if this is not required in order to treat students.
The law allows us to use and disclose PHI without your specific authorization for treatment,
payment, operations and other specific purposes explained on the next page. This includes the
sharing of information, when necessary and appropriate, with other health care components of the
University, such as the athletic department, student health center, campus pharmacy or the
counseling center, as necessary for your continued care. It also includes contacting you for
appointment reminders and follow-up care. All other uses and disclosures require your specific
YOUR HEALTH INFORMATION RIGHTS ALLOW YOU TO:
. Request a restriction on the uses and disclosures of PHI as described in this notice, although
we are not required to agree to the restriction you request. You should address your request in
writing to the Privacy Officer. We will notify you within 30 days if we cannot agree to the restriction.
. Obtain a paper copy of this Notice and upon written request, inspect and obtain a copy of your health
record for a fee of $.60 per page and the actual cost of postage per NRS 629.061, except that you are not
entitled to access, or to obtain a copy of, psychotherapy notes and information compiled for legal proceedings.
. Amend your health record by submitting a written request with the reasons supporting the request to the
Privacy Officer. In most cases, we will respond within 30 days. We are not required to agree to the requested
. Obtain an accounting of disclosures of your health information, except that we are not required to account for
disclosures for treatment, payment, operations, or pursuant to authorization, among other exceptions.
. Request in writing to the Privacy Officer that we communicate with you by a specific method and at a specific
We will typically communicate with you in person; or by letter, e-mail, fax, and/or telephone.
. Revoke an authorization to use or disclose PHI at any time except where action has already been taken.
OUR RESPONSIBILITIES AS REQUIRED BY LAW:
. Maintain the privacy of PHI and provide you with notice of our legal duties and privacy practices with respect to PHI.
. Abide by the terms of the notice currently in effect. We have the right to change our notice of privacy practices
and we will apply the change to your entire PHI, including information obtained prior to the change.
. Use or disclose your PHI only with your authorization except as described in this notice.
. Follow the more stringent law in any circumstance where other state or federal law may further restrict the
disclosure of your PHI.
FOR MORE INFORMATION OR TO REPORT A PROBLEM, CONTACT THE PRIVACY OFFICER AT:
UNR Student Health Center,
Mail Stop 196 Reno, NV 89557
If you feel your rights have been violated, you may file a complaint in writing with the Privacy Officer.
If you are not satisfied with the resolution of the complaint, you may also file a complaint with the
Secretary of Health and Human Services. Filing a complaint will not result in retaliation.
We may use or disclose your PHI for treatment, payment and operations, and for purposes described below:
We will use and exchange information obtained by a physician, nurse practitioner, nurse or other medical
professionals, staff, trainees and volunteers in our office to determine your best course of treatment.
The information obtained from you or from other providers will become part of your medical records. We
may also disclose your PHI to other outside treating medical professionals and staff as deemed necessary
for your care. For example, we may disclose your PHI to an outside doctor for referral. We will also
provide your health care providers with copies of various reports to assist them in your treatment. If
you are a student-athlete, we may disclose PHI to athletic trainers and coaches pertaining to medical
conditions that may restrict your ability to compete.
We may send a bill to you or to your insurance carrier. Also, the disbursement office may receive PHI
as necessary to pay a claim. The information on or accompanying the bill may include information that
identifies you, as well as that portion of your PHI necessary to obtain payment.
HEALTH CARE OPERATIONS:
Members of the medical staff, trainees, medical students, a Risk or Quality Improvement team, or similar
internal personnel may use your information to assess the care and outcomes of your care in an effort to
improve the quality of the healthcare and service we provide or for educational purposes. For example,
an internal review team may review your medical records to determine the appropriateness of care. There
may also be times in which our accountants, auditors, health information specialists or attorneys may
review your PHI to meet their responsibilities.
OTHER USES AND DISCLOSURES NOT REQUIRING AUTHORIZATION:
. Business Associates: There are some services provided to our organization through contracts with
business associates, such as laboratory and radiology services. We may disclose your health information
to our business associates so that they can perform these services. We require the business associates to
safeguard your information to our standards.
. Notification: We may disclose limited health information to friends or family members identified by you
as being involved in your care or assisting you in payment. We may also notify a family member, or another
person responsible for your care, about your location and general condition.
. Legally Required Disclosures & Public Health: We may disclose PHI as required by law, or in a variety of
circumstances authorized by federal or state law. For example, we may disclose PHI to government officials
to avert a serious threat to health or safety or for public health purposes, such as to prevent or control
communicable disease (which may include notifying individuals that may have been exposed to the disease,
although in such circumstance you will not be personally identified), federal or state health oversight
agencies, child abuse or neglect, domestic violence, to an employer to evaluate work related injuries,
and to public officials to report births and deaths.
. Law Enforcement & Subpoenas: We may disclose PHI to law enforcement such as limited information for
identification and location purposes, or information regarding suspected victims of crime, including
crimes committed on our premises. We may also disclose PHI to others as required by court or administrative
order, or in response to a valid summons or subpoena.
. Information Regarding Decedents: We may disclose health information regarding a deceased person to: 1)
coroners and medical examiners to identify cause of death or other duties, 2) funeral directors for
their required duties and 3) to procurement organizations for purposes of organ and tissue donation.
. Research: We may also disclose PHI where the disclosure is solely for the purpose of designing a study,
or where the disclosure concerns decedents, or an institutional review board or privacy board has determined
that obtaining authorization is not feasible and protocols are in place to ensure the privacy of your
health information. In all other situations, we may only disclose PHI for research purposes with your
. Marketing & Fund Raising: We may contact you with information about treatment alternatives or other
health related benefits and services that may be of interest to you. We may also contact you as part
of a fund raising effort.
. Directory information: We may disclose limited information regarding your name and location for
directory purposes to those persons who ask for you by name or to members of the clergy. You may
request that we not include your name in the directory.
DISCLOSURES REQUIRING AUTHORIZATION:
The release of health information to other treating professionals outside the University System will be
made with written authorization from the patient, which you have the right to revoke at any time, except
to the extent we have already relied upon the authorization or in the event of an emergency.