On behalf of the employees at the Student Health Services, we would like to inform
you of things that you might not be aware of as a new or existing patient.
HIPAA (Health Insurance Portability and Accountability Act) – is a federal law that
requires the Southern Miss Student Health Services to protect your health information
and to keep everything confidential.
You will be given a copy of our notice of privacy practices and required to sign this
form upon your first visit.
You as a patient have rights and responsibilities. A copy of these rights and responsibilities
can be found in each patient room.
Patient Rights and Responsibilities
As one of our patients, you have certain rights and responsibilities.
To quality health care
To be treated with dignity, consideration, and respect in a manner that does not discriminate
against age, ancestry, color, disability or handicap, national origin, race, religious
creed, sex, sexual orientation or veterans status
To know the names and professional/malpractice status of people serving you
To privacy to the best of our ability
To confidentiality of your records
To receive accurate information to the extent known about your health-related concerns
To know the effectiveness, possible side effects, and problems of all forms of treatment
To participate in choosing a form of treatment and decisions regarding your treatment
To receive education and counseling
To select and/or change your health care provider and request a second opinion or
referral to a provider/place of your choice
To choose the pharmacy provider where your prescriptions are filled
To receive education about your medications
To choose who your medical information is shared with
To review your medical records with a clinician
To receive information about services and any related costs
To develop an advanced directive
To be respectful of all health care providers, staff and other patients
To inform your provider about any living will or advance directive
To accept financial responsibility for charges not covered by insurance
To seek medical attention promptly
To be honest about your medical history, prescriptions (including over the counter),
To follow health advice and medical instructions or accept responsibility for the
To provide a responsible adult to transport you home from this facility and remain
with you for 24 hours if required by your provider
To report any significant changes in symptoms or failure to improve
To respect clinic policies
To keep appointments or cancel in advance
To seek nonemergency care during regular office hours
To inform a staff member if you do not want any part of your visit filed on insurance
To provide suggestions or grievances about Moffitt Health Center
If you have suggestions, concerns, questions, or to report a grievance, please contact
the HIPAA Privacy Officer, 601-266-5390.
A no-show is considered to be any scheduled primary care, procedure, or nurse visit
where the patient does not present for the appointment or cancels their appointment
less than 1 hour prior to the appointment.
Patients with morning appointments between 8 a.m. and 9 a.m. will be considered cancellations,
not no-shows, if they leave a message by 9 a.m. the day of their appointment.
Patients are encouraged to arrive 15 minutes before their appointment. If a patient
is more than 15 minutes late for an appointment they may be considered a no-show.
Being seen will be at the provider's discretion based on the nature of the concern
and the schedule of the provider.
A patient may cancel an appointment in-person, by calling or emailing MHC or via the
There will be a $10 charge per no-show, charged to the student's account (Bursar account).
If a patient feels there are special circumstances related to their no-show visit,
they may request a review of their no-show fees. To submit an appeal, email firstname.lastname@example.org.
Please contact 601.266.5390 for any questions or concerns. Patient medical records
can be faxed to 601.266.4205.
Before prescribing controlled stimulant medications for ADHD, Moffitt Health Center
requires documentation of a comprehensive evaluation/psychological testing by a licensed
professional with experience in ADHD assessment. ADHD screenings and prior medical
records of stimulant medication refills are not sufficient documentation of the diagnosis.
Documentation should state the specific disability as diagnosed. The ADHD diagnosis
should be made by someone with appropriate professional credentials and should reference
the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. Documentation
should describe the comprehensive testing and techniques used to arrive at the ADHD
diagnosis. Evaluators must be authorized and licensed by the state in which they practice
to administer the necessary tests and to diagnose ADHD and these credentials must
be listed on the ADHD assessment.
If you have already been tested for ADHD and have the necessary documentation as described
above, it is not necessary to be tested again. You may bring a hard copy of your ADHD
assessment done by a licensed professional or have those records faxed to our clinic.
A medical records release form (found above) will allow you to request that information
and have it sent from your previous provider directly to Moffitt Health Center.
Once all documentation and assessment information has been obtained and reviewed,
your provider will discuss medication options with you to determine which medication
would be most appropriate for the management of symptoms. An EKG may be requested
before a stimulant medication is started. Providers will monitor controlled substance
prescription activity on the Mississippi PMP website. Drug testing may be conducted
to ensure you are taking your medication and are not taking other mood altering substances
that will adversely affect ADHD.
Class 2 controlled substances cannot be refilled. Moffitt Health Center providers
will prescribe controlled ADHD medications for only one month at a time. You will
be responsible for coming to the clinic to get a new prescription each month.
The prescription for class 2 controlled substances is printed on special paper that
prevents tampering, faxing and copying. Alternatively, a written prescription may
Controlled substances are monitored by the Drug Enforcement Agency of the Department
of Justice. Misuse, selling, distributing (sharing with a friend) is a felony. The
first offense is punishable by no more than 20 years in prison and/or fined no more
than 5 million dollars. If death or serious injury occurs as a result of unlawful
use or distribution, the party may face at minimum 20 years to life in prison. Under
the Controlled Substances Act, a person convicted of selling or attempting to sell
amphetamines near a school, including a college, or other areas where young people
may be present, faces twice the maximum prison sentence, twice the maximum fine, and
twice the term of supervised release. (21 U.S.C. 860.)
DO NOT SHARE YOUR MEDICATION (see paragraph above).
We recommend that you also submit a copy of your official ADHD assessment to the USM
Office of Disability in order to get extended testing time and/or other classroom