The Patient has a RIGHT to:

• Be treated with respect and dignity.
• Professional and courteous care without discrimination.
• Know the name and title of those individuals involved in his/her care.
• Privacy and confidentiality regarding medical care.
• Approve or refuse release of medical records, except when required by law or in a medical emergency.
• Expect records to be kept confidential as required by law.
• Request communication in a language that improves understanding.
• Be informed about diagnosis, treatment and prognosis in terms that can be understood.
• Receive information about procedures and treatments including length, risks, benefits, cost and alternatives to facilitate participation in care decisions.
• Know the fees for in house laboratory tests, procedures, treatments and services that are rendered at SHS.
• Refuse a treatment or plan of care to the extent permitted by law and be notified of medical consequences of that decision.
• A second medical opinion and appropriate referral.
• Consent or decline participation in research after being fully informed.
• Receive information and related forms (option 1, option 2) regarding Advanced Directives.
• Express suggestions and concerns in an appropriate manner.

The Patient has a RESPONSIBILITY to:

• Be respectful and act in a considerate and cooperative manner.
• Provide accurate information to assist the provider in compiling a complete medical record.
• Ask questions and seek clarification regarding medical care.
• Follow instructions of a treatment plan and convey problems that interfere with compliance.
• Arrive as scheduled for appointments and, if necessary, call to cancel an appointment in a timely manner.
• Comply with posted rules and regulations within Student Health Services.
• Pay any charges billed.

HIPAA Information

The HIPAA Privacy Officer is Wagida Abdalla, MD, Executive Director of Student Health Services.

You may contact the Privacy Officer if you have a concern about the confidentiality of your medical information shs.gmu.edu

Notification of Privacy Practices

Parent Information about Confidentiality

Your student will visit Student Health for a variety of health concerns, and we know that you will want information about the status of their care. If your student is over the age of 18 years, we are required by law to keep that information confidential. We will only be able to share information with written consent from your student, or in a life threatening emergency.

Complaints

If you’d like to file a complaint about Student Health Services to officials inside of the University, you may contact:

Carol Filak, PhD
Student Health Services, Administrative Director
703-993-2832

Wagida Abdalla, MD
Student Health Services, Medical Executive Director
703-993-2826

Pamela Patterson
Assistant Vice President/Dean of Students, University Life
703-993-2884

If you’d like to file a complaint about Student Health Services to officials outside of the University, you may contact:

The Virginia Board of Medicine
http://www.dhp.virginia.gov/enforcement/complaints.htm
Virginia Department of Health Professions
Perimeter Center
9960 Mayland Drive, Suite 300
Henrico, VA 23233-1463
Telephone: 1-800-533-1560 or (804) 367-4691
Fax: (804) 527-4424
Email:  enfcomplaints@dhp.virginia.gov

The Virginia State Council of Higher Education
http://www.schev.edu/
101 N. 14TH St., 10TH FL, James Monroe Bldg.
Richmond, VA 23219
Tel: (804) 225-2600
Fax: (804) 225-2604

The Virginia Office of the Governor
http://www.governor.virginia.gov/
Mailing address:
P.O. Box 1475
Richmond, Virginia 23218
Street address:
Office of the Governor
Patrick Henry Building, 3rd Floor
1111 East Broad Street
Richmond, Virginia 23219
Tel: (804) 786-2211
Fax: (804) 371-6351
TTY/TDD (For the Hearing Impaired):
1-800-828-1120, or 711

Virgina Bureau of Insurance

http://www.scc.virginia.gov/boi/complaint.aspx

Mailing Address:

State Corporation Commission

Virginia Bureau of Insurance

P.O. Box 1157

Richmond, VA 23218

Phone: 877-310-6560

Fax Information: (804) 371-9944