Each time that you utilize the services of the ESU Department of Students Wellness and its Units of Student Health Services and Counseling Services (hereinafter "Units"), we make a record of your visit. This record may include medical and mental health information about you such as test results, billing information, diagnoses, treatment and mental health information. This Notice describes our privacy practices including how we may use and disclose your medical and mental health information and your rights and our responsibilities regarding this information. This Notice applies to all of the records of your care generated by the Department of Student Wellness and its Student Health Services and Counseling Services units. As allowed by law, we may use or disclose (share) medical and mental health information with each other for treatment, payment and day to day operations.

WHAT IS PROTECTED HEALTH INFORMATION?

Protected Health Information is all the information regarding your medical and mental health care at ESU Department of Student Wellness and its Units, Student Health Services and Counseling Services, health care information given to us at your request by other providers, and health care billing information. Generally, it is the information in your medical and mental health records. The Office of Disability Services maintains certain student, medical and mental health information.

OUR RESPONSIBILITIES REGARDING YOUR MEDICAL AND MENTAL HEALTH INFORMATION

ESU Student Wellness strives to protect your medical and mental health information and records. The law requires Student Wellness Units keep your medical and mental health information private. ESU must give you this Notice about our privacy practices, follow these practices, and notify you if ESU cannot agree to a request to restrict use or disclosure of your information. The Office of Disability Services is required to keep student, medical and mental health records confidential unless disclosure is allowed by law.

USES AND DISCLOSURES WITH YOUR WRITTEN CONSENT

You will be requested to sign a written consent form enabling Student Health Services and Counseling Services to use and disclose your protected health information for treatment, payment, and day-to-day health care operations:

1. Treatment: Student Health Services and Counseling Services will use and disclose medical and mental health information about you to provide and coordinate your health care and services. Example: Departments may share your medical information to plan your care. This could include prescriptions, lab work and other tests. We may share information with people not at ESU, such as a referring physician.
2. Payment: Student Health Services and Counseling Services will use and disclose medical and mental health information about you to bill and collect payment from you, the student health insurance company, or third-party payer. Example: You may receive lab work to diagnose your problem, and your health care provider and a lab technician may then review the results. Your health care provider may then direct the nurse to give you medicine for your problem. Then, your bill for this care may be sent to your student health insurance for payment.
3. Health Care Operations: Student Health Services and Counseling Services will use and disclose medical and mental health information about you to schedule appointments and coordinate your health care and related services. Student Health Services and Counseling Services will use your protected health information for internal quality assessment.
4. Other: Student Health Services and Counseling Services will use and disclose medical and mental health information about you to contracted service providers, so that they can perform the work we have asked them to do or to a friend or family member who is helping with your care. If you are not able to agree or object, such communications shall be made only by authorized healthcare providers when, in their professional judgment, such disclosure is in your best interest.

USES AND DISCLOSURES WITHOUT YOUR CONSENT

Student Health Services and Counseling Services may use or disclose medical and mental health information about you without your consent in certain situations. We may use or disclose your protected health information without your consent when:

1. Emergencies: When there is an emergency and your health care provider attempts to get consent as soon as is reasonably practicable after delivery of care, or there is potential that you are in imminent risk of doing harm to yourself or others, or when there are communication barriers to obtaining consent from you and the health care provider determines that your consent is inferred from the circumstances, or if Student Health Services or Counseling Services is required by law to treat you, and your health care provider has tried but is unable to get your consent.
2. Legal Requirement: We may use and disclose your protected health information as required by law: to report abuse, neglect, or domestic violence; comply with health audits and inspections; for public health purposes (legally reportable diseases); for government programs; and workers' compensation.
3. Law Enforcement and Court Proceedings: We may disclose protected health information to comply with lawful law enforcement requests for information or legal proceedings.
4. Research: We may use and disclose protected health information, as allowed by law; to researchers when their research has been approved by the institutional review board and privacy protocols have been established to ensure the privacy of your protected health information.
5. Other: We may also share medical information with a coroner or medical examiner. For example, we may do this for identification or cause of death determinations as allowed or required by law. In addition, the Counseling Center is an internship site for students majoring in a mental health field. If your counselor is an intern, your case may be discussed with and supervised by a licensed counselor and a faculty member from the intern's academic division. The intern may confidentially discuss your case as part of a practicum internship class. The intern may also ask you if the session may be electronically recorded to aid supervision or classroom learning. You will be fully informed and asked to sign a Consent Form if this is the case.

