CALIFORNIA STATE UNIVERSITY, FULLERTON STUDENT HEALTH & COUNSELING CENTER NOTICE OF PRIVACY PRACTICES
Welcome to the Student Health and Counseling Center at California State University, Fullerton. The Student Health & Counseling Center (SHCC) is staffed by a team of medical and mental health professionals to assist you in addressing your physical and mental health concerns. In order to provide you with the highest quality of care, SHCC utilizes an integrated treatment approach. Our multi‐disciplinary team of clinicians works collaboratively to optimize your wellness through seamless prevention and intervention. SHCC values the privacy of its patients and the confidentiality of the personal and health information entrusted to us. In order to protect your personal health information, we have policies and procedures regarding disclosing your Personal Health Information (PHI).
How We May Use and Disclose Medical Information About You
Medical and Mental Health treatment:
Information obtained by a counselor, nurse, clinician (a physician, psychiatrist, nurse practitioner) or other member of your health care team will be documented in your medical record and used to determine the course of treatment that should work best for you. Information is shared between services at SHCC on a strict “need to know” basis. The SHCC staff work as an integrated treatment team to provide quality care. Healthcare providers, including but not limited to, SHCC physicians, nurse practitioners, nurses, pharmacists, counselors, athletic trainers, physical therapists, and health educators may consult with other healthcare providers regarding treatment considerations on an as‐needed basis. Medical and mental health information is documented in a shared electronic medical record to facilitate integrated and coordinated care. SHCC contracts with other healthcare entities in order to provide certain ancillary services and support staffing needs. All contracted entities are required to uphold the same strict security and confidentiality policies and procedures. In an emergency situation, SHCC staff may refer you to another clinician or hospital; vital information may be shared with these health care providers.
SHCC may use and disclose health information about you so that the treatment and services you receive may be billed to and payment may be collected from you or a payor. For example, we may need to give your health plan information about a service you received here so that your health plan will reimburse you for the service. In cases of unpaid financial obligations or no show fees, SHCC will send the charge to Student Financial Services to be processed. The bill will show the following health information: name, student identification number, and date of service. No information relating to medical diagnoses, treatment/procedure, counseling session, or medications will be on this document.
Quality Improvement and Oversight Activities:
Members of the clinical staff and quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide. Oversight may include internal and external audits, chart reviews, investigations, licensures, and inspections required for compliance with government, college, accreditation programs and laws. Only the minimal necessary information will be released. On occasion, these reviews will involve sighting of individual information by the auditor, accreditation surveyors, etc. All individuals performing these reviews, audits, etc. will be required to agree with and sign the nondisclosure confidentiality standards of SHCC before being allowed access.
Public Health and Safety:
Health information may be disclosed as required by law to the proper authorities to report deaths, certain infectious diseases, occupational injuries and diseases, child abuse/neglect, domestic violence, problems with medications and other products as required by law to prevent/control disease, injury or disability to the patient or to others. In life threatening/extreme emergency situations, we may use or disclose health information to notify, or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition. Information may be disclosed if it is determined that there is imminent danger to self or others, or unable to care for themselves. In rare cases where there is a risk to the student or community, SHCC reserves the right to notify the Office of the Vice President for Student Affairs or Campus Police.
As Required by Law:
We will disclose health information about you when required to do so by federal, state, or local law. It may also be disclosed when legally requested by national security, intelligence, and other federal officials.
Research and Training Participation:
SHCC participates in the research and teaching mission of the university. Therefore, students from medical schools, nursing, physical therapy, athletic training, pharmacy, and mental health, counseling, and peer educators may participate in your care under the close supervision of a licensed professional. You have the right to decline if you do not wish for a student to be involved in your care. Aggregate data, that does not identify an individual, may also be gathered and used for research.
SHCC may contact you by phone, text, email, patient portal, voicemail, or letter as needed at the listed telephone number and/or address to follow up on care, provide a reminder of an appointment or to relay other relevant information. Lab results WILL NOT be left on a voicemail unless prior permission has been received. SHCC does not use e‐mail to initiate therapeutic conversations, as e‐mail is not considered confidential. Your e‐mail address will be used for scheduling purposes and client feedback surveys only. Unless the patient withdraws consent in writing, PHI will be made available to the patient via a secure patient portal established for each student.
Marketing and Fundraising:
SHCC does not sell or release any health information for fundraising or marketing purposes. It would be required of SHCC to notify you for authorization to release this information for this purpose and to provide you the option to opt out of receiving any information from this type of release.
Breach of Information:
SHCC is required by law to notify you if there has been an unsecured breech of your personal health information (PHI). A “breech” is defined as the unauthorized acquisition, access, use, or disclosure of protected health information which compromises the security or privacy of such information, except where an unauthorized person to whom such information is disclosed would not reasonably have been able to retain such information.
Your Individual Rights
You have a right to:
- Look at or obtain copies of your medical information. You must make your request in writing. You may also request access by sending a letter to the CSUF Student Health & Counseling Center. A fee may be charged for copying medical records.
- Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in the case of an emergency). It is the responsibility of the patient to relay these restrictions to other health organizations, pharmacies or healthcare providers of these restrictions if you are referred for treatment and wish to avoid information being disclosed to a health plan.
- Request that we communicate with you about your medical information by different means or to different locations. Your request that we communicate your medical information to you by different means or to different locations must be made in writing to CSUF Student Health & Counseling Center.
- Request that we change your medical information. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.
- Request an accounting of who we have disclosed your personal health information to.
- Restrict disclosures of PHI to a health plan for which the patient has paid out-of-pocket and in full.
Changes to this Notice
California State University, Fullerton, Student Health & Counseling Center reserves the right to change its privacy practices. If we make a change in our privacy practices, you will be notified of the changes. Copies of this Notice may be obtained from the reception desk located in Student Health & Counseling Center or on our website at www.fullerton.edu/shcc/.
Information and Complaints
Patients may file complaints regarding the security and/or privacy of their personal health information to:
Kathy Spofford Director California State University, Fullerton Student Health & Counseling Center 800 N. State College Blvd. P.O. Box 6830 Fullerton, CA 92831-6830 (657) 278‐2822 email@example.com
If you believe your privacy rights have been violated, you can file a complaint with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
Please click here if you would like a copy of this form.
Permission to treat
I grant permission to the clinician(s) in the Student Health and Counseling Center of California State University, Fullerton, to treat the student whose signature appears below for illness and/or injuries, to conduct all examinations and laboratory and minor surgical procedures as deemed advisable and are rendered under customary medical care, and to make necessary referrals to private physicians and other indicated community facilities. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care, but is given to provide authority and power for the aforementioned clinician(s) to render care which is his/her best judgment may be deemed advisable. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California.
State law (California Code of Regulations, Title 17, Public Health, Section 2500, 1990) requires health-care providers to report certain diseases and conditions of public health importance to the local health department. (List available on request).