Texas A&M University Student Health Services is required by law to maintain the privacy of certain confidential health information known, under FERPA, as Student Health Records, or SHR, and to provide you with a Notice of our legal duties and privacy practices with respect to your SHR. We are required to abide by the terms of this version of this notice, most currently in effect.
SHS Financial Practices
I understand that there are charges for services received at Student Health Services including a $15.00 office visit charge for general medical visits. Other visit types may have a higher charge based on the level of service, such as telemedicine, mental health or specialty visits. Payment for my visit is expected at the time of service. Unpaid health center charges or charges posted after my visit will be transferred to my student bursar account. I understand that there may be a delay in the posting of incurred SHS charges from the SHS clinical management system to my TAMU student bursar account.
If I have health insurance, SHS will file a claim to my health insurance company/carrier except for Medicaid, CHIPS, and other Medicaid Products (e.g. Superior, Molina, Community Health, Texas Women’s, STAR, Cooks Children, etc.). I am responsible for all co-pays, deductibles, co-insurance and non-covered services. Student Health Services will balance bill any amount not paid by your insurance carrier. All balances after insurance will be collected as above.
As my right, if I do not want a claim filed to my insurance I will contact Patient Services after my visit and make other payment arrangements.
Access the SHS Financial and General Consent policy here: Student Financial and General Consent Policy.
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.
Your information is protected by federal law. Texas A&M University Student Health Services is required to maintain the privacy of certain confidential health information known as Student Health Records, or SHR, and to provide you with this notice of our legal duties and privacy practices with respect to your SHR. We are required to abide by the terms of this version of this notice, most currently in effect.
My records may be shared with another healthcare provider if it is determined that a referral or consultation is needed for ongoing or continuing care. Additionally, TAMU CAPS and Student Health Services collaborate closely for the health of Texas A&M students. Our departments routinely share information related to health concerns, appointment attendance, assessments, and treatment planning for coordination of care purposes.
Uses and Disclosures of Student Health Records (SHR)
Texas A&M University Student Health Services may use SHR for the purposes of treatment, payment, and health care operations, in most cases without your written permission. Examples of our use of your SHR for these purposes are:
For Treatment – This includes such things as verbal and written information that we obtain about you and use pertaining to your medical condition and treatment provided to you by us and other medical personnel including doctors who give orders to allow us to provide treatment to you. It also includes information we give to other healthcare personnel to whom we transfer your care and treatment, which includes transfer of SHR via telephone to the hospital or dispatch center as well as providing the hospital with a copy of the written record we create in the course of providing you with treatment and transport.
For Payment – This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including such things as organizing your SHR and submitting bills to insurance companies (either directly or through a third party billing company), management of billed claims for services rendered, medical necessity determinations and reviews, utilization review, and the collection of outstanding accounts.
For Health Care Operations – This includes quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, and creating reports that do not individually identify you for data collection purposes.
Other Permitted Uses and Student Health Records (SHR)
Other ways in which Texas A&M University Student Health Services is permitted to use and/or disclose your SHR are:
As Required by Law - We may use or disclose your SHR to the extent that federal, state, or local law requires the use or disclosure. When used in this Notice, "required by law" is defined as it is in 34 CFR Part 99 – Family Educational Rights and Privacy.
For Public Health Activities – We may use or disclose your SHR for public health activities that are permitted or required by law. For example, we may use or disclose information to a public health authority authorized to receive reports of child abuse or neglect.
For Health Oversight Activities – We may disclose your SHR to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, civil, administrative, or criminal proceedings or other activities. Oversight agencies seeking this information include government agencies that oversee (1) the healthcare system, (2) government benefit programs, (3) other government regulatory programs, and (4) compliance with civil rights laws.
Reporting Abuse or Neglect – We may disclose your SHR to a government authority that is authorized by law to receive reports of abuse, neglect, or domestic violence. Additionally, as required by law, we may disclose to a government entity authorized to receive such information, if we believe that you have been a victim of abuse, neglect, or domestic violence.
