Health Services Forms & Policies

Please Review Carefully

The privacy of your health information is important to you and to us.

Our Legal Duty

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request.

You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact the Student Health Center.

Uses and Disclosures of Health Information

We use and disclose health information about you for treatment, payment, and health care operations. For example:

Treatment:

We may use or disclose your health information to a physician, laboratory, pharmacy or other healthcare provider providing treatment or services to you. Your physical and mental health information is disclosed within the Student Health Center for treatment coordination if medically applicable.

Payment:

We may use and disclose your health information to billing and insurance companies to obtain payment for services we provide to you.

Healthcare Operations:

We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conduction training programs including clinical supervision of providers, accreditation, certification,
licensing or credentialing activities.

Your Authorization:

In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by our authorization while it was in effect. Unless you give us written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.

To Your Family, Friends and Houghton University Personnel:

We may disclose your health information to a family member, friend or to another person to the extent necessary to help with your health care or with payment for your health care, but only if you agree that we may do so. Generally, an authorization signed by you will be required prior to disclosing your health information to these individuals.

Persons Involved in Care:

We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, general condition or death. If you are present, then prior to use or disclosure or your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only heath information that is directly relevant ot the person’s involvement in your health care. We will also, use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.

To Your Parents If You Are A Minor (under 18 years old):

I required by federal or state law and you are a minor, your health information may be disclosed to your parents. Generally, health information regarding contraception, pregnancy, sexually transmitted disease, assault, and drug and alcohol use will not be released to parents or guardians without signed authorization by the patient.

Marketing Health-Related Services:

We will not use your health information for marketing communications without your written authorization.

Required by Law:

We may use or disclose your health information when we are required, by law, to do so.

National Security:

We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials heath information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose your health information to law enforcement officials, or in response to a court or administrative order, subpoena, discovery request or other lawful purposes.

Abuse or Neglect:

We may disclose your health information to appropriate authorities if we reasonably believe that you are a victim of current, on-going abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.

Appointment Reminders:

We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).

Patient Rights

Access:

You have the right to view or obtain copies of your health information , with limited exceptions (for example, you do not have the right to access psychotherapy notes). To obtain access to your health information you must make a request in writing to the address at the end of this Notice. We will charge you a reasonable cost-based fee for expenses such as copies and staff time. If you request copies, we will charge you $.15 for each page, $20.00 per hour for staff time to locate and copy your health information, and postage if you want copies mailed to you.

Restrictions:

You have the right to request (in writing) that we place additional restrictions on our use or disclosure of your health information. You may also request that we communicate with you by alternative means or at alternative locations. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).

Amendment:

You have the right to request that we amend your health information. (Your request must be in writing and it must explain why the information should be amended.)

Electronic Notice:

If you receive this Notice on our web site or by electronic mail (e-mail), you are entitled to receive this Notice in written form.

Questions and Complaints

If you have questions or concerns, or if you want more information about our privacy practices, please contact any staff member of the Houghton University Student Health Center.

If you are concerned that we may; have violated your privacy rights, or if you disagree with a decision we have made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information, you may voice your grievance by submitting it in writing to Dr. David Brubaker, Director, Houghton University Student Health Center. You may also submit a written complaint to the U.S. Department of Health and Human Services.

We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with Student Health Center staff or with any other department or agency.

The Right to:

• Treatment with consideration, respect and dignity
• Privacy during physical examinations, interviews and discussions
• Confidentiality of all records and disclosures except as required by law or when the patient gives written consent for release of information is given.
• Participate in decision-making involving one’s own wellness and health care interventions
• Information presented in understandable terms regarding diagnosis, treatment, prognosis, possible risks, and the medical consequences of refusing treatment.
• An explanation of fees.
• Request a specific provider and/or obtain a second opinion.
• Address questions, suggestions or grievances to the provider, Director of Student Health Services or VP for Student Life.

The Responsibility to:

• Keep and be on time for appointments and, if necessary, cancel appointments as far in advance as possible.
• Respond to health care providers and staff with courtesy.
• Describe symptoms and details of condition honestly.
• Provide the health care provider with accurate information about past and current medical conditions, treatments and medications
• Follow instructions for treatments and medications.
• Ask for clarification when needed.
• Provide insurance information on request.

Students are asked to bring their insurance card with them whenever they visit the health center.

If the physician is not available on site and a student is referred to an offsite facility (doctor’s office, urgent care, ER, etc) the student’s insurance will be billed by the rendering facility and the student will be responsible for any co-pays as outlined in their insurance policy.

MMR:

Effective August 1, 1990, New York State Public Health Law 2165 requires all students born after January 1, 1957 to show proof of immunity against measles, mumps, and rubella.  In compliance with that law, the Student Health Center must have documentation of the administration of 2 MMR vaccines (after the age of one and separated by at least one year) prior to the first day of classes.  If a student believes they have already had two shots, but cannot provide documentation of the dates, an alternative is to have blood work drawn to prove immunity.   Failure to provide adequate documentation of immunity may result in exclusion from classes until such time that the requirements are fulfilled.

Requests for medical exemptions must be accompanied by a statement from a physician documenting the nature of the medical contraindication and the expected duration of the condition (i.e. temporary or permanent).

Requests for religious exemptions must be made in writing by the student (not their parents) outlining the specific ways in which the administration of the immunization conflict with their religious convictions.

Immunization is available through the Student Health Center if needed.

MENINGOCOCCAL VACCINE:

State Law also requires the Student Health Center to document that each matriculating student has been given information about meningococcal disease and the available vaccine against it, and to document that each student who has not been vaccinated has been offered the vaccine.

The required Response Form is included in the Immunization Record portion of the Admission Health form.  Each student must indicate whether they received the immunization, declined the vaccine, or plan on getting the vaccine.  The Response Form must be signed by a Health Care Provider.

Though this form is required only on admission to college, by law a response form signed for admission to one college cannot be accepted at another.  Therefore, transfer students must provide Houghton University with a separate Response Form, even if they have taken care of this requirement at another school.

Failure to provide the required Response Form prior to the first day of classes may result in exclusion from classes until such time that the requirement is fulfilled.