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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.
If you have any questions about
this Notice, please contact:
Privacy Officer
Purdue University
West Lafayette, IN
Telephone: (765) 494-7113
E-mail: hipaa-privacy@purdue.edu
WHO MUST COMPLY WITH THIS NOTICE
This Notice applies to the following departments that provide health care services to students, faculty, and others including but not limited to: the Purdue University Student Health Center in West Lafayette, the Purdue Pharmacy, and Purdue’s SLHS Audiology and Speech-Language Clinics. It also applies to the following portions of the University that provide business support to the listed health providers: Accounts Receivable; Internal Audit; Information Technology at Purdue (partial); Student Services Workstation Technology; Public Records Office; Printing Services; Insurance Services Enterprise; OnePurdue Initiative; Environmental Health; Pharmacy, Nursing and Health Sciences Technical Services; SLHS Business and Main Offices; and SLHS Electronics and Technical Support. For convenience, the listed health care providers and the listed business support groups will be referred to in this Notice as “Health Care Providers.” The full list of covered components at Purdue University may be found at the following Web site: www.purdue.edu/hipaa. This Notice does not apply to the remainder of Purdue’s departments and schools.
Purdue’s Health Care Providers are
legally required to protect the privacy of your health information
and to provide you with a notice of privacy practices. This
Notice describes how the Health Care Providers may use and
disclose your protected health and medical information.
It also describes some rights you have regarding your health
information. Health information is information about you
that is received, used, or disclosed by Purdue’s Health
Care Providers concerning your physical or mental health,
health care services provided to you, or your health insurance
benefits and payments. Protected health information may
contain information that identifies you, including your
name, address, and other identifying information.
HOW WE MAY USE AND DISCLOSE YOUR
PROTECTED HEALTH INFORMATION
Mental health information, including psychological
or psychiatric treatment records, and information relating
to communicable diseases, including HIV records, are subject
to special protections under Indiana law. We will generally
only release such records or information with your written
authorization or with an appropriate court order. Alcohol
and drug abuse treatment information is also subject to
special protections under federal law. We will usually need
to get your written authorization or an appropriate court
order before we release this information. Except where there
are special protections under Indiana law or other federal
laws, we may use and disclose your health information without
your authorization for the following purposes:
For treatment. The Health Care Providers
may use and disclose your health information to provide
or assist with your treatment. For example, we may provide
your health information to a laboratory in order to obtain
a test result important for diagnosing or treating a condition
you may have.
To obtain payment for health care services.
We may use and disclose your health information in order
to bill and collect payment for the treatment and services
provided to you. For example, we may provide limited portions
of your health information to your health plan to get paid
for the health care services we provide to you. We may also
provide your health information to our business associates
who assist us with billing, such as billing companies, claims
processing companies, and others that process our health
care claims. We will only disclose the minimum amount of
information needed to obtain payment.
For health care operations. Your health
information may also be used or disclosed to improve and
conduct health care operations. For example, we may use
your health information in order to evaluate the quality
of health care services that you received, or to evaluate
the performance of the Health Care professionals who provided
health care services to you. We may also provide your health
information to our auditors, attorneys, consultants, and
others in order to make sure we are complying with the laws
that affect us. We may also use a sign-in sheet at registration
or other appropriate areas, and we may call you by name
in waiting and service areas.
When a disclosure is required by federal, state,
or local law, judicial or administrative proceedings, or
law enforcement. For example, we make disclosures
when a law requires that we report information to government
agencies and law enforcement personnel about victims of
abuse, neglect, or domestic violence; when dealing with
gunshot and other wounds; or when ordered in a judicial
or administrative proceeding.
Public health activities. For example,
we report required information about various diseases to
government officials in charge of collecting that information,
and we may provide coroners with necessary information relating
to an individual’s death.
Health oversight activities. For example,
we will provide information to assist the government when
it conducts an investigation or inspection of a health care
provider or organization.
Research purposes. In certain limited circumstances,
we may provide health information in order to conduct medical
research. Use of this information for research is subject
to either a special approval process, or removal of information
that may directly identify you. In most instances, we will
require your written authorization prior to using or disclosing
health information for research purposes.
Avoiding a serious threat of harm. In order
to avoid a serious threat to the health or safety of a person
or the public, we may provide health information to law
enforcement personnel or persons able to prevent or lessen
such harm.
Certain government functions. We may disclose
health information of military personnel and veterans in
certain situations, as well as for national security purposes
or when required to assist with governmental intelligence
operations.
Workers’ compensation. We disclose
health information in order to comply with workers’ compensation laws.
Appointment reminders and health-related benefits
or services. We may use health information to provide
appointment reminders, or give you information about treatment
alternatives, other health care services or benefits we
offer.
Business Associates. We will share your
health information with business associates that assist
our Health Care Providers. Business associates include people
or companies outside of Purdue who provide services to our
Health Care Providers. For example, health information may
be disclosed by the Student Health Center to a bill processing
company to obtain payment for services rendered. We have
agreements with our business associates to protect the privacy
of your health information.
