- You have the right to inspect your medical record with a 24-hour notice.
- If you would like a copy of your medical record, contact the medical record office by calling (920) 424-2092, sending a secure message on the Student Health Portal, or via email firstname.lastname@example.org. Please allow 48 hours to process your request. Check price list for medical record fees.
- If you would like a copy of your medical record sent to someone else, you will need to complete and sign an .
- Records received from another facility are not released.
- A fee is charged for records retrieval. Please call the Student Health Center at 920-424-2424 for more information about the cost associated with requesting a copy of your medical record.
- All records are destroyed 10 years after your last clinic visit.
Our Policy on Privacy
All services at the Student Health Center are strictly confidential. Information will not be released to family members, friends, professors or college administrators without your consent. You must complete an Authorization for Disclosure of Health Information form in order for us to release information to anyone other than yourself or other health care providers.
You will be asked to review the document and electronically sign the form on your Student Health Portal prior to your first visit at the Student Health Center. This is a form required by law (HIPAA) to ensure that you are made aware of who has potential access to your health care records.
Patient Rights and Responsibilities
- Be treated with dignity and respect
- Confidentiality of care and medical records
- Receive accurate information about diagnosis, treatment and prognosis
- Participate in decisions about care and give informed consent before any procedure is performed
- Be informed of options for after-hours and emergency care
- Information about costs and payment related to services provided
- Refuse to participate in experimental research
- Choose your health care provider
- Know the names, positions and credentials of health care providers
- Review and receive copies of medical records
- Be seen within a reasonable amount of time
- Refuse treatment and be informed of the consequences of refusal
- Not be discriminated against because of race, creed, sex, national origin, sexual orientation or disabilities
- Seek medical attention promptly
- Be honest about your medical history
- Ask about anything you do not understand
- Respect clinic personnel and policies
- Follow health advice and medical instructions
- Report any significant changes in symptoms or failure to improve
- Keep appointments or cancel in advance
- Provide useful feedback about services and policies
- Pay for charges incurred
If you have chronic medical problems, we recommend that you have your medical provider send us a copy of your medical record. This enables us to better coordinate care with your primary care health care provider.
It is important for you to be aware of your own medical problems including:
- What medications you are taking
- Any allergies to medications, foods, bee stings and how the allergy affects you
- Family medical history
- Immunization history
- Other prior health problems such as surgeries, illnesses or hospitalizations
It is important to make provisions for your health care in the event you are unable to make those decisions for yourself.
A living will is a document instructing physicians, relatives or others to refrain from the use of extraordinary measures, such as life-support equipment, to prolong one’s life in the event of a terminal illness.
Power of attorney is a written document giving someone you specify the legal ability to act on your behalf.
The Wisconsin Department of Health and Human services has advance directive forms available on their website.