Notice of Health Information Practices (HIPPA Notice)
This notice describes how information about you may be
used and disclosed and how you can get access to this information.
Please review it carefully.
At Butler University Health Services we are committed to
treating and using protected health information about you
responsibly. This Notice of Health Information Practices describes
the personal information we collect, and how and when we use or
disclose that information. It also describes your rights as they
relate to your protected health information. This Notice is
effective April 14, 2003, and applies to all protected health
information as defined by federal regulations.
Understanding Your Health Record/Information
Each time you visit Health Services, a record of your visit is
made. This may pertain to phone calls as well. Typically, this
record contains your symptoms, examination and test results,
diagnoses, treatment, and a plan for future care or treatment. This
information, often referred to as your health or medical record,
serves as a:
- Basis for planning your care and treatment,
- Means of communication among the many health professionals who
contribute to your care,
- Legal document describing the care you received,
- Means by which you or a third-party payer can verify that
services billed were actually provided,
- A tool in educating heath professionals,
- A source of data for medical research,
- A source of information for public health officials charged
with improving the health of this state and the nation,
- A source of data for our planning and marketing, and
- A tool with which we can assess and continually work to improve
the care we render and the outcomes we achieve.
Understanding what is in your record and how your health
information is used helps you to: ensure its accuracy; better
understand who, what, when, where, and why others may access your
health information; and make more informed decisions when
authorizing disclosure to others.
Your Health Information Rights
Although your health record is the physical property of Health
Services, the information belongs to you. You have the right
- Obtain a paper copy of this notice of information practices
- Inspect and copy your health record (subject to certain
- Request to amend your health record (subject to certain
- Obtain an accounting of many of the disclosures of your health
information that we make,
- Request communications of your health information by
alternative means or at alternative locations,
- Request a restriction on certain uses and disclosures of your
information (subject to certain limitations), and
- Revoke your authorization to use or disclose health information
except to the extent that action has already been taken.
If you would like more information about these rights and how to
exercise them, you should contact: the Director, Student Health
Services at (317) 940-9385.
Health Services is required to:
- Maintain the privacy of your health information,
- Provide you with this notice as to our legal duties and privacy
practices with respect to information we collect and maintain about
- Abide by the terms of this notice,
- Notify you if we are unable to agree to a requested restriction
or a requested amendment, and
- Accommodate reasonable requests you may have to communicate
health information by alternative means or at alternative
We reserve the right to change our practices and to make the new
provisions effective for all protected health information we
maintain. Should our information practices change, we will maintain
the new notice at our offices. We will post a copy of our current
notice at Health Services. You may request a copy of our current
notice at any time by contacting the Director of Health
We will not use or disclose your health information without your
authorization, except as described in this notice. If you have
authorized us to use or disclose your health information for a
purpose that is not described in this notice, we will discontinue
to use or disclose your health information after we have received a
written revocation of the authorization according to the procedures
included in the authorization. You should be aware that we are
unable to withdraw any uses or disclosures that we may have already
made with your written authorization.
For More Information or to Report a Problem
If have questions and would like additional information, you may
contact the Health Services Director, Health Services or designee
at (317) 940-9385.
If you believe your privacy rights have been violated, you can
file a complaint with the practice's Director or with the Office
for Civil Rights, U.S. Department of Health and Human Services.
There will be no retaliation for filing a complaint with either the
Privacy Officer or the Office for Civil Rights.
Examples of Disclosures for Treatment, Payment, Health Care
Operations, and Other Uses and Disclosures
This notice does not describe every possible use or disclosure
of your health information, however any use or disclosure we make
of your health information will fall into one of the following
We will use your health information for treatment.
For example: Information obtained by a nurse,
physician, or other member of your health care team will be
recorded in your record and used to determine the course of
treatment that should work best for you. Your physician will
document in your record his or her expectations of the members of
your health care team. Members of your health care team will then
record the actions they took and their observations. In that way,
the physician will know how you are responding to treatment.
We will also provide your physician or a subsequent health care
provider with copies of various reports that should assist him or
her in treating you once you've received treatment at Health
We will use your health information for payment.
For example: A bill may be sent to you or a
third-party payer. The information on or accompanying the bill may
include information that identifies you, as well as your diagnosis,
procedures, and supplies used. Health Services will bill your
student account (upon your request) for some of the procedures,
tests, labs, insurance co-pays, or immunizations that we may give.
