Camp Health Record Form (Page 4 of 4) in pdf

Notice of HIPPA Privacy Practices

Shrine Mont Camps and Conferences works very hard to maintain the integrity of your

child’s health information. In keeping with the Federal health privacy regulations (enacted

April 2003), we are notifying you of the ways in which we maintain this confidentiality and

handle your child’s health information.

1. All treatments and medications administered to the camper while in residence are

recorded on the appropriate health form by the camp nurse. These and all other

health records are kept in a secure location when not in active use.

2. Access to health records is restricted to those with a need to know: camp nurses,

physicians to whom the camper has been referred, the chaplains, the Shrine Mont

Camp Director, and directors of the appropriate camp where the camper is in

attendance.

3. Where appropriate, selected information regarding a camper’s health is shared with

the counselors of the appropriate camp. This is to assist the staff in interactions with

the camper, and to alert them of any potential health problems which may develop.

This information is NOT shared with other campers or staff from other camps. Staff

and counselors are instructed to keep all information confidential.

4. When a camper is referred off-site for medical treatment, a copy of the medical

release form and the health information form are sent with the adult accompanying

them to the physician or emergency room. If these copies are not collected by the

treating physician, they are returned to the camp nurse.

5. At the conclusion of the camp session, all health records are stored in a locked file

cabinet, accessible only to the camp nurse staff and the Shrine Mont Camps Director.

6. Copies of all health treatments records may be released to the parents/guardians at

their request. There is no charge for this.

7. Copies of health records are released to other parties only with the appropriate

proof of legal authorization.

Camp Health Record Form Page 4