Medical Records

Health Information Management is responsible for storing and administering all requests concerning patient medical records. You may request a copy of your records be sent to a 3rd party for medical treatment, or request a copy for yourself for personal use. For more information on this process, please select “Medical Records” on the menu bar.

If you are a new patient and have a chronic illness, please obtain a clinical summary from your current physician, and bring it to your first scheduled appointment with us.

To facilitate either the release of your records, or submission of information for inclusion in your records, please download the appropriate form below, fill out, and submit to us. You can fax your completed forms to 407.823.3359 or mail them to:

UCF Health Services
Attn: Business Office
P. O. Box 163333
Orlando, FL 32816-3333

Processing usually takes 24-48 hours.

Privacy Laws

We abide by HIPPA Standards. Students who are 18 or older must give us written consent in order to release any medical information to third parties, including their parents. You can find the consent forms below.

What is HIPAA?

HIPAA is the common name for the Health Insurance Portability and Accountability Act, which is a federal law that was passed in 1996. The primary goals of HIPAA are to improve the continuity of health insurance coverage for employees, to decrease the expense of health coverage through standardization of electronic transactions and to protect the privacy and confidentiality of personally identifiable health information. The Privacy Regulations section of HIPAA is what will primarily pertain to UCF students.

The Privacy Regulations

Give you more control over your health information
Set boundaries on the use and release of your health records
Establish appropriate safeguards that health care providers and others must achieve to protect the privacy of your health information
Create a balance when public responsibility requires disclosure

Notice Of Privacy Practices

The HIPAA law states that each healthcare facility is required to distribute a copy of their Notice of Privacy Practices to each patient. Each patient must sign an acknowledgment that they received this information.

The Notice of Privacy Practices informs you, the patient, of how your personal health information may be used or released to others. It also describes your rights and how to use them. Finally, the Notice of Privacy Practices explains how to file a privacy-related complaint.

The Health Center’s Notice of Privacy Practices is distributed in an abbreviated format. A copy of the full-length Notice can be obtained, in person, at the reception desk.

Patient Rights

The HIPAA law provides patients with seven “rights” concerning your personal health information and medical records. It is important that you understand these rights and how they affect your privacy. It is also important that you understand how to use these rights.

The right to get a copy of the Health Center’s Notice of Privacy Practices.
This notice is distributed at the reception desk when you check into the Health Center. If you do not receive one, please ask for it.

The right to see and copy your medical records.
You can obtain these records through the Health Center’s Health Information Management. Certain content (i.e. psychiatric notes) is exempt from this right.

The right to request restrictions on your medical record.
This means that you can request that your information not be released to family or friends who may be involved in your care. This form is available online, as well as with the Privacy Officer at the Health Center. There are instances where this request can be denied – please review the form for further details.

The right to receive confidential information at a second address or fax.
You may fill out a form requesting that mail be sent to an alternate address. This form is available online, as well as with the Privacy Officer at the Health Center. Please review the form for further details.

The right to ask your doctor to amend your medical record.
You may request that an amendment or an explanation be added to your medical record. This right does NOT allow changes to be made. This form is available online, as well as with the Privacy Officer at the Health Center. There are instances where this request can be denied – please review the form for further details.

The right to an accounting of disclosures of your medical records.
Some releases of your medical information must be tracked if not in the pursuit of payment, treatment or operations. You may request a copy of this tracking log. Only releases made after April 14, 2003 will be tracked. This form is available online, as well as with the Privacy Officer at the Health Center. Please review the form for further details.

The right to file a complaint.
If you feel your privacy rights have been violated, you may file a complaint with both the Health Center and the federal government. Complaint forms are available online as well as with the Privacy Officer at the Health Center. Please review the form for further details. Also, see the next section on Complaints.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Health Center or with the Secretary of the Department of Health and Human Services.

To file a complaint with the Health Center contact Gina Shahbandar, Privacy Compliance Officer at gshahban@mail.ucf.edu

All complaints must be submitted in writing.

Privacy Compliance Officer: Gina Shahbandar
Security Compliance Officer: Terry Wheeler
Patient Advocate: Betty Calton

Office of Civil Rights, Department of Health & Human Services
200 Independence Ave.
S.W., Washington, D.C.
20201
1-877-696-6775
http://www.hhs.gov

Forms

Authorization Forms
Authorization to receive information
Authorization for release of information
Authorization for release of psychiatric information
Authorization for visitor being present during the appointment

HIPAA Forms
Accounting of Disclosures Request Form
Amendment and Correction Request Form
Authorization to Release Information with Medrec
Communication Accommodation Request Form
Complaint Form
Notice of Privacy Practices
Restriction of Disclosures Request Form