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UNCP Home About UNC Pembroke Administration Policies and Regulations All Regulations REG 11.40.02 - Student Health Services Release of Medical Information Regulation
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REG 11.40.02 - Student Health Services Release of Medical Information Regulation

Authority: Vice Chancellor for Student Affairs


  • First Issued: Prior to 1999
  • Revised: June 1999; June 10, 2013
  • Last Revised: February 20, 2017

Additional References:

Contact Information: Director of Student Health Services, 910.521.6219


1.1 Confidential information in the medical record is considered privileged information and cannot be released without the patient’s written consent. Confidentiality is to be broken only if the patient poses a danger to self or others.


2.1 Employees of student health services with access to medical information shall respect the doctrine of confidentiality and not divulge any information contained in the medical record unless authorized to do so by the patient. The director of student health services and university general counsel shall be consulted in case of doubt.

2.2 The release of medical information, including diagnostic tests to outside physicians, requires the patient’s written authorization, or that of a parent or guardian if the patient is under 18 years of age or mentally incompetent. An authorization will not be considered valid if the signature date is more than one year old. An original authorization is preferred, but copies are acceptable if clear and legible.

2.2.1 Minor patients (under 18 years of age) can sign the medical release form under the following conditions:

2.2.1.a. when seeking services for the prevention, diagnosis, and treatment of venereal disease;

2.2.1.b. when the patient is pregnant;

2.2.1.c. when a member of the armed forces;

2.2.1.d. when married or divorced;

2.2.1.e. when emancipated by a decree issued by a court of competent jurisdiction.

2.3 An authorization should contain all of the following information:

2.3.a. patient’s name;

2.3.b. name of facility releasing the information;

2.3.c. name of the individual or facility that is to receive the information;

2.3.d. specific type of information to be released;

2.3.e. reason for the release;

2.3.f. signature of patient or authorized designee;

2.3.g. date consent is signed;

2.3.h. signature of witness; and

2.3.i. statement that the consent can be revoked at any time.

2.4 Authorizations are required for release of information to:

2.4.a. physicians and extenders not on the UNC Pembroke health services staff;

2.4.b. attorneys;

2.4.c. insurance companies;

2.4.d. schools or universities;

2.4.e. law enforcement agencies;

2.4.f. immigration and naturalization service;

2.4.g. employers;

2.4.h. social security administration;

2.4.i. internal revenue service;

2.4.j. civil service departments;

2.4.k. university personnel;

2.4.l. veterans’ administration; and

2.4.m. parents.

2.5 Authorizations for release of patient information must be placed in the medical record and a notation made as to what information was sent and to whom it was sent.

2.6 Upon release of the information, a cover letter or form that states it is confidential medical records and may not be disclosed to anyone other than the person listed should be sent with the information.

2.7 Authorizations are not required for release of information to patient care and in-state and federal court orders.

2.7.1 In the case of an emergency where the patient is unable to authorize release of his/her medical information or when time does not permit obtaining such a release, needed information will be released so that a determination of emergency treatment may be rendered.

2.7.2 Another physician or health care facility that is at that moment treating the patient (after verification, ask that they send a valid authorization as soon as possible).

2.7.3 Authorizations are not required for state and local health departments when reporting communicable diseases.

2.7.4 All student health services staff shall have access to medical records necessary to treat or assist with the treatment of a patient.

2.7.5 If a subpoena or court order is received requesting the transfer or release of a patient’s medical record or of information contained in the record, the UNCP Student Health Services director shall be informed.

2.7.6 The UNCP student health services director shall immediately inform university general counsel before acting upon the subpoena or court order request.

2.7.7 Medical records shall contain documentation of the disposition of the subpoena or court order request and release of records made in conformity with the subpoena or court order.


3.1 Information received from other health facilities should be treated as confidential under the same guidelines that apply to records created in student health services. Copies from outside health facilities may not be provided. Patients may view the records if desired, in the presence of a UNCP student health services staff member.


4.1 The original or parts of an original medical record shall not be removed from the student health center except upon receipt of a subpoena and court order. Records will be kept eleven years after the student leaves the university and subsequently are destroyed.