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Policy No.: 6070
Effective Date: 03/17/03
Revised Date:
Revised Date:

Conditions of Treatment Form Policy

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)

Individually identifiable health information including demographic information, collected from an Individual, whether oral or recorded in any medium, that:

• is created or received by UNMC/ACE; 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 and identifies the Individual or with respect to which there is a reasonable basis to believe the information can be used to identify the Individual.

PHI includes genetic information, which includes information about:

• an Individual’s genetic tests;
• the genetic tests of an Individual’s family members; or
• the manifestation of a disease or disorder in such Individual’s family members (i.e., family medical history).

PHI excludes:

• individually identifiable health information of a person who has been deceased for more than fifty (50) years.
• education records covered by the Family Educational Rights and Privacy Act (FERPA); and
• employment records held by UNMC in its role as employer.

Additional Information

• Contact Privacy Officer
• See Conditions of Treatment Form Procedures

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