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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. Please review it carefully. HIPPA privacy rules require that we furnish you with this notice.

Effective: 7/1/2005 | Updated 8/6/2025

Purpose

This notice explains how St. Cloud State University Medical Clinic and Counseling and Psychological Services uses and discloses (releases) your personal health information and the rights that you, as a consumer, have to access this information and keep it private. We are required by federal and state law to protect the privacy of your personal health information and to provide you with this notice.

Questions

Director, SCSU Medical Clinic at (320) 308-4848 or Special Advisor to the President (320) 308-2122

We must follow the privacy practices that are described in this notice. We reserve the right to change our privacy practices and the terms of this notice. When we make a significant change in our privacy practices, a revised notice will be made available. To the extent applicable, any changes in our privacy policy will affect information we receive or create after the effective date of the new policy.

Our Uses and Disclosures of Your Personal Health Information

We can use your health information for the following purposes:

• Treatment."Treatment" generally means the provision, coordination, or management of health care and related services among health providers or by a health care provider with a third party, consultation between health care providers, or referral of a patient from one health care provider to another. For example, a doctor may use the information in your medical record to determine which treatment option, such as a drug or surgery, best addresses your health needs. The treatment selected will be documented in your medical record, so that other health care professionals can make informed decisions about your care.
• Payment.In order for your insurance company to pay for your treatment, we must submit a bill that identifies you, your diagnosis, and the treatment provided to you. As a result, we will pass such health information onto an insurer in order to help receive payment for your medical bills.
• Health Care Operations."Health care operations" include certain administrative, financial, legal, and quality improvement activities necessary to run our business and support the core functions of treatment and payment. We may need your diagnosis, treatment, and outcome information in order to improve the quality or cost of care we deliver. These quality and cost improvement activities may include evaluating the performance of your doctors, nurses and other health care professionals, or examining the effectiveness of the treatment provided to you when compared to patients in similar situations.

We will use your information to send appointment reminders to you via email and text message (if you opt in).

Unless you are incapacitated, we will give you an opportunity to object to the following uses or disclosures of your information:

• Family and Other Individuals Involved in Your Care.We may disclose to family members, friends, and persons you indicate are involved with your care, personal information that is directly relevant to their involvement in your care.
• Disaster Relief Efforts.We may release your health information to organizations authorized to handle disaster relief efforts so those who care for you can receive information about your location or health status.
• Treatment Options.We may look at your medical information and decide to tell you about another treatment or a new service we offer.

In special circumstances specified in law, certain health information may be released to legal authorities, such as law enforcement officials, court officials, or government agencies for specified purposes without seeking your permission. For example we may have to respond to a court order. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. The following provides more detail about such disclosures:

• For Public Health Activities.We may be required to report your health information to authorities to help prevent or control disease, injury, or disability. This may include using your medical record to report certain diseases, injuries, birth or death information, information of concern to the Food and Drug Administration, or information related to child abuse or neglect. We may also have to report to your employer certain work-related illnesses and injuries so that your workplace can be monitored for safety.
• For Health Oversight Activities.We may disclose your health information to authorities so they can monitor, investigate, inspect, discipline or license those who work in the health care system or for government benefit programs.
• To Respond to a Court Order or Subpeona.We may have to disclose your health information as part of judicial or administrative proceedings.
• To Avoid a Serious Threat to Health or Safety.As required by law and standards of ethical conduct, we may release your health information to the proper authorities if we believe, in good faith, that such release is necessary to prevent or minimize a serious and approaching threat to your or the public's health or safety.
• For Workers' Compensation.We may disclose your health information to the appropriate persons in order to comply with the laws related to workers' compensation or other similar program. These programs may provide benefits for work-related injuries or illness.

This is a listing of agencies and persons to whom we may release your health information for specific purposes: Department of Health; Department of Human Services; Department of Public Safety; Department of Commerce; Department of Employee Relations; Department of Labor & Industry, insurers and employers in workers compensation cases; OCR/HHS Secretary; State Fire Marshall; Health Boards; Health professional licensing boards or agencies; Law enforcement agencies; Medical examiners and coroners; Potential victims of serious threats of physical violence; Local human services agencies.

Your Authorization Is Required for Other Disclosures

Except as described above, we will not use or disclose your medical information unless you authorize us in writing to disclose your information. You may revoke your permission, which will be effective only after the date of your written revocation. Your medical records may also contain psychotherapy notes from individual, joint, group or family sessions you may have participated in. You will need to sign a separate authorization for the use and disclosure of this information. You may revoke your permission to use and disclose your psychotherapy notes by sending a written revocation to SCSU Medical Clinic.

