91AV

Your medical records are kept for seven years after you graduate from the 91AV. If you wish to obtain a copy of your immunization or medical records, you will need to provide us with a request in writing. There will be a $15.00 fee.

Your request should contain:

• Full name, including maiden name
• Class year
• Date of Birth
• What part of your record you wish to obtain
• Where you want them sent
• Signature and Date

For the Biddeford Campus:
Call: (207) 602-2358
Fax:  (207) 602-5904

For the Portland Campus:
Call: (207) 221-4242
Fax:  (207) 523-1913

All medical records are confidential. Information in your medical records will not be released to anyone, including your parents, without written permission from you.  HIV/AIDS testing records need a separate release form and signature.

91AV NOTICE OF PRIVACY PRACTICE

As a Student Health Center patient you have the right to:

• Considerate and respectful care with recognition of your personal dignity.
• Access all of the health care and treatment services we provide, consistent with available resources and generally accepted standards.
• Refuse treatment to the extent permitted by law and government regulations, and the right to be informed of the consequences of such refusal of treatment.
• Question the adequacy of care being provided.
• Privacy and confidentiality, to the extent permitted by law, concerning your medical care and records. You have the right, and will be afforded the opportunity, to approve or refuse the release of such information, except when the release is required by law.
• Know the identity and professional status of the health care provider primarily responsible for providing/managing your care, as well as other health care personnel involved in your treatment
• Participate in decisions involving your health care and the explanation, which should be clear and easily understandable, of your diagnosis, treatment, and prognosis of your illness. When it is medically inadvisable to disclose such information to you, an appropriate family member, another individual designated by you, or a legally authorized designee will be informed.
• Be informed of possible complications, risks and benefits, and alternative treatments associated with consent or refusal for treatment in order to make knowledgeable decisions about your course of care.
• Be advised if the Student Health Center proposes to engage in or perform experimental research in order to make knowledgeable decisions about your care. You have the right to refuse to participate in experimental research.
• Receive care and treatment in a safe environment, and be informed of the facility’s rules and regulations that relate to patient and visitor conduct. You and your family also have the right to be informed of the University Health Care patient grievance process, designed for the initiation, review, and resolution of patient complaints.
• Request and obtain the name and specialty, if any, of the provider or other person responsible for your care or the coordination of your care.
• Refuse to be examined, observed, or treated by students or any other staff without jeopardizing access to medical care and attention.
• Request and receive an explanation of the relationship, if any, of the provider to any health care facility, health plan, or educational institutions if this relationship relates to your care or treatment.

As a Student Health Center patient you are responsible for:

• Being considerate of the rights of other patients and Student Health Center personnel, which includes controlling the level of your noise in the clinic. You are also responsible for being respectful of the property of other persons and the facility.
• At all times, you are expected and are responsible for being respectful to all individuals within the clinic premises, and should report any instance where you have not been given the same treatment.
• Complying with the medical and nursing treatment plan, including follow-up care, agreed upon by you and the health care provider(s). This includes keeping appointments and notifying Student Health Center in a timely manner, at least 24 hours in advance, when you cannot keep an appointment. You also have the responsibility of letting your provider know whether or not you understand your treatment plan and what is expected of you.
• Reporting any complaints, recommendations or questions you have to one of our staff members. Doing so will help us better serve our entire patient community.
• Following our rules and regulations affecting patient conduct, including, but not limited to, not smoking, parking regulations, etc.
• Providing, to the best of your knowledge, accurate and complete information regarding your past medical history and other matters relating to your health.
• Copies of Patient Rights and Responsibilities can be found at each Student Health Center site.