Health Services will also give you a receipt for services rendered
upon your request.
We will use your health information for regular health
For example: Members of the medical staff, the
risk or quality improvement manager, or members of the 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 healthcare and service we
Business associates: There are some services
provided in our organization through contacts with business
associates. When these services are contracted, we may disclose
your health information to our business associate so that they can
perform the job we've asked them to do and bill you or your
third-party payer for services rendered. To protect your health
information, however, we require the business associate to
appropriately safeguard your information in accordance with the
Recovery Act-High Tech Act Sub Title D.
Notification: We may use or disclose
information to notify or assist in notifying a family member,
personal representative, or another person responsible for your
care, your location, and general condition.
Communication with family: Health
professionals, using their best judgment, may disclose to a family
member, other relative, close personal friend or any other person
you identify, health information relevant to that person's
involvement in your care or payment related to your care.
Abuse, Neglect, or Domestic Violence: We may
notify the appropriate government authority if we reasonably
believe that you have been the victim of abuse, neglect, or
Judicial and Administrative Proceedings: We may
disclose your health information in response to a court or an
administrative order. We may also disclose your health information
in response to a subpoena, discovery request, or other lawful
process by another person, but only if we believe that the party
seeking the information has made reasonable efforts to tell you
about the request or to obtain an order protecting the information
Research: We may disclose information to
researchers when their research has been approved by an
institutional review board that has reviewed the research proposal
and established protocols to ensure the privacy of your health
information. We may also allow researchers to view health
information if they are designing a research project; however, we
will require them to keep the health information confidential and
prevent them from contacting you.
Coroners, Medical Examiners, and Funeral
directors: We may disclose health information to coroners,
medical examiners, and funeral directors consistent with applicable
law to carry out their duties.
Organ Procurement Organizations: Consistent
with applicable law, we may disclose health information to organ
procurement organizations or other entities engaged in the
procurement, banking, or transplantation of organs for the purpose
of tissue donation and transplant.
Emergencies: We may use or disclose your health
information when we believe in good faith that it is necessary to
prevent a serious threat to your health or safety or the health or
safety of another person or the public.
Appointment Reminders and Health-Related
Benefits: We may contact you to provide appointment
reminders or information about treatment alternatives or other
health-related benefits and services that may be of interest to
Fundraising: We may contact you as part of a
Food and Drug Administration (FDA): We may
disclose to the FDA health information relative to adverse events
with respect to food, supplements, product and product defects, or
post marketing surveillance information to enable product recalls,
repairs, or replacement.
Workers compensation: We may disclose health
information to the extent authorized by and to the extent necessary
to comply with laws relating to workers compensation or other
similar programs established by law.
Public Health: As required by law, we may
disclose your health information to public health or legal
authorities charged with preventing or controlling disease, injury,
Correctional institution: Should you be an
inmate of a correctional institution, we may disclose to the
institution or agents thereof health information necessary for your
health and the health and safety of other individuals.
Law Enforcement: We may disclose health
information for law enforcement purposes as required by law or in
response to a valid subpoena.
Military and Veterans: We may disclose the
health information of individuals who are members of the Armed
Forces, as required by appropriate military command authorities.
Health information may be disclosed for purposes of determining an
individual's eligibility for or entitlement to benefits under
appropriate military laws. We may also disclose the health
information of foreign military personnel to the appropriate
foreign military authority.
National Security and Intelligence Activities:
We may disclose your health information to authorized federal
officials for lawful intelligence, counterintelligence, and other
national security activities as authorized by law.
Protective Services for the President and
Others: We may disclose your health information to
authorized federal officials, so they may adequately provide
protection to the President, other authorized persons, or foreign
heads of state. Health information may also be disclosed to conduct
Health Oversight: Federal law makes provision
for your health information to be released to an appropriate health
oversight agency, public health authority or attorney.
Whistleblowing: Federal law allows for your
health information to be disclosed to certain public agencies,
provided that a work force member or business associate believes in
good faith that we have engaged in unlawful conduct or have
otherwise violated professional or clinical standards and are
potentially endangering one or more patients, workers or the
Notice of Health
Information Practices (PDF)
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