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Phone: 1-304-243-8152

Academics: Authorization for Release of Protected Health Information (PHI)

Date approved:
April 2015
Approved by:
Senior VP for Mission & Ministry
Date to be reviewed:
April 2016
Reviewed by:
Compliance Coordinator
Date revised:
Revision number:
Compliance Committee:
As Scheduled

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To obtain authorization for release of Protected Health Information (PHI) and disability documentation from students with disabilities.


2.1 Policy Statement

Students with disabilities will provide written and signed authorization for their confidential and protected health information and disability documentation to be released or obtained by the Director of Disability Services at Wheeling Jesuit University.

2.2 Definitions
2.3 Procedure

  1. Students with disabilities will sign and date an authorization for the Release of Protected Health Information form provided by the Director of Disability Services that will designate the particular record to be released or obtained.
  2. The signed, non-electronic authorization form will be retained in the confidential files of students by the Disability Services Director, will be valid for the specified timeframe, and will be available upon request.
  3. Students have the right to revoke authorization at any time with a written and signed request.


The Director of Disability Services has the authority to change, modify, or approve exceptions to this policy at any time, with or without notice, in accordance with federal disability regulations or modifications and amendments to those regulations, with the approval of the Chief Academic Officer and the President of the University or his designee (Compliance Coordinator).


Authorization for Release of Protected Health Information
Fax Cover Sheet

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