Disclosures to family, friends, or others.
In very limited cases, we may provide health information
to family members, or close friends who are directly involved
in your care or the payment for your health care, unless
you tell us not to. For example, we may tell a friend who
asks for you by name where you are in our facility, and
we may allow a friend or family member to pick up a prescription
for you. We may also contact a family member if you have
a serious injury or in other emergency circumstances. We
may discuss medical information in the presence of a family
member or friend if you are also present and indicate that
it is okay to do so.
All other uses and disclosures require your prior
written authorization. In any other situation not
described above, we will ask for your written authorization
before using or disclosing any of your health information.
If you do sign an authorization to disclose your health
information, you can later revoke that authorization in
writing. This will stop any future uses and disclosures
to the extent that we have not taken any action relying
on the authorization.
RIGHTS YOU HAVE REGARDING YOUR
HEALTH INFORMATION
The Right to Request Limits on
Uses and Disclosures of Your Health Information.
You have the right to ask that Purdue’s Health Care
Providers limit the use and disclosure of your health information.
We will consider your request but we do not have to accept
it. If we do, we will put any limits in writing and abide
by them except in emergency situations where the information
is needed. You may not limit the uses and disclosures that
we are legally required to make.
The Right to Choose How We Send Health Information
to You. You have the right to ask that we send
your health information to you at an alternate address (for
example, sending information to your work address rather
than your home address) or by alternate means (for example,
by fax instead of regular mail). We must agree to your request
if we can easily provide it in the format you requested.
The Right to See and Get Copies of Your Health Information.
In most cases, you have the right to look at or get copies
of your health information that we have, but you must make
the request in writing. If we do not have your health information
but we know who does, we will tell you how to get it. We
will respond to you within 30 days after receiving your
written request. In certain situations, we may deny your
request. If we do, we will tell you, in writing, our reasons
for the denial and explain your right to have the denial
reviewed. If you request copies of your health information,
we will charge you a reasonable fee as permitted by Indiana
law. Instead of providing the health information you requested,
we may provide you with a summary or explanation of the
health information. We will only do this if you agree to
receive information in that form and if you agree to pay
the cost in advance.
The Right to Get a List of Certain Disclosures We
Have Made. You have the right to request a list
of instances in which we have disclosed your health information.
The list will not include uses or disclosures made for treatment,
payment, and health care operation, or information given
to your family or friends with your permission or in your
presence without objection. It will also not include disclosures
made directly to you or when you have given us a written
authorization for the release of health information. The
list will also not include information released for national
security purposes or given to correctional institutions.
To obtain this list, you must make a request in writing
to the Privacy Officer identified above. The list we will
give you will include disclosures made in the last six years
unless you request a shorter time, but will not include
any disclosure that occurred before April 14, 2003. We will
provide the list to you upon request once each year at no
charge
The Right to Amend or Update Your Health Information.
If you believe that there is a mistake in your health information
or that a piece of important information is missing, you
have the right to request that we amend the existing information.
You must provide the request and your reason for the request
in writing to the Privacy Officer identified above. We may
deny your request in writing if the health information is:
1) correct and complete; 2) not created by us; 3) not allowed
to be disclosed, or 4) not part of our records. Our written
denial will state the reasons for the denial and explain
your right to file a written statement of disagreement with
the denial. If you do not file a statement of disagreement,
you have the right to ask that your request and our denial
be attached to all future disclosures of your health information.
If we approve your request, we will make the change to your
health information, tell you that we have done it, and tell
others that need to know about the change to your health
information.
The Right to Get This Notice by E-Mail. You
have the right to get a copy of this Notice by e-mail. Even
if you have agreed to receive Notice via e-mail, you also
have the right to request a paper copy of this notice.
CHANGES TO THIS NOTICE
Purdue’s Health Care Providers are
required to abide by the terms of this Notice of Privacy
Practices. However, we may change our notice at any time.
The new notice will be effective for all protected health
information maintained by the covered Health Care Providers
of Purdue. A revised Notice of Privacy Practices will be
posted at the main entrances to our covered healthcare provider
areas, may be requested from the Privacy Officer listed
above, and may be found on our website at www.purdue.edu/hipaa.
WHAT TO DO IF YOU BELIEVE YOUR
PRIVACY RIGHTS HAVE BEEN VIOLATED
If you think that we may have violated your privacy rights, or you disagree with a decision we made about your health information, you may file a complaint with our Privacy Officer at the telephone number or e-mail address listed at the top of this notice. You also may send a written complaint to the Secretary of the Department of Health and Human Services. Further information about how to file a complaint is available from the Privacy Officer. We will not punish you or retaliate against you if you file a complaint about our privacy practices.
EFFECTIVE DATE OF THIS NOTICE.
This notice applies to uses and disclosures of your health information beginning on September 5, 2007.
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