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Patient Privacy Notice

Student Health Services

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.

Privacy rules require that we furnish you with this notice. The required acknowledgment of receipt of this form is found in your Patient Portal.


The Student Health Services (SHS) medical providers, professional staff, employees and volunteers follow the privacy practices described in this Notice. Your medical information is maintained in records that will be handled in a confidential manner, as required by law. However, SHS representatives must use and disclose your medical information to the extent necessary to provide you with quality health care. To do this, your medical information must be shared with others as necessary for treatment, payment and health care operations.


Treatment includes sharing information among health care providers involved in your care. For example, your treatment provider may share information about your condition with other CSUB SHS providers in order to make a diagnosis or to improve the quality of care (review and training purposes, etc.). In addition, we also may use your medical information as required by your insurer to obtain payment for your treatment.


Your medical information may be used—unless you ask for restrictions on a specific use of disclosure—for the following purposes:

  • Appointment reminders.
  • To inform you of treatment alternatives, benefits or services related to your health. (You will have an opportunity to refuse to receive this information.)
  • To carry out health care treatment, payment and operational functions through business associates (Family PACT billing, etc.).
  • Alcohol and drug abuse information has special privacy protections. SHS medical providers will not disclose any information relating to substance abuse treatment unless: (i) consent is obtained in writing; (ii) a court order requires disclosure of the information; (iii) medical personnel need the information to meet a medical emergency; (iv) qualified personnel use this information for the purpose of conducting scientific research, management audits, financial audits or program evaluation; or (v) as required by law to report a crime, threat to commit a crime, abuse or neglect.
  • Worker's Compensation. (Your medical information regarding benefits for work-related illnesses may be released as appropriate.)
  • Internal Quality Assurance/Improvement studies
  • Health oversight activities (audits, inspections, investigations, licensure, etc.).
  • To prevent a serious threat to health or safety.
  • Law enforcement (in response to a court order or other legal process; to identify or locate an individual being sought by authorities; about the victim of a crime under restricted circumstances; about a death that may be the result of criminal conduct; circumstances relating to reporting information about a crime, etc.).
  • Disaster relief agency if injured in a disaster.
  • National security and intelligence activities.
  • Protection of the President or other authorized persons for foreign heads of state, or to conduct special investigations.
  • Lawsuits and disputes. (We will attempt to provide you advance notice of a subpoena before disclosing the information.)
  • As required by law.


Except as described above, we will not use or disclose your medical information unless you provide written authorization. You may revoke your permission, which will be effective only after the date of your written revocation. In addition, please note the Counseling Center is not part of Student Health Services. Your counseling record is created by a Counseling Center counselor or psychiatrist and is not part of your medical record. Therefore, your physician at the SHS would need permission to see your counseling record, as would your counselor to see your medical record. A records release form may be requested at the front desk if you wish to review your records or obtain a copy.


Provided that you make a written request, you can invoke the following rights regarding your medical information:

  • Right to know the CSUB Student Health Services's policies and procedures regarding your health information. No member of the University's management, staff or faculty is entitled to receive health information about you. Additionally, neither your spouse nor your parents are entitled to this information. In some cases, your protected health information may be provided without your consent (see “What Are Other Ways Your Medical Information Can Be Used?” section).
  • Right to request restrictions. You may request limitations on your medical information that we use or disclose for health care treatment, payment or operations (for example, you may ask us not to disclose that you have had a specific treatment). However, we are not required to agree to your request. If we agree—and, unless the information is needed to provide you with emergency services—we will comply with your request.
  • Right to confidential communications. You may request communication in a certain way or at a certain location, but you must specify how or where you wish to be contacted.
  • Right to inspect and request a copy. You have the right to inspect and request a copy of your medical information regarding decisions about your care. A records release form may be requested at the front desk if you wish to review your records or obtain a copy. Under limited circumstances, your request may be denied. In that instance, you may request review of the denial by another licensed health care professional chosen by the SHS medical providers. The SHS will comply with the outcome of the review.
  • Right to request amendment. If you believe the medical information we have about you is incorrect or incomplete, you may request an amendment. This is subject to preserving the integrity of the document of the treatment process and requires specific information. The SHS medical providers are not required to accept the amendment.
  • Right to accounting disclosures. You may request a list of the disclosures of your medical information that have been made to persons or entities other than for health care treatment, payment or operations in the past six (6) years, but not prior to April 14, 2003.
  • Right to a copy of this Notice. You may request a copy of this Notice at any time, even if you have been provided with an electronic copy.


We—the Student Health Services's (SHS) medical providers—are required by law to provide you with this Notice. We will be governed by this Notice for as long as it is in effect. We reserve the right to change this Notice, our practices and to make the new provisions effective for all individually identifiable health information we maintain—both current and future. Each time you register for health care services, you may receive a copy of the Notice in effect at the time. This written notice of SHS privacy practices and your privacy rights is provided as a matter of law. Please acknowledge receipt of this privacy notice by signing into your Patient Portal, or obtaining a copy at the SHS front desk. A copy of this form will be placed in your permanent medical record.


If you believe your privacy rights have been violated, you may file a formal complaint with the SHS Risk Management Chair ( or 661-654-3453) or with the Secretary of the United States Department of Health and Human Services. You will not be penalized or retaliated against in any way for making a complaint to these organizations.

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