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.
Protected health information may be used by Health Service staff and disclosed to other Health Service staff in your treatment and Health Service operations, including, but not limited to, records maintenance, research and staff training. Such information also may be:

1. Used to secure payment for services rendered or products provided by the Health Service;
2. Used to confirm your visit to the Health Service on a given date upon inquiry by a faculty member; no other information will be given in response to such inquiries from faculty
3. Exchanged between the Health Service and the Training Room staff in the treatment of varsity athletes.

No one, including your parents, outside providers of health care, or faculty, has access to your protected health information without your written permission, except as required by law (Examples: reporting of certain communicable diseases to the NC Department of Health and Human Services or responding to a lawfully issued court order).

To protect the confidentiality of your written medical information, these directives are followed:

1. You must complete the "Authorization to Release Patient Medical Information" before copies will be released to you or a third party.
2. FAXing medical information will be done ONLY in situations of medical urgency.
3. The use of e-mail in sharing your medical information is limited to general information and clarification about your medical care.
4. Correspondence about you from other health care providers to the Health Service is not released.

You have the right:

• To request restrictions on the uses and disclosures of your medical information, though the Health Service may not agree;
• To receive confidential communications of protected health information;
• To inspect, copy, and/or request amendment of your protected health information;
• To receive an explanation of how your protected health information has been disclosed
• To revoke any prior authorization for use or disclosure of your protected health information through a written statement to the extent permitted by applicable laws or regulations;
• To obtain a paper copy of this Privacy Notice upon request; and
• To file a complaint with the M.S. Shook Student Health Service or the Secretary of the United States Department of Health and Human Services if you feel your privacy rights have been violated.

To obtain further information or to exercise any of your rights:

Please contact the Privacy Officer of the Health Service at 828-262-3100. All employees of Appalachian State University are prohibited from retaliating against you for filing a complaint or exercise of your other rights under law or University policies.
The M. S. Shook Student Health Service is required by law to maintain the privacy of protected health information and to provide notice of its legal duties and privacy practices with respect to this information. Additionally, the Health Service is required to abide by the terms of the notice currently in effect.

The Health Service reserves the right to change the terms of the notice and make the changes effective for all protected health information that it maintains. In a timely manner, the revised notice will be published on the Health Service web site, placed at the sign-in areas of the Health Service, and distributed by paper copy upon request.