This notice describes how medical information about Schiffert Health Center’s patients may be used and disclosed, and how patients can obtain access to their information. Please review it carefully.

Schiffert Health Center values the privacy of its patients and the confidentiality of the personal health information entrusted to us. In order to protect this privacy, policies and procedures are put into place that limit disclosure of personal information to only those who are responsible for the medical care of the patient, those that the patient has given permission, and/or those required by law or public safety.

Confidentiality Policy Details

Medical Treatment – Medical and personal information may need to be shared with medical practitioners, nurses, pharmacists, health educators, dietitians, medical records, clinic clerical personnel, and medical technologists (laboratory, radiology, and pharmacy) employed by the Schiffert Health Center in order to provide effective and efficient care. 

Billing – Billing information that contains personal information including name, student-identification number, date of service and charge is sent to the university's Accounts Receivable Office for billing. The bill appears as "Medical Clinic Charge" or "Pharmacy Charge" without the medical diagnoses, procedures or any medication disclosed. Bills are mailed by the Accounts Receivable Office to the address provided by the student.

Third Party Payment – Itemized billing statements that include a student’s name, student-identification number, date of service and charge above AND diagnoses, procedures, or medications will be released to the patient or his/her designated representative only upon specific request and with written consent of the patient. 

Oversight Activities – Oversight includes internal and external audits, chart reviews, investigations, licensures, and inspections required for compliance with government, university, accreditation programs and laws, as well as the Health Center's quality assurance/risk management programs. Only the minimal necessary information will be released and it will usually be of a general/composite nature. However, on occasion, these reviews will involve sighting of individual information by the auditor, accreditation examiner, or official. All individuals performing these reviews or audits will be required to agree with and sign the non-disclosure confidentiality standards of the Health Center before being allowed access.

Public Health and Safety – Personal and health information may be disclosed to the proper authorities to report deaths, certain infectious diseases, occupational injuries and diseases, child abuse/neglect, domestic violence, problems with medications and other products as required by law to prevent/control disease, injury or disability to the patient or to others.

Legal Requirements – Personal and medical information may be disclosed as required by court or administrative order, subpoena, discovery request, or other lawful process. It may also be disclosed when legally requested by national security, intelligence and other federal officials.

Other Uses – Uses and disclosures of health and personal information other than described above will be made only with the patient's written authorization. Such authorization when given may be revoked in writing by the patient at any time.

The right to inspect and obtain copies of personal medical information – Such requests must be made in writing. A cost-based fee may be charged for copying medical records. Schiffert Health Center may deny, in writing, the release or viewing of personal medical information if Schiffert Health center administration determines that the release of the information may be harmful to the patient or another person. When such a request is denied, the patient may request a review of the denial by a designated Schiffert Health Center and/or university official who did not participate in the decision to deny. Such requests must be made in writing to Schiffert Health Center privacy official(s) designated in section “D.” below.

The right to request amendments of medical information – Such requests must be made in writing to the Medical Records Department. Such requests will be reviewed by Schiffert Health Center and may be denied. If denied, a written denial and its reasons will be provided to the patient and he/she has the right to submit a rebuttal and request for review of such denial. These requests are to be made in writing to the designated Schiffert Health Center privacy official(s) designated in paragraph “D.” below.

The right to receive an accounting of any disclosures of protected information made after April 14, 2003.

The right to request limits on the amount or types of medical information released – Such requests must be made in writing to the Medical Records Department. Schiffert Health Center may not agree with this request when it is felt to be in the patient’s best interest to release the information and/or when such a release is mandated by the uses outlined in section “A.” above.

The right to request that communications between the patient and Schiffert Health Center be kept confidential.

This notice is effective from April 14, 2003 and is posted in prominent locations throughout Schiffert Health Center. It is also posted on the Schiffert Health Center website ( Copies of the notice are available upon request. Schiffert Health Center reserves the right to make changes to this notice and/or its procedures without notification other than posting or making available copies of revised notices.

Complaints regarding the security and/or privacy of personal health information may be filed with the Assistant Vice President for Student Affairs, Chris Wise or the Director of Schiffert Health Center, Kanitta Charoensiri, D.O., M.B.A.

Chris Wise, Assistant Vice President for Student Affairs

209 McComas Hall (0140)
Virginia Tech

Blacksburg, VA, 24061 


Kanitta Charoensiri, D.O., M.B.A.
 Director, Schiffert Health Center
213 McComas Hall (0140)

Virginia Tech

Blacksburg, VA
, 24061

Patients may file formal complaints about possible violations of the privacy rules with:

Office of Inspector General, Office of Public Affairs 
Department of Health and Human Services
 Room 5541, Cohen Building
 330 Independence Avenue, S.W. 
Washington, D.C. 20201 

Phone: 202-619-1343
  Fax: 202-260-8512

Complaint Intake, Office of Licensure & Certification
 Virginia Department of Health
 9960 Maryland Drive, Suite 401 
Richmond, VA 23233-1463 

Phone: 800-955-1819 
 Fax: 804-527-4503

PrivNotice 02/2009;2012;2016