You Have Rights Regarding Your Medical Information 

You have several rights with regard to your health information. Specifically, you have the right to:

Inspect and Request a Copy of Your Health Information. With very few exceptions, you have the right to inspect and obtain a copy of your heath information. Please use the Consent Form to Release Health Information to make your request in writing. We will respond within 10 working days, unless an extension is necessary. You have the right to request your health information in an electronic format as indicated on the consent form if that health information is readily producible in an electronic format. Copies of electronic records will be provided in PDF on a portable media device provided by SCSU Medical Clinic. If you request copies, we may charge you a reasonable fee as permitted by law. If we deny your request, you may be entitled to a review of that denial.

Request to Amend Your Health Information. If you believe that your health information is incorrect, you may ask us to correct the information. You may be asked to make such requests in writing and to give a reason as to why your health information should be changed. However, if we did not create the health information that you believe is incorrect, or if we disagree with you and believe your health information is correct, we may deny your request. You may be entitled to a review of that denial. You may respond with a written statement of disagreement to be included in your records.

Request Restrictions on Certain Uses and Disclosures. You have the right to ask for certain restrictions on how your health information is used or to whom your information is disclosed, even if the restriction affects your treatment or our payment or health care operation activities. We are not required to agree in all circumstances to your requested restriction. However, in most situations we must agree to restrict disclosure to your health plan if you request this in writing and agree to pay for the services out-of-pocket in full.

As Applicable, Receive Confidential Communications of Health Information. You have the right to ask that we communicate your health information to you in different ways or places. For example, you may want us to contact you only at work or through a written letter sent to a private address. Your must make your request in writing and specify how or where you wish to be contacted. We will accommodate reasonable requests.

Receive a Record of Disclosures of Your Health Information. You have the right to request and obtain a list of the disclosures we have made of your health information. This list will include the date of each disclosure, who received the disclosed health information, a brief description of the health information disclosed, and why the disclosure was made. We may not charge you for the list unless you request such a list more than once per year.

Obtain a Paper Copy of this Notice. Upon your request, you may at any time receive a paper copy of this notice, even if you earlier agreed to receive this notice electronically.

Right to be notified of breach. If your unsecured health information has been impermissibly used or disclosed, we must notify you of the breach.

Complaints

If you believe your privacy rights have been violated, you, or your legal representative, may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing such a complaint. To file a complaint with either entity:

Medical Director of St. Cloud State University Medical Clinic
720 Fourth Avenue South
St. Cloud, MN 56301
320-308-3191

Director of Counseling and Psychological Services
720 4^th Ave. South
St. Cloud, MN 56301
320-208-3171

Special Advisor to the President
SCSU President's Office
720 Fourth Avenue South
St. Cloud, MN 56301
320-308-2122

Office of Civil Rights
Medical Privacy Complaint Division
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
866-627-7748

Client Rights and Informed Consent

Your counseling record is contained in an electronic health record and protected by all existing state laws and professional ethics regarding counseling records. Your counseling record is stored on a secure server. Your counseling record is NOT part of your academic record and no one has access to it except CAPS staff and/or Medical Clinic staff. CAPS and Medical Clinic staff work as part of an integrated care team to provide holistic care to students.  Medical Clinic staff and Counseling Center staff share an electronic health record system and can access the records of shared clients. You will be informed of the members of your treatment team. Records are maintained for ten (10) years after the end of counseling, at which point they are destroyed. You have the right to review your counseling record with your clinician.

Access to your counseling records both verbally and in written form will be available only when you sign a Release of Information Form for records or information to be disclosed to another entity. You have the right to revoke a Release of Information by making this request to your provider. Your protected health information is only shared by professional CAPS staff and Medical Clinic staff except in the following circumstances where disclosure to another entity may be required by law:

• When there is risk of imminent harm to you or another person;
• When court ordered;
• When suspected abuse of children or vulnerable adults is involved;
• When there is suspected prenatal exposure to controlled substances;
• When you sign a release of information for records to be shared or verbal correspondence;
• In addition, our accreditation standards or insurance companies may require very limited access to client files.

When a mental health professional has a statutory duty to warn another of a client’s serious threat of physically violent behavior or determines that a client presents a significant threat of suicide by possessing a firearm, the mental health professional must communicate the threat or risk to the sheriff of the county where the client resides and make a recommendation to the sheriff regarding the client’s fitness to possess firearms.

Scheduling and Insurance

In most instances, services at CAPS services at CAPS will be billed to your health insurance.  If you do not have health insurance, we have advocates who can work with you to obtain health insurance coverage. If you have questions about your health insurance coverage, please call the customer service number on the back of your insurance card to ask about your benefits. You may also speak with one of our receptionists or your provider regarding insurance questions.

