University Health and Counseling Services
Ambrose Center

About Us

Notice of Privacy Practices

This notice describes how your health information (namely, your health records) may be used and disclosed and how you can get access to this information. Please ask the receptionist if you would like to have a personal copy of this notice.

Uses and Disclosures of Your Health Information

Medical Record Law allows UHCS to use or disclose your health information without your specific permission only under certain conditions or circumstances. Following are descriptions of those conditions and circumstances.

  • Treatment: UHCS may use healthcare information about you to provide you with health treatment or services, to coordinate or manage your health care services, or to facilitate consultation or referral as part of your treatment.

For example, UHCS may disclose your health information to doctors, nurses, or other health providers who are involved in taking care of you. Providers involved in your treatment will need access to your health information to determine if you have any conditions or clinical history that could affect your treatment. UHCS staff may also share your health information with each other in order to coordinate the evaluation, diagnosis and treatment of your condition.

  • Payment: UHCS may use and disclose your health information to your insurance company or other third parties as required for you to obtain reimbursement for claims you may file to recover costs of care at UHCS.

For example, UHCS may need to give your insurer information about your treatment so they can reimburse you. UHCS may also tell your health insurer or HMO about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment. When you charge your care to student billing, we provide only the minimum necessary, such as your name, ID number, date, and amount, and the designation Health Center charge.

  • Health Care Operations: UHCS may use and disclose your health information within UHCS for operations purposes i.e., your record may be reviewed internally for the purpose of improving services to all UWW students. These reviews include, among other things:
    • Quality assessment and improvement activities;
    • Activities relating to improving health or reducing health care costs;
    • Developing protocols for treating certain conditions;
    • Care management: assuring full treatment has been rendered;
    • Case coordination and related functions;
    • Competence and performance reviews of staff;
    • Training, accreditation, certification, licensing, credentialing, or other related activities;
    • Clinical review and auditing functions, including fraud and abuse detection and compliance programs;
    • Review for compliance with laws and regulations;
    • Business or program planning and development;
    • Internal grievance resolution;
    • Business management and general administrative activities; and
    • Creating reports using de-identified health information (i.e., your name is removed and a data base formed providing aggregate information for the purpose of describing to funding sources and others the scope and type of services provided by UHCS.

Following are additional examples of what is included under health operations:

    • We use your health information to review our treatment and services and to evaluate the performance of our staff in caring for you;
    • We may combine your health information about many UHCS patients or counseling clients to decide what additional services UHCS should offer, what services are not needed, and to study the safety and effectiveness of treatments;
    • We may disclose your health information to doctors, nurses, and other UHCS staff for staff education or care planning purposes;
    • We may compare aggregate, de-identified health information at UHCS with aggregate health information obtained from student health services at other universities;
    • We may gather de-identified health information so that researchers can use it to study health care and health care delivery without learning the identity of specific individuals;
    • We may access your healthcare record in order to give you a reminder call of your appointment;
    • We may review your healthcare record in order to recommend possible treatment options or alternatives that may be of interest to you.
    • We may review your health-care record to determine your possible eligibility for certain health-related benefits or services;
    • In the event of an urgent medical problem or life threatening condition, UHCS may take measures designed to protect your well-being and safety and that of others. This may include notifying a friend, partner, or family member to assist in your care.
    • For appointment times most in demand, we make reminder calls to you in order to assure the time is used. The message we leave will give only the first name of the caller, phone number, and reminder of a next days appointment. It is possible that, despite our best efforts, another party might listen to our message, call the number we give, and ascertain that you are receiving a service at UHCS.

Medical Record Law allows UHCS to use or disclose your health information without your consent or authorization for certain functions and activities described below:

  • Public Health Risks: UHCS may disclose your medical records for public health activities, including:
    • To prevent or control disease, injury, or disability, to report births and deaths, and for public health surveillance or intervention;
    • To report to the FDA adverse events or product defects, to track products, to enable product recalls, or to conduct post-market surveillance as required by the FDA;
    • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
    • To enable an employer to facilitate workplace medical surveillance as required by law.
    • To enable International Student Services to protect the health and safety of the UWW campus by requiring tuberculin tests or other health tests of international students matriculating on the UWW campus.

  • Victims of Abuse, Neglect, or Domestic Violence: If you have been a victim of abuse, neglect, or domestic violence, UHCS may make this disclosure to the appropriate governmental authority as required or permitted by federal, state, or local law.
  • Health Oversight Activities: UHCS may disclose your health information to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure, or disciplinary activities, and other similar proceedings. UHCS may not disclose your health information if you are subject of an investigation that is not directly related to your receipt of health care or public benefits.
  • Judicial and Administrative Proceedings: As permitted or required by state or federal law, UHCS may disclose your health information in response to a court order.
  • Law Enforcement: If we determine that a students condition is such that they represent a substantial probability of serious harm to self or others, we may, per Wisconsin law, contact the police and request an emergency detention or other action to protect the safety of that student or others.
  • Coroners and Medical Examiners: UHCS may disclose protected health information to a coroner or medical examiner to identify a deceased person or determine the cause of death.
  • Research: Under certain circumstances UHCS may use and disclose your health information for research purposes.

