Download and complete an Authorization for Disclosure of Protected Health Information form (pdf - 29.98 KB). Complete sections 1,2,3,4,6 & 9. Mail, fax or return the form in person to the Center
for Student Wellness.
Contact information:
217 Crawford Building, Rock Hill, SC 29733, secure fax: 803/323-3332.
The Center for Student Wellness may implement a reasonable charge for making copies
of any clinical record or other document. Charges will not exceed amounts authorized
by Section 44-115-80 of the South Carolina Codes, The South Carolina Physician's Patient
Records Act.
All conversations, examinations, and interviews with students are covered by state
law and ethics of confidentiality. In emergency cases, where life or limb is threatened,
the policy of confidentiality will be governed by one of reasonableness and accepted
statutes. A student's permission must be given by written consent before Health Services
can release specific medical information or any portion of a medical record including
releases to parents, university officials, and external agencies.
Notice of Privacy Practices (pdf - 61.38 KB)
Although Health Services has transitioned to Electronic Health Records, some past Health Records are stored in paper format under double lock. In accordance with South Carolina state law, these paper Health Records are maintained for a period of ten years after the last date that service was rendered to the pateint, unless otherwise required by law. After that time, charts are destroyed in a manner that assures their confidentiality.
