Student Handbook

NOTICE OF INFORMATION PRACTICES

Uses and Disclosures of Health Information

Health information about you is obtained and kept on file in the Department of Nursing. This is done to fulfill the terms of written agreements between the department and clinical agencies with whom the department affiliates for clinical experiences. In general, a written authorization to release information is required from you to share health information with any third party not involved in your medical care. If you choose to sign an authorization to disclose information about you, you can later revoke that authorization to stop any future uses and disclosures.

Identifiable health information about you may be disclosed without your authorization to theses affiliating agencies only to document that legal health requirements have been met.

Individual Rights

In most cases and according to New York State Medical Records law, you have the right to review or receive a copy of your health information. You also have the right to receive a list of instances where we have disclosed health information about you for reasons other than related administrative purposes. If you believe that information in your record is incorrect or if important information is missing, you have the right to request a correction of the existing information or add the missing information.

Complaints

If you are concerned that your privacy rights have been violated, or you disagree with a decision made about access to your records, you may contact the person listed below. You may also send a written complaint to the U.S. Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request.

Our Legal Duty

We are required by law to protect the privacy of your health information, provide this notice about our information practices, and follow the information practices that are described in this notice.

If you have questions or complaints, please contact:

Kathy Peterson
Chairperson, Department of Nursing
SUNY Brockport
Brockport, N.Y. 14420
(585) 395-5306

I acknowledge that I have received a copy of this Notice of Privacy Practices

_____________________________ (signature)

_____________________________ (PRINT NAME) (DATE)

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