The University of  Toledo Outpatient Pharmacies



The Student Medical Center is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. The Medical Center is required to follow the privacy practices described in this Notice.

We reserve the right to change our privacy practices and the terms of this Notice at any time. If we change our notice, we will post the revised notice in the facility and will have them available upon request. You can receive a copy of the current notice at any time. The effective date is listed just below the title. You will be asked to acknowledge in writing your receipt of this Notice.

You may view this Notice or any new notices on our web site at


The Medical Center is committed to maintaining the confidentiality of your health information. Your health information may be used and disclose for purposes of treatment, payment, and health care operations. Outside of these permitted uses, we will not disclose your health information without a signed authorization from you, unless the law permits or requires us to use or disclose this information without your authorization. You have the right to revoke that authorization in writing except to the extent any action has been taken in reliance on the authorization.

Treatment, Payment, and Health Care Operations. Except as otherwise provided, the Medical Center may use and disclosure your health information for purposes of treatment, payment, and as otherwise necessary and permitted by law, for our health care operations. This may include disclosure to another health care provider, such as a physician who is involved in your treatment, disclosure for purposes of approval of reimbursement from your health plan, or disclosure for audit purposes to our accountant.

Stricter Law. Certain provisions of Ohio law may be more stringent than the federal laws and regulations protecting the privacy of your medical information. The Student Medical Center will, as required by law, comply with the more stringent provisions of Ohio law.

Business Associates. It may be necessary for us to provide your health information to certain outside persons or entities that assist us with our health care operations, such as auditing, accreditation, legal services, etc. These business associates are required to properly safeguard the privacy of your health information.

Appointments, Services, and Fundraising Efforts. We may contact you to provide appointment reminders, information about treatment alternatives, or other health-related benefits and services that may be of interest to you. We may contact you to support our fundraising efforts. You may opt-out of receiving any further fundraising communications from our facility by notifying the Student Medical Center privacy officer in writing of your name, address, and request to be removed from our fundraising mailing and contact lists.


Family and Friends. With your approval and using our professional judgment, your health information may be disclosed to family and friends who are directly involved in your care or in the payment for your care.

If you are unavailable, incapacitated, or in an emergency medical situation, and we determine that a limited disclosure may be in your best interest, we may share limited health information with such individuals without your approval.


We may use or disclose medical information about you without your prior authorization for several other reasons. Subject to certain requirements, we may give out medical information about you without prior authorization for public health purposes, accrediting organizations such as AAAHC, required abuse or neglect reporting, food and drug administration, legal proceedings, law enforcement, research studies, coroners, funeral directors, criminal activity, military activity, worker’s compensation purposes, and emergencies.

We also disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances or in response to valid judicial or administrative orders.

We may use or disclose your medical information for research purposes but only with your prior authorization or a proper waiver of authorization from the Internal Review Board or Privacy Board.


1. Restrictions on Use and Disclosure of Individual Health Information. You have the right to request that we restrict how we use and disclose your health information. These restrictions must be made in writing and signed by you or your representative. The Student Medical Center is not required to agree to your restrictions. We cannot agree to limit uses/disclosures that are required by law. In the event of a termination of an agreed-to restriction by us, we will notify you of such termination. You may terminate, in writing or orally, any agreed-to restriction by sending such termination notice to the Student Medical Center Privacy Officer.

2. Access and/or Copying Your Health Information. You have the right to request to inspect and/or copy your health information. Your request must be in writing on an access form that you can obtain from the Student Medical Center. You or your legal representative must sign the form and return it to the front desk.

If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies access.

Depending on the circumstances, you may request a review of the decision to deny access. If we deny your request, you will be given written notice that will explain the basis of the denial and your right to appeal.

3. Amendments to Individual Health Information. You have the right to request that your health information be amended or corrected. In certain cases, we may deny your request for amendment. If so, you will be given written notice explaining the basis and your right to appeal. You may also submit a statement of disagreement to the denial. All amendment requests must be in writing, signed by you or your representative, and must state the reasons for the amendment. If we make an amendment, we may notify others who work with us and have copies of your record if we believe that such notification is necessary. You may obtain a Request for Amendment form from the front desk at the Student Medical Center.

4. Accounting for Disclosures of Individual Health Information. You have the right to receive an accounting of certain disclosures of your health information made by us. Requests must be made in writing and signed by you or your representative. Request for accounting forms are available from the Student Medical Center’s front desk. The first accounting in any 12-month period is free.

5. Right to Paper Copy. If you are reading this on the Internet or a posting, you have the right to receive a paper copy of this or any revised Notice or an electronic copy by e-mail upon request to the Student Medical Center Privacy Officer.

6. Confidential Communications. You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of a specific way or location for us to use to communicate with you.

How to Complain About Our Privacy Practices.

If you believe that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the Privacy Officer at the Student Medical Center, phone: (419) 530-3464. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services at 200 Independence Avenue, SW, Washington D.C. 20201 or call 1-877-696-6775. There will be no retaliation for filing a complaint.

This Notice describes how the Student Medical Center has extended certain protections to your protected health information (PHI) and how, when, and why we may use and disclose your PHI. With certain exceptions, the Student Medical Center will use or disclose your PHI in the minimum necessary manner to accomplish the intended purpose of the use or disclosure. The Student Medical Center will share PHI as is necessary to provide quality health care and receive reimbursement for those services as permitted by law.

If you have any questions about this Notice, please contact the SMC privacy officer at 419-530-3464.
Last Updated: 6/26/15