Privacy Notice




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.


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.

We recognize our responsibility for safeguarding the privacy of your health information. This Notice describes your rights and our obligations for using your health information and informs you about laws that provide special protections for your health information. It also explains how your personal health information is used and how, under certain very specific circumstances, it may be disclosed to those who need to access it. It tells you how any changes in this Notice will be made available to you.

Understanding what is in your record and how your health information is used helps you to:

  • Ensure accuracy in the record;
  • Better understanding who, what, when, where, and why others may access your health information;
  • Make a more informed decision when authorizing disclosures to others;
  • Decide how best to contact you (for example, by calling, e-mailing, or sending you a letter) to remind you about appointments, diagnostic results, to advise you about other health-related benefits and services.

Health Information Use

Your record contains documentation of your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often called your health or medical record, serves as a:

  • Means of communication among the health professionals who contribute to your care
  • Legal record describing the care you received
  • Source of information that we may disclose to researchers when their research proposal has been approved by an Institutional Review Board (IRB) and with established protocols to ensure the privacy of your health information
  • Source of information for public health officials
  • Source of data for facility planning and marketing
  • Tool with which we can monitor, evaluate and continually work to improve the care we render and the outcomes we achieve

Our Responsibilities

This organization is required to:

  • Maintain the privacy of your health information
  • Provide you with a Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
  • Abide by the terms of this Notice
  • Notify you if we are unable to agree to a requested restriction
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will advise you in advance. We will not use or disclose your health information without your authorization, except as described in this Notice.

Use and Disclosure Without Your Authorization

The law allows or requires us to use and disclose your health information without your authorization for a number of purposes designed to enhance health care services, protect patient safety, public health, and to ensure that our facilities and practitioners comply with government and accreditation standards. For example, we may provide health information to:

  • Other care providers such as physicians, nurses, therapists for purposes of referral or treatment;
  • Government oversight agencies (including the FDA, US Food & Drug Administration, and when otherwise required by law) with data for health oversight activities such as auditing or licensure;
  • Public health authorities with information on communicable diseases and vital records;
  • Workers' Compensation agencies and self-insured employers for work-related illness or injuries;
  • Appropriate individuals when we believe it necessary to avoid a serious threat to health or safety or to prevent serious harm to an individual;
  • Researchers, if an IRB approves use and disclosure without patient authorization;
  • Law enforcement when required by law, including mandatory abuse reporting; and
  • Coroners, medical examiners and funeral directors.

Your Rights

Your rights are listed below: If you would like to exercise any of these rights, inquire at the front desk or ask a staff member for the proper form.

  • The right to inspect and receive copies: You may request a copy of your records in writing by using the UST Authorization for Use and Disclosure of Protected Health Information Form. You may be charged fees for copies provided.
  • The right to amend your record: You may request to amend your record if you think it is incorrect or that important information is missing.
  • The right to request confidential communications: You may request that we communicate with you about medical matters in a particular way or at a certain location.
  • The right to request restricted use: You may request in writing that we not use or disclose your information for certain purposes.
  • The right to obtain an accounting of disclosures: You may request to receive a list of certain instances when we have disclosed your health information.


If you believe your privacy rights have been violated, you can file a complaint with the UST HS/AD or:

U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
(202) 619-0257
Toll Free: 1-877-696-6775


If you have any questions about your rights or this Notice, or would like to make a complaint, contact:

UST Director, Health Services
2115 Summit Avenue
St. Paul, MN 55105

UST Associate Director of Athletics
2115 Summit Ave.
St. Paul, MN 55105