When appropriate CAPS offers in-person and HIPAA-compliant telehealth services. The telehealth service model allows for the delivery of mental health services when there are barriers that prevent a client(s) and provider(s) from meeting in the same physical location. Your provider will determine if you are appropriate for telehealth services. These services require access to a compatible electronic device and high-speed internet connection. These services require access to a private location. There are circumstances when telehealth may not be appropriate and a face to face visit necessary. Some of these circumstances include, but are not limited to a need for interactive therapy that must be done in-person or the presence of recent high-risk behavior.

You have been given a copy of our Do Not Show Policy (DNS). Please be sure to keep your scheduled appointments or call us to cancel with at least 24 hours’ notice.

Email is not a safe way to transmit confidential information. If you want to send a message to your provider, you may do so using the secure patient portal. All messages through the portal become a part of your electronic health record and remain confidential.

Please do not message CAPS providers to schedule or change an appointment. You can schedule, change, or cancel your appointment by calling 320-308-3171 to speak with a receptionist. You may also request an appointment through the SCSU Counseling Center website: www.stcloudstate.edu/counseling. Please do not message CAPS providers for urgent or emergency needs as these messages my not be checked on a daily basis, nor evenings, weekends or holidays. If you are in need of an emergency-related/urgent appointment, please call CAPS (320-308-3171) during normal office hours of 8 a.m. to 4:30 p.m. weekdays. You can also request an appointment in person by walking into the clinic without an appointment during office hours. If you need emergency-related/urgent help after office hours, you should contact the local Crisis Response Team at 320-253-5555 or 1-800-635-8008 or contact emergency services by dialing 911.

Your provider may ask you about other treatment services you are engaging in in order to prevent duplication of services and to assist with being sure you have appropriate care based on your individual needs. In this case, your provider will assist to coordinate services with other professionals involved.  You will be told the identity of all providers involved in the coordination of your care.

Information Regarding Your Care

You will be given information in writing about the identity of your treatment provider or individual involved in coordinating your care. You will be given information about your diagnosis, treatment, alternatives, risks and prognosis in language that is understandable. You will be able to discuss your treatment, expectations, confidentiality, risks/protections and conditions for termination of treatment with your provider. You may be accompanied by a family member or other chosen representative, or both, if you choose. You will be given prompt and reasonable responses to your questions and requests.

You will be involved in treatment planning and be given continuity of care. You can decline or terminate services at any time.

If your provider feels that the issue presented by you is one that they cannot help in resolving, then they may suggest referrals off campus. Your provider will not start or continue counseling with you if his/her objectivity toward you is compromised for any reason. Examples of this may be that they already know you, are working with your partner or relative, or your concerns are too similar to their own unresolved events. In addition, if you are a student, but also an employee at SCSU, there may be circumstances where a dual relationship exists that impairs a provider’s objectivity. These situations will be discussed and you may be referred to the community.

All providers have available their areas of competence, also found on our website. Staff members who are clinical trainees working under supervision (e.g., pre-licensure employees, pre-doctoral interns or master’s level practicum students) will be identified as such.

Your provider considers you as an individual and will strive to not impose stereotypes, values or roles related to age, gender, religion, race, disability, nationality or sexual preference.

CAPS staff may ask you to evaluate your counseling experience here through a client satisfaction survey. Your participation is anonymous and voluntary. We appreciate your help with this effort to evaluate our services and strive for continued improved quality.

The Counseling Center (adjust "Counseling Center" to whatever is appropriate for your campus) works with Mantra Health, a digital mental health vendor, and Wellround Provider Group, P.A., Mantra Health’s affiliated provider group, to provide certain tele-mental health services. We may refer you to them for consultation, evaluation and/or treatment. When we make a referral, with your consent, we will share your information with them to the extent necessary for the provider to offer consultation, evaluation and/or treatment.

Your Rights

• You have the right to refuse any of the tests or techniques used by your clinician and you may request a different clinician if desired and clinically supported.
• You have the right to examine public records maintained by the following Minnesota boards who oversee the work done by our CAPS providers: Social Work, Psychology, Marriage and Family or Behavioral Health and Therapy.
• You have the right to obtain Rules of Conduct documents from all of the above boards, which are posted to their websites.
• You have the right to reasonable accommodations if you have a communication impairment or speak a language other than English.
• You have the right to be treated with courtesy and respect.
• You have the right to receive services that are free from any type of maltreatment and are free from any type of discrimination.
• You have the right to make a formal or informal complaint which is taken seriously and can be made at any time to any member of our CAPS team or Medical Clinic staff.
• You have the right to report any perceived violation of the above rights to the Director of Counseling and Psychological Services, Jennifer Rocheleau Dorholt, PsyD, LP, at 320-308-3171 or the Vice President for Student Life and Development at 320-308-3111.