OTHER USES AND DISCLOSURES BASED ON YOUR AUTHORIZATION

Other uses and disclosures of your protected health information not covered by this Notice will only be made upon your written permission. If you provide such written permission, you may revoke it at any time.

Unless otherwise required by law, Counseling Services will obtain written authorization from you before releasing psychotherapy notes and notes of your conversations with professionals during private, group or other counseling sessions, which Counseling Services may keep separate from your medical record.

YOUR RIGHTS RELATED TO YOUR MEDICAL AND MENTAL HEALTH INFORMATION: YOU HAVE THE FOLLOWING RIGHTS IN YOUR PROTECTED HEALTH INFORMATION

1. Inspect and Copy: To the extent allowed by law, you have the right to inspect and be provided a copy of your medical and mental health information used to make decisions about your care, unless this might be harmful to you or to others. This includes medical and billing records, but does not include some records such as psychotherapy notes. Your request to access records must be in writing and a fee may be charged for processing your request.
2. Amendment: You have the right to request amendment of your medical and mental health information, if you believe the records are inaccurate or incomplete. You must request amendment in writing from Student Health Services and/or Counseling Services. You must provide the reason for the requested amendment. We may decline your request in certain circumstances such as but not limited to the record originated elsewhere, it is not part of the records we use, or it is accurate and complete.
3. Accounting of Disclosures: You have the right to receive an accounting of certain disclosures of your protected health information. You must submit a request in writing.
4. Restrictions: You have the right to request restrictions on certain uses and disclosures of your protected health information by Student Health Services and Counseling Services. If the request is approved, we will comply with your request unless the information is required for emergency treatment. Requests for restrictions must be made in writing, specify the information you want limited, how you want it limited, and to whom you want it to apply.
5. Confidential Communications: You have the right to request to receive communications of your protected health information in certain ways. You must make this request in writing, which will be accommodated if reasonable.
6. Paper Copy of Notice: You have the right to obtain a paper copy of this Privacy Notice. You may request a paper copy by calling 620-341-5222.
7. Complaints: You have the right to complain to Student Health Services, Counseling Services, to the Department of Student Wellness, and to the U.S. Health and Human Services Secretary, if believe your privacy rights have been violated. There will be no retaliation of any kind against you by Student Health Services or other Student Wellness units.

Those records which are student educational records as defined by FERPA and maintained Office of Disability Services are subject to the rights set forth in the University's FERPA policy. The records maintained by the Office which are subject to the ADA will be handled as so required.

ADDITIONAL INFORMATION

Protected Health Information properly disclosed at your request by Student Health Services and Counseling Services to another health care provider can be disclosed by them without the knowledge of Student Health Services and Counseling Services.

If you are using Counseling Services, the counselor may ask you to see a medical doctor to help determine if there is a medical condition, medication or other physical basis for a condition which needs medical attention. Continued counseling services may depend on cooperation with results of such referral, sharing referral results with my counselor, receiving additional service determined by my counselor, the counselor's ability to confer with other service providers, and establishing a counselor-approved ongoing cooperative team of service providers. You also have the right to discontinue counseling services at any time by notifying your counselor and your counselor may terminate Counseling Services if it is determined that your treatment needs require resources or competencies beyond those available at Counseling Services.

If other applicable law prohibits or limits use or disclosure of your Protected Health Information, Student Health Services and Counseling Services follow the more stringent law.

Any use or disclosure other than those described above is performed only after you give your consent. You may cancel your consent at any time by notifying Student Health Services or Counseling Services in writing.

The Student Health Services and Counseling Services reserve the right to change the terms of this Privacy Notice, and will provide clients with a copy of the revised notice.

If you have concerns about any Department of Student Wellness services or wish to file a complaint, you may contact the Director of Student Wellness at 620-341-5222. This Privacy notice is in effect as of Jan 1, 2011.