Patient Forms and Policies - University of Houston
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Patient Forms and Policies

Medical Records

All information is considered confidential and will not be released without the patient's written consent or a signed court order. The Student Health Center retains medical records for 10 years past the last date on which the service was given (22 TAC §§ 165).

Minor Consent to Treat

The following consent forms must be completed by a parent or legal guardian for UH students under the age of 18 before an appointment can be scheduled.

Medical Excuse Note Policy

The Student Health Center medical excuse policy is consistent with recommendations from the American College Health Association and the policies of our peer institutions. It also reflects our commitment to maintaining patient confidentiality, teaching students how to use healthcare resources appropriately, and supporting meaningful dialogue between students and faculty or their employer.

Department Billing

UH Departments may request that Faculty, Staff, or Students receive their Hepatitis B Immunizations, Hepatitis B Titers, TB Skin Test, or QuantiFERON (QFT) test at the Student Health Center. The charges for these services will be billed directly to the department.

Notice of Privacy Practices

The University of Houston Student Health Center (SHC) is committed to preserving the privacy of your health information. We are required by HIPAA (the Health Insurance Portability and Accountability Act of 1996) to ensure the privacy of your protected health information ("PHI"), and to provide you with this notice explaining when and under what conditions we may use or disclose your medical information, and what rights you have with respect to your PHI. Your PHI is contained in a medical record that is the physical property of SHC. Acknowledgment of the Notice of Privacy Practices is obtained electronically through the Healthy Coog Patient Portal.

Patient's Rights and Responsibilities

As a patient of the UH Student Health Center or any other healthcare facility, you have certain rights, including the right to privacy, respect, professionalism, and competent medical care. You also carry certain responsibilities to help optimize the care you receive.

Consent to Treat and Health Care Agreement

The UH Student Health Center is an integrated healthcare facility providing medical and mental health services. Acknowledgment of the Consent to Treat and Telemedicine Informed Consent is obtained electronically through the Healthy Coog Patient Portal.

Financial Responsibility Agreement

Payment is expected at the time services are render. When visiting the Student Health Center for in-person or telehealth services, patients will be asked to acknowledge that they have read and understand their financial responsibilities prior to treatment.

Appointment No Show/Late Arrival/Late Cancellation Policy

Appointment No Shows, Late Arrivals and Late Cancellations penalize patients who have to wait for an appointment with one of our clinics. It could even force a patient to seek care outside the Student Health Center costing them more than our services in-house.