Campus Health: Permission to Treat Policy

This policy establishes that Campus Health requires patients to sign a Patient Agreement before receiving services, covering consent to treatment, confidentiality, and financial authorization. It outlines the procedures front desk and Health Information Management staff must follow to record and store that signed agreement.

Unit Policy

Title

Campus Health: Permission to Treat Policy

RI-31

Introduction

Purpose

This policy establishes that Campus Health requires patients to sign a Patient Agreement before receiving services, covering consent to treatment, confidentiality, and financial authorization. It outlines the procedures the front desk and Health Information Management staff must follow to record and store that signed agreement.

Scope

This policy applies to Campus Health front desk personnel and Health Information Management staff responsible for obtaining, recording, and storing patient agreements.

Policy

Campus Health (CH) recognizes and respects the right of a competent adult patient to consent to delivery of care, treatment, and services within the facility.

Procedure

CH front desk personnel will verify that each patient arriving for services has a Patient Agreement on file by checking the Patient Information screen – Release of Information Flag set to "Y". If they do not, they will ask the patient to sign a Patient Agreement that outlines:

1. Permission for diagnostic and treatment procedures,
2. Confidentiality acknowledgment,
3. E-mail notification,
4. Financial information and authorization to process insurance claim, and
5. Eligibility for services.

After obtaining the signed Patient Agreement form, the front desk personnel will change the Release of Information flag on the Patient Information screen from "N" to "Y" and enter the date the form was signed in the "Signature Date" field.

Health Information Management staff will scan the signed document into the patient's electronic health record.

Attachments

• Attachment 1: Campus Health Services Patient Agreement
• Attachment 2: Counseling and Psychological Services Consent Form

Reviewed by

Contact Information

Primary Contact

Name: Melody Gibson, Health Information Manager

Telephone: 919-966-6557

Email: mgibson@email.unc.edu

Publication Details

Issuing Officer: Ken Pittman, Executive Director of Campus Health

Effective Date: September 1992

Last Review Date: November 2023

Next Review Date: November 2026