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The University of Oklahoma
Notice of Privacy Practices

Acknowledgment and
Consent Forms

MENINGITIS:
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THE UNIVERSITY OF OKLAHOMA NOTICE OF PRIVACY PRACTICES

The University of Oklahoma Notice of Privacy Practices. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. OU Notice of Privacy Practices...

ACKNOWLEDGMENT AND CONSENT FORMS

Acknowledgment and Consent Forms. By signing these forms you acknowledge that you have received a copy of the University's Notice of Privacy Practices and consent to the use of your health records for treatment, payment and operations purposes described in the Notice of Privacy Practices. Acknowledgment and Consent Forms...

PATIENT RIGHTS AND RESPONSIBILITIES

OU Health Services recognizes the basic rights of patients and encourages patients to assume responsibility for their own welfare. OU Health Services administration has empowered each department to employ specific policies and procedures, when applicable, that reflect and protect these rights. OU Health Services will ensure that information pertaining to eligibility for services, services available, payment policies and fee for services, provisions for after-hours and emergency services, and other polices and procedures that may affect patient care are readily available.

RIGHTS
OU HEALTH SERVICES AFFORDS YOU, OUR PATIENT, THE RIGHT TO:

be treated with respect, consideration, and dignity;

privacy to the extent consistent with adequate medical care. Case discussions, consultations, examinations and treatments will be confidential and conducted discreetly under the federal guidelines of HIPAA;

upon request, receive the name and function of any person providing services to you;

confidentiality of all records pertaining to your treatment;

refuse or approve release of medical information, except as otherwise provided by applicable state and federal law;

obtain from your health care provider complete and current information concerning your diagnosis, treatment, and expected outcome in terms you can reasonably be expected to understand;

be given the opportunity to participate in decisions involving your health care, whenever possible;

information necessary for informed consent prior to any procedure or treatment, except in an emergency. This information shall include explanation of specific procedures or treatments, their value and significant risks, and explanation of alternative treatments;

refuse treatment and be informed of the consequences of your actions;

a reasonable response to your request for services customarily rendered and consistent with your treatment;

expect reasonable continuity of care and be informed by your health care provider of possible continuing health care requirements;

refuse to participate in experimental research;

upon request, examine and receive an itemized explanation of your bill, regardless of source of payment;

treatment without discrimination as to race, color, religion, sex, national origin, source of payment, political belief, disability or sexual orientation;

to be informed of methods for expressing grievances and suggestions to your university health services;

request a second opinion or change primary or specialty health care providers if other qualified health care providers are available;

when patients request, their advanced directive will be placed in their medical record and stored there until otherwise directed.

RESPONSIBILITIES
IT IS YOUR RESPONSIBILITY AS THE PATIENT TO:

provide accurate information regarding your health history and change of health status while undergoing treatment;

provide accurate personal information, (name, Sooner ID#, address, phone, date of birth, insurance etc.);

let it be known if you do not comprehend your treatment or what is expected of you during your care;

comply with a plan of treatment as recommended by your health care provider, keep follow-up appointments or notify your health care provider when unable to do so;

accept any consequence of your actions if you refuse treatment or do not carry out the care as recommended by your health care provider;

arrange for payment of services received;

conduct yourself in a respectful manner giving consideration to other patients and health center personnel. Maintaining a low noise level, controlling your minor children, and not smoking in the building are expected behavior.

For more information call: (405) 325-4611