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Patient Privacy Notice

CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Student Health Services
PRIVACY NOTICE

1. You have the right to know the Health Center’s policies and procedures regarding your health information, and, in most instances, to consent or to refuse consent to disclose such information to others. No member of the University’s management, staff, or faculty is entitled to such information without your written consent. Neither your spouse nor a parent is automatically entitled to receive health information about you. By law, your protected health information may be provided without your consent in some criminal investigations or in certain public health and emergency circumstances.

2. Your protected health information consists of that which we collect in the course of your medical care here and such information as you provide or authorize us to get from others. Such information also may be used for internal quality assurance studies, but study results will not be disclosed to outside agencies so as to identify you or your medical condition.

3. Your medical record is accessible only to members of the Health Center staff serving you. Safeguards regarding incidental use and disclosure of protected information within the Health Center have been established which still permit the staff to freely explore and discuss the best treatment options with and for you. When not in use, the record is physically secured as is any health information in electronic form.

4. Your counseling record, created by a Counselor in the Counseling Center, is not part of the medical record. Your physician needs your permission to see your counseling record, as does your counselor to see your medical record.

DISCLOSURE OF PROTECTED HEALTH INFORMATION

1. You must specifically authorize the Health Center to use or disclose protected information in most non-routine circumstances. The Health Center does not sell or otherwise provide protected health information to a business that wants to market its products or services to you.

2. With your written permission, a copy of part or all of a medical record may be sent to other physicians, hospitals, attorneys, investigating agencies, or others you designate. There may be a charge for such copies.

YOUR RIGHTS

1. You may request a copy of your record for your personal use. You may request corrections of your record subject to preserving the integrity of the documentation of the treatment process. Normally, a review of your medical record should be done in consultation with a health care professional. A Records Release form may be requested at the front desk if you wish to review your records or obtain a copy.

2. If you believe your privacy protections have been violated, you may file a formal complaint with the Health Center or the University. You may also have the right to pursue formal legal actions in state or federal court.

3. This written notice of Health Center privacy practices and your privacy rights is provided as a matter of law. Please acknowledge receipt of this privacy notice by signing below in the space indicated. A copy of this form will be placed in your permanent medical record. We reserve the right to change our practices and to make the new provisions effective for all individually identifiable health information we maintain. Should we change our information practices, we will mail a revised notice to the address you have supplied us.

We may revise our Notice of Privacy Practices from time to time. Student Health Services abides by the most current Notice in effect (which is indicated at the bottom right side of this page). This Notice of Privacy Practices is also posted in the Lobby of Student Health Services.

If you have any questions, concerns, or complaints about the notice or your medical information, please contact the Risk Management Chair at (661) 654-3453.