For example, UHCS may conduct a study on identifying and treating students with asthma. All such research is subject to review and approval by UWW Institutional Review Board (IRB) for research involving human subjects. The IRB evaluates a proposed research project and its use of protected health information, balancing research needs with patients need for privacy of the medical records. Before UHCS uses medical records for research, the project will have been approved by the IRB. In addition, UHCS will ask for your specific permission if a researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care.

  • Serious Risk of Harm: If there is a serious risk of harm to your health or safety, or to the health or safety of another, UHCS may use and disclose information from your clinical record for the purpose of preventing such harm when, in the judgment of the clinician, the risk is unlikely to be reasonably reduced or managed through clinical care.
  • Specialized Government Functions: Medical Record Law authorizes UHCS to use or disclose your medical records for certain specific legal purposes, such as for reporting communicable diseases as required under public health laws, In accordance with the Patriot Act, we may be required to disclose your health information to authorized federal officials who are conducting national security and intelligence activities or providing protective services to the President or other important officials. By law we cannot reveal when we have disclosed such information to the government.

Workers Compensation: UHCS may release your medical records for workers compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Other uses and disclosures of medical records not covered by this notice or the laws that apply to UHCS will be made only with your authorization. If you authorize UHCS to use or disclose your medical records, you may revoke that authorization at any time by giving us written notice. If you revoke your authorization, UHCS will no longer use or disclose your medical records as specified by the revoked authorization.

You have the following rights regarding medical records that UHCS maintains for you:

  • Right to Request Restrictions: You have the right to request restrictions or limitations on our uses or disclosures of your health information (medical records) for purposes of treatment, payment, or health care operations. You also have the right to request that we limit our disclosure of your medical records to someone who is involved in your care or payment for your care.

However, UHCS is not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide for your care and safety or that of others. In your request, please tell the director 1) what information you want to limit; 2) whether you want to limit its use, disclosure, or both; and 3) to whom you want the limits to apply.

  • Right to Request Mode of Communication: You have the right to request that UHCS communicate with you about medical matters through specific channels, that is, in a certain way or at a certain location. For example, you can ask that we only contact you at work, or only at home, or only by mail.

Your request for mode of communication should be made in writing to UHCS. We will not ask you the reason for your request and will attempt to accommodate all reasonable requests.

  • Right to Inspect and Copy: You have the right to inspect and copy your medical records. However, pending further clarification of federal regulations, Counseling Services may restrict your access to mental health records during your treatment, except for information about your medications or somatic treatment. Upon completion of your mental health treatment, you have the same right of access to your mental health records as you do to your regular medical records.

To request inspection or copying of your records, you should make your request in writing. Please note that a request to inspect your medical records means that you may examine them during working hours at a mutually convenient time and place within the Ambrose Building. If you request a copy of the information, UHCS may charge a reasonable fee for the cost of copying, mailing, or other supplies associated with your request. UHCS may deny your request to inspect and copy in certain circumstances.

  • Right to Amend: If, in your opinion, your medical records are incorrect or incomplete, you may request that UHCS amend your records. You have the right to request an amendment for as long as the information is kept by UHCS.

Your request must give the reasons for the amendment. UHCS may deny your request for an amendment if it is not in writing or does not include a reason. UHCS may also deny your request for amendment if it covers medical records that:

    • Were not created by UHCS, unless the person who actually created the information is no longer available to make the amendment;
    • Are not part of the medical records kept by or for UHCS;
    • Are not part of the information which you would be permitted to inspect and copy, as discussed above;

UHCS will incorporate into your record a statement written and signed by you specifying your clarifications. Your statement will become a permanent part of your record.

  • Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your medical records by UHCS.

A request for this accounting of disclosures should be made in writing to UHCS. Your request must specify a time period, which may not be longer than six years. Your request for accounting of disclosures should indicate in what form you want to receive that information (e.g. by phone, mail). The first accounting within a 12-month period will be free. For additional accountings UHCS may charge for its costs after notifying you of the cost involved and giving you the opportunity to withdraw or modify your request before any costs are incurred.

  • Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice at any time, even if you previously agreed to receive this Notice electronically. To obtain a paper copy of this notice, please contact the Health or Counseling receptionist.

UHCS reserves the right to amend this Notice at any time. Each version of the Notice will have an effective date on the first and succeeding pages. When amendments are made, UHCS reserves the right to make the changes effective for medical records held by UHCS at the time the amendment is made as well as any medical records UHCS may receive or create in the future.

UHCS will post a copy of the current notice in the lobby as well as on its website. Each time you come for service, you will have an opportunity to review the current notice and to request a paper copy from the receptionist.

If you believe your privacy rights have been violated, you may file a written complaint with UHCS. 

You will not be intimidated, threatened, coerced, discriminated against, or otherwise retaliated against for filing a complaint.

The UHCS contact person for issues regarding patient privacy and Medical Record Law is the Health Director or designee. The contact phone number is 472-1305.

You will receive initial response within 10 working days of your contact.


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This site is not meant to replace the advice of a health care or counseling professional. You should not rely on any information on these pages, or information generated for you by this site, to replace consultations with qualified professionals regarding your own specific situation. Some links take you to a source outside of UHCS. The owners of that site, not UHCS, are responsible for the content.