Legal Proceedings – We may disclose your SHR (1) in the course of any judicial or administrative proceeding (2) in the response to an order of a court or administrative tribunal to the extent such disclosure is expressly authorized (3) in response to a subpoena, a discovery request, or other lawful process, once we have met all administrative requirements of the 34 CFR Part 99 – Family Educational Rights and Privacy.
Law Enforcement – Under certain conditions, we also disclose your SHR to law enforcement officials. Some of the reasons for such a disclosure may include, but not limited to: (1) it is required by law or some other legal process (2) it is necessary to locate or identify a suspect, fugitive, material witness, or missing person (3) it is necessary to provide evidence of a crime that occurred on our premises.
For Research – We may disclose your SHR to researchers when an institutional review board or privacy board has (1) reviewed the research proposal and established protocols to ensure the privacy of the information and (2) approved the researched.
Coroners, Medical Examiners, Funeral Directors, and Organ Donation – We may disclose SHR to a coroner or medical examiner for purposes of identifying a deceased person, determining a cause of death, or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose, as authorized by law, information to funeral directors so that they may carry out their duties. Further, we may disclose SHR to organizations that handle organ, eye, or tissue donation and transportation.
To Prevent a Serious Threat to Health or Safety – Consistent with federal and state laws, we may disclose your SHR if we believe that the disclosure is necessary to prevent or lessen a serious and imminent threat to health or safety of a person or the public. We may also disclose SHR if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security, Protective Services – Under certain conditions, we may disclose your SHR if you are, or were, Armed Forces personnel for activities deemed necessary by appropriate military command authorities. If you are a member of foreign military service, we may disclose your information to the foreign military authority. We also may disclose your SHR to authorized federal officials for conducting national security and intelligence activities, and for the protection of the President, other authorized persons, or heads of state.
Inmates – If you are an inmate of a correctional institution, we may disclose your SHR to the correctional institution or to a law enforcement official for (1) the institution to provide health care to you (2) your health and safety and the health and safety of others, or (3) the safety and security of the correctional institution.
Worker's Compensation – We may disclose your SHR to comply with worker's compensation laws and other similar programs that provide benefits for work related injuries or illnesses.
Others Involved in Your Health Care – Unless you object in writing we may disclose your SHR to a friend or family member (Emergency Contact) that you have identified as being involved with your health care. We also may disclose your information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. If you are not present or able to agree to these disclosures of your SHR, then we may, using our professional judgment, determine whether the disclosure is in your best interest.
Required Disclosures of Your Student Health Record (SHR)
The following is a description of the disclosure that we are required by law to make:
Disclosure to You – We are required to disclose to you most of your SHR in a "designated record set" when you request access to this information. Generally a "designated record set" contains medical and billing records as well as other records that are used to make decisions about your health care benefits. We are also required to provide, upon your request, an accounting of most disclosures of your SHR that are for reasons other than treatment, payment, and health care operations.
Other Uses and Disclosures of Your Student Health Record (SHR)
Other uses and disclosures of your SHR that are not described above will be made only with your written authorization. If you provide us with such an authorization, you may revoke the authorization in writing. However, the revocation will not be effective for information that we have used or disclosed relying on the authorization.
The following is a description of your rights with respect to your STUDENT HEALTH RECORD:
Right to Request a Restriction – You have the right to request a restriction on the SHR we use or disclose about you for treatment, payment or health care operations. We are not required to agree to any restriction that you may request. If we do agree to the restriction, we will comply with the restriction unless the information is needed to provide emergency treatment to you.
Right to Request Confidential Communications - If you believe that a disclosure of all or part of your SHR may endanger you, you may request that we communicate with you regarding your information in an alternative manner or at an alternative location. For example, you may request that we contact you only at your work.
