Notice of Privacy

Notice of Privacy Practices (To be read and signed by student and/or parents/guardians)

This notice describes how health information about you may be used and disclosed and how you may access your information. Please review carefully. The privacy of your health information is important 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 must follow the FERPA and HIPPA privacy practices that are described in this Notice while it is in effect.

You may request a copy of this Notice at any time.

Uses and Disclosures of Health Information

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

Treatment: We may use and disclose your health information to a physician for other healthcare providers providing treatment to you.

Payment: We may use or disclose your health information 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, conducting training programs, 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 your authorization while it was in effect.

To Your Family and Friends: We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend, or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree verbally or in writing that we may do so. We will ask for your permission in writing.

Persons Involved in Care: We may use or disclose your health information to assist in the notification of your location, your general condition, or death to a  family member, your personal representative, or another person responsible for your care. If you are present, then prior to use or disclosure, we will provide you with an opportunity to object to such uses. In the event of your incapacity or in emergency circumstances, we will disclose your health information based on our professional judgment. We will 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.

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

Law Enforcement: We may disclose to authorized federal, state or local law enforcement officials, the information required for lawful intelligence, counterintelligence, and other national security activities when required to do so by law.

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages and emails).

Patient Rights

Access: You have the right to look at or get copies of your health information with limited exceptions. You must make a request in writing to obtain access to your health information.

Restriction: 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 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. We may deny your request under certain circumstances.

Notice of Privacy Practices (To be read and signed by student and/or parents/guardians)

By signing below, I acknowledge that I have been given a copy of the Health Services Notice of Privacy Practices to read. I may request a copy of the Privacy Practices for my records. I also consent to the use and disclosure of my medical information to treat me and arrange for my medical care, to seek and receive payment for the services provided to me, and for the business operation for Manhattan University Health Services.