Patient Rights As a UHS client/patient, you have the right to: General Rights Receive individualized service(s) with attention to intersecting identities including age, race, color, sexual orientation, religion, marital status, sex, gender identity, national origin or sponsor Receive humane care and treatment, with respect and consideration Access information regarding the scope and availability of services Be informed of the provisions for off-hour emergency coverage Receive information concerning diagnosis, treatment, risks involved, and prognosis of an illness or health-related condition. When receipt of such information would substantially and adversely affect your health, the information shall be made available to an appropriate person on your behalf Participate actively in decisions regarding your health care treatment Ask for a second professional opinion regarding diagnosis or treatment Change practitioners Refuse treatment to the extent permitted by law and to be fully informed of the medical consequences of your action Receive information regarding the amount that you will be billed by University Health Services after services are rendered and, if you are on the Student Health Plan, how to submit a claim in order to receive reimbursement Request interpretation assistance Informed Consent Receive from your health care provider information necessary to give informed consent prior to the start of any nonemergency procedure or treatment or both Be informed about any legal reporting requirements regarding any aspect of screening, treatment, or care1 Be informed of and to exercise the option to refuse to participate in any research related to care without compromising access to treatment Privacy and Confidentiality2 Maintain privacy and confidentiality when seeking or receiving care, except for life threatening situations or conditions Be assured of the confidentiality of your medical records Medical Record Receive a copy of your medical record Request to have your medical record amended Revoke your authorization to release your medical information except to the extent that action has not already been taken Complaints3 File a complaint regarding any concerns related to confidentiality or the quality of your health care. Feedback can be provided directly to your caregiver, your caregiver’s supervisor, or to the Director or Executive Director, UHS. Alternatively, you may provide your feedback using our online form. Patient Responsibilities As a UHS client/patient, you have the responsibility to: Provide complete information about your illness/problem, to enable proper evaluation and treatment, including information about over-the-counter products, dietary supplements and any allergies or sensitivities Ask questions so that you can understand your condition or problem Follow the agreed-upon treatment plan prescribed by your provider and participate in your care Use prescription or medical devices, as prescribed, for yourself only Inform the practitioner(s) if your condition worsens or an unexpected reaction occurs from a medication Behave respectfully toward all health care professionals and staff, as well as other patients and visitors Reschedule/cancel an appointment to allow another person to be given that time slot Provide requests for permission to release medical records in writing, to UHS Pay bills or file health claims in a timely manner. If you are not on the Student Health Plan, you are responsible for identifying how to file a claim with your insurer Accept personal financial responsibility for any charges not covered by insurance UHS' confidentiality policy ensures a patient's rights to privacy. University Health Services is committed to a model of care that integrates the unique physical, psychological and emotional factors that contribute to the health and well-being of each individual. To achieve this integrated approach, all clinical providers within UHS work as members of interdisciplinary teams and share patient related information whenever appropriate to enhance the quality of care. Except in serious emergencies notification of parents or guardians is the student's right and responsibility. Written authorization from the patient is necessary to release any health records, either to themselves or to a third party, except when required by law (e.g., reporting certain communicable diseases to the Health Department; circumstances that reasonable indicate a patient intends to carry out a threat or act of imminent, serious physical violence against themself or another). State and federal statutes protect patient records. 1 An informed consent shall include, as a minimum, the provision of information concerning the specific procedure or treatment or both, the reasonably foreseeable risks involved, and alternatives for care or treatment, if any, as a reasonable medical practitioner under similar circumstances would disclose, in a manner permitting the patient tomake a knowledgeable decision. 2University Health Services (UHS), including Counseling & Psychological Services (CPS), Medical Services, and SHARE, protects the privacy and confidentiality of patient information. In addition, Counseling & Psychological Services (CPS), SHARE, and all units within Medical Services (including Athletic Medicine, Infirmary, and Occupational Health) are designated as Confidential Resources. Our licensed doctors, counselors, nurses, and practitioners, and the dedicated staff who support them, are focused on your individual health care needs. Information you share with us (including the circumstances that led you to visit UHS) will only be disclosed with your express written permission, unless there is an imminent threat of serious harm or a specific legal obligation to reveal such information (e.g., if there is suspected abuse or neglect of a minor). 3 If you wish to express a grievance, we recommend that you speak with your caregiver first or ask to speak with their supervisor. If you are not satisfied with this health professional’s response to your concerns, we recommend that you place your grievance in writing and submit this written grievance to the Office of the Executive Director, indicating your preferred method of follow-up contact (e.g. in person meeting, telephone consultation, written response). The Executive Director’s contact information is as follows: email [email protected]; tel. 609-258-1430; mailing address: Executive Director/UHS, McCosh Health Center, Washington Road, Princeton University, Princeton, NJ 08544. If you are not satisfied with the response of the Executive Director, you may bring your grievance to the attention of the Office of the Vice President for Campus Life at Nassau Hall, Princeton University, Princeton NJ 08544 or the Office of Human Resources, 100 Overlook Center, Suite 400, Princeton NJ 08540. UHS reserves the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our practices change, we will make information available to the patients and clients we serve.