Right to Inspect and Copy - You have the right to inspect and copy your SHR that is contained in the "designated record set." However, you may not inspect or copy psychotherapy notes or certain other information. We may deny your request to inspect and copy your SHR in certain limited circumstances. If you are denied access to your information, you may request that the denial be reviewed. A licensed health care professional chosen by us will review your request and the denial. The person performing the review will not be the same one who denied your initial request. Under certain conditions our denial will not be reviewable. If this event occurs, we will inform you in our denial that the decision is not reviewable.
Right to Request Amendment - If you believe that your SHR is incorrect or incomplete, you may request that we amend your information. In certain cases, we may deny your request for amendment. If we deny your request, you have the right to file a statement of disagreement with us. This statement will be linked with the disputed information and all future disclosures of the disputed information will include your statement of disagreement.
Right of Accounting – You have a right to an accounting of most disclosures of your SHR that are for reasons other than treatment, payment, or health care operations. An accounting will include the date(s) of disclosure, to whom we made the disclosure, a brief description of the information disclosed, and the purpose of the disclosure.
Right to a Paper Copy of This Notice – You have the right to a paper copy of this Notice, even if you have agreed to accept this notice electronically.
You also have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services or the Department of Education if you believe your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments, or complaints you may direct all inquiries to the Student Health Services Director.
Texas A&M University Student Health Services reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all student health records that we maintain. Any material changes to the Notice will be promptly posted in our facilities and posted on our web site. You can get a copy of the latest version of this notice by contacting the Student Health Services Director as listed.
If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact: the Texas A&M Privacy Office at email@example.com (979) 845-9853 or Dr. Martha Dannenbaum, Director, Texas A&M University Student Health Services, A. P. Beutel Health Center, 1264 TAMU, College Station TX 77843 or by phone at (979) 458-8300.
Your health care at Texas A&M University Student Health Services (A.P. Beutel Health Center) is a cooperative effort between you and your health care provider. Student Health Services staff would like for you to be aware of your individual rights as well as your responsibilities.
You Have the Right to:
- Reasonable and impartial access to available, medically indicated care, treatment, and service within our capability and capacity regardless of race, religion, beliefs, cultural values, gender, age or financial status
- Be treated with respect, consideration, and dignity
- Privacy as appropriate for this setting
- Expect reasonable attempts to communicate in your primary language or manner
- Confidentiality of disclosures and records within the limits of the law
- Receive, to the degree known, complete information concerning your diagnosis, evaluation, treatment, and prognosis
- Receive information about advance directives
- Participate in decisions involving your care
- A high standard of patient safety while in our care
- Consent to, or refuse, care and/or treatment and be informed of medical consequences
- Select and/or change your health care provider
- Know the name, credentials, and professional status of people serving you
- Review your medical records with a clinician
- Information about our services, the associated costs, and payment policies
- Opt out of participation in experimental research
- Access educational, counseling, protective and advocacy services
- Access emergency services
You Have the Responsibility to:
- Provide proper identification
- Provide complete and accurate information about current condition, medical history, medications, supplements, and any allergies or sensitivities
- Follow the prescribed treatment plan and report any significant changes in symptoms or failure to improve
- Inform a doctor or nurse if you do not understand the treatment plan
- Provide a responsible adult that can transport you from the facility and remain with you if directed by your healthcare provider or indicated on discharge instructions
- Inform your clinician of any directive that could affect your care
- Accept financial responsibility for charges incurred
- Be respectful of our other patients, staff, visitors, and SHS property
- Keep appointments or cancel the appointment in advance
- Undertake preventive health practices which promote health and safety and delay or avoid disease and injury
- Accept responsibility for outcomes related to refusing treatment or not following the medical team's instructions
- Provide feedback about services and policies.
- Respect the privacy and preserve the confidentiality of other patients and SHS staff.
With respect to your health information, you also have the following rights: Right to Inspect and Copy, Right to Request Restrictions, Right to Request, Amendment, Right to Disclosure Accounting, and Right to Request Alternate Methods of Communication.