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Earlham College Health Services Privacy Form
Your Privacy Is Important To Us Earlham College Health Services is committed to protecting the information you share with us, and in turn respecting your privacy. This Privacy Statement will explain what type of information we keep, how we use your information and how we protect your information. Health Services reserves the right to change this Privacy Statement at any time and will notify students of any changes required by law. What Information We Keep Health Services understands your concerns regarding the confidentiality of information you share with us. We keep information that you share with us during your admission registration to the College, appointments, and immunization information if you receive the immunization at our clinic, and we keep information sent from other health care providers that assist in your health care. We collect this information to accurately identify you, understand your needs, and provide excellent medical care. We refer you to outside providers as necessary, and comply with federal, state and College regulations. What We May Disclose Unless we have written consent, we do not disclose any nonpublic personal information about patients or former patients to anyone, except as permitted by law. We may use the information you share with us internally to respond to or assist in improving our care, or in audits conducted by our accrediting bodies. Only with your written consent or to the extent permitted by law, may we share the information we keep with nonaffiliated health care providers, professors, parents of students over 18 years of age, or other parties. Protecting Your Personal Information Health Services takes the security of your information very seriously and has established security standards and procedures to prevent unauthorized access to your medical information. We maintain physical, electronic and procedural safeguards to protect your information. Only authorized personnel within our organization who need to service your record, or who are involved in your care see your information. These individuals are trained properly to handle confidential information and must abide by the terms of our confidentiality agreement. Former Students If you are no longer a student at Health Services, we will adhere to the same information policies and practices to prevent unauthorized access to your medical information. Please sign acknowledging that you have read the above, and return this form and the white health forms in the envelope provided. _______________________________________________ _______
Counseling and Health Services Offices |
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Earlham College · 801 National Road West · Richmond,
Indiana 47374-4095 |