Confidentiality Form                                                                                                                                                        [home]

 

 

Confidentiality Statement:

All communications between student and staff are strictly confidential and under no circumstances will information be released from the Wilkins Wellness Center without the student's written approval. 

Patient's Rights and Responsibilities
YOU HAVE THE RIGHT:

1.         To receive considerate and respectful care.
2.         To receive an explanation of your diagnosis and treatment in terms you can
             understand.
3.         To refuse treatment, except as prohibited by law, and to be informed of the
             consequences of making this decision.
4.         To expect that your personal privacy will be respected.
5.         To expect that your medical records will be kept confidential and will be       
             released only with your written consent, or in cases of medical emergencies,
             or in response to court-ordered subpoenas.  (Confidentiality can be violated if
             the individual poses a significant threat of harm to self or others.) 
6.         To access this medical information and request amendments to the medical records.  
7.         To revoke or limit authorization.
8.         To know the names and positions of people involved in your care.
9.         To ask for and receive an explanation of any charges that may be made.
10.       To review any medical records created and maintained regarding your care
             and treatment. 

YOU ARE RESPONSIBLE:
1.         For providing accurate information about your present and past health history.
2.         For asking questions if you do not understand the explanation of your
            diagnosis, treatment, or any instructions.
3.         For providing the necessary personal information to complete your file.
4.         For any charges for care provided.
5.         For following rules and regulations.

 

 

 
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