Notice of Privacy Practices

Effective Date: May 1, 2015

UALR Health Services is required by law to maintain the privacy of your “Protected Health Information” (PHI) and to provide you with this notice of privacy practices. PHI is information about you, including demographic data such as name, address, phone number, or any other information that may identify you. This notice describes the ways in which we may use and disclose your PHI and health information, notifies you of your rights (including how to access your health information), and of our obligations regarding the use and disclosure of your PHI and health information.  PLEASE REVIEW IT CAREFULLY.

Examples of these situations are listed below:

  • For Treatment: UALR healthcare providers may use your medical history to decide what treatment is best for you. The healthcare providers may also tell another provider about your condition so that provider can help determine the most appropriate care for you. Different personnel in our organization may share information about you and disclose information to people who do not work for UALR Health Services in order to coordinate your care, i.e., phoning in prescriptions, submitting outsource lab work, and verifying insurance benefits and submitting claims.
  • Workers’ Compensation: We will release PHI and health information for workers’ compensation claims.
  • For Payment: If we bill your insurance company for treatment and services received, we need to provide the insurance company with information about the treatment and service you received so they will pay us.
  • For Health Care Operations: We may use and disclose your PHI and health information for general operating purposes – to make sure that you and our other patients receive quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use your health information to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective.
  • To Avoid Harm: We may disclose your PHI and health information about you when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person.
  • Required By Law: We will disclose health information when required to do so by federal, state or local law (i.e. in response to a court order, subpoena, warrant, summons or other similar process).
  • Public Health Risks: We may disclose health information to a public health authority, or to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition. We also may disclose personal health information in regard to reactions to food, medications, products, or product defects as required by the FDA.


  • We will not use or disclose your PHI or health information (including reasons for visits or outcomes of visits) to your parents, other family members or friends, without your specific, written authorization. In emergency situations, a verbal authorization will be accepted and documented in your medical record.  If you are unable to verbalize authorization, the healthcare provider may need to disclose the information determined necessary for your care, treatment, and safety.
  • Research: All research projects, other than those used for healthcare operations, must be approved by the UALR Institutional Review Board (IRB).  Health Services will ask for your written permission if the researcher will have access to your name, address or other information that reveals who you are.  Research results will NEVER include protected health information but data and statistics only.

You have the following rights regarding your PHI and health information maintained at UALR Health Services.

  • Right to Inspect and Copy: You have the right to inspect and request a copy of your medical records. You must submit a “Consent to Release Medical Information” in order to do so. You have the right to request a copy of your health information in electronic form if we store your health information electronically. We may deny your request to inspect and/or copy your record or parts of your record in certain limited circumstances. If you are denied copies of or access to health information that we keep about you, you may ask that our denial be reviewed.
  • Right to Amend: If you believe health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment as long as the health information originated in UALR Health Services. We will not amend records forwarded to UALR Health Services from an outside provider.  To request an amendment, you must complete and submit a “Request for Medical Record Correction/Amendment Form.” We may deny your request for an amendment if your request is not in writing or does not include a reason to support the request. If we deny or partially deny your request for amendment, you have the right to submit a rebuttal and request the rebuttal be made a part of your medical record.
  • Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures. This is a list of the disclosures we have made of medical information about you for purposes other than treatment, payment, health care operations. To obtain this list, you must submit a “Request of Accounting Disclosures.”
  • Right to Request Restrictions: You have the right to ask us not to disclose certain parts of your health information for treatment, payment, or healthcare operations. You may also request that information not be disclosed to family members or friends who may be involved in your care.  We are not required to agree to your request. If we do agree, we will comply with your request unless such information is needed to provide you emergency treatment or we are required by law to use or disclose the information.  NOTE:  We ARE required to agree to your request if you pay for treatment, services, supplies and prescriptions “out of pocket” and you request the information not be communicated to your health plan for payment or health care operations purposes. There may be instances where we are required to release this information if required by law.
  • Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice.

CHANGES TO THIS NOTICE:  We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will inform you of any significant changes to this Notice. This may be through a sign prominently posted at our location, a notice posted on our web site or other means of communication.

BREACH OF HEALTH INFORMATION: We will inform you if there is a breach of your PHI.

COMPLAINTS: If you believe your privacy rights have been violated, you may file a complaint with the Director of Health Services, the Vice-Provost for Student Affairs, or with the Secretary of the Department of Health and Human Services.  To file a complaint with the Director of Health Services, you may send an email to or a letter through the U.S. Post Office addressed to Marie Sandusky, UALR Health Services, 2801 South University Ave., DSC 102, Little Rock, AR 72204.  You will not be penalized for filing a complaint.