Conditions of Treatment Form

POLICY NO : 6070

EFFECTIVE DATE: 03/17/03

Conditions of Treatment Form Policy

NOTE: These guidelines are provided to assist UNMC workforce, including those in the patient treatment areas of the Munroe-Meyer Institute, the College of Medicine Optical Shop, the Lions Eye Bank and the College of Dentistry, as applicable, comply with HIPAA regulations. Those departments and clinics which fall under the jurisdiction of The Nebraska Medical Center and/or University Medical Associates should consult the policies and procedures of those entities for authoritative guidance.

Basis for Policy

It is the policy of the University of Nebraska Medical Center (UNMC) to use and disclose protected health information in accordance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements and Executive Memorandum No. 27, HIPAA Compliance Policy.

Policy

The University of Nebraska Medical Center (UNMC) shall provide information to the patient and obtain general consent using the appropriate Conditions of Treatment Form prior to providing treatment or services.

Definitions

Protected Health Information (PHI) is individually identifiable health information. Health information means any information, whether oral or recorded in any medium, that:

• is created or received by UNMC; and
• relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual.
  

Records containing PHI, in any form, are the property of UNMC. The PHI contained in the record is the property of the individual who is the subject of the record.

Protected health information excludes education records covered by the Family Educational Rights and Privacy Act (FERPA), and employment records held by UNMC in its role as employer.

For more information, contact Sheila Wrobel, Privacy Officer, or see Conditions of Treatment Form Procedures.

This is a new UNMC Policy.

This page updated on Monday, February 16, 2004, by dkp.