LINCOLN MEMORIAL UNIVERSITY-DEBUSK COLLEGE OF
OSTEOPATHIC MEDICINE
STANDARDIZED PATIENT/PATIENT MODEL PROGRAM
HANDBOOK FOR 2015/2016
Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) is
dedicated to creating an environment in which clinical, communication and professional skills for
future health care providers are nurtured and honed.
LMU-DCOM conducts clinical skills evaluations and assessments using Standardized Patients (SP),
and Patient Models (PM). Your commitment and dedication as a SP, and/or PM is appreciated and
we certainly want to ensure that your continued support is fulfilling, enriching and enjoyable.
Please carefully review the following handbook which will contribute to your experience with the
LMU-DCOM Standardized Patient/Patient Model Program.
Contact information for SP/PM program personnel:
Sue Cobb
Standardized Patient/Patient Model Coordinator
423-869-6460
sue.cobb@lmunet.edu
DCOM Office 204
Location:
Lincoln Memorial University-DeBusk College of Osteopathic Medicine
6965 Cumberland Gap Parkway
Harrogate, TN 37752
Modified May 8, 2013
Lincoln Memorial University-DeBusk College of Osteopathic Medicine
PROCEDURES, POLICIES & EXPECTATIONS OF THE SP/PM:
Definitions
Standardized Patient (SP) and Standardized Client (SC) encounters are video and audio recorded
to allow the students, faculty, specified staff members, and peer reviewers to view the encounter.
Immediately after the encounter, the SP/SC will complete a computerized checklist based on
student performance.

Definition of Standardized Patient & Performance criteria: A Standardized Patient (SP)
is a part-time employee that has been trained to portray a specific patient scenario. They are
given details of fictional patient and family histories, symptoms, medications, and other
information so they may act out cases for health professional students.
Definition of Standardized Client & Performance criteria: A Standardized Client (SC) is
a part-time employee that has been trained to portray a specific client scenario. They are
given details of fictional clients unique to the exercise and instruction how to interact with
students of health professions as well as assisting in inter-professional education
opportunities for students of various disciplines.

Definition of Patient Model: A Patient Model (PM) is a part-time employee willing to serve
as an actual Patient for complete physical examination training including genitals and rectum
for males, and for females, pelvic and breast exams. There may be multiple people in the
room during the patient model encounter including, but not limited to, students,
facilitators/instructors, proctors/monitors and other patient models. Patient Models will
receive an initial examination each semester from a licensed physician for the purpose of
establishing a baseline from which the physician can instruct students. This examination does
not constitute the beginnings of a doctor/patient relationship. The Patient Model must sign a
release form agreeing to these conditions. Patient model encounters are not video and audio
recorded. Patient models may be asked to provide written or verbal comments about their
encounter. They may also be trained to instruct students in proper technique.
Auditioning Process

As part of the new part-time employment recruitment process, all new SP/SC candidates,
including those who have signed up but not yet participated in an OSCE will be required to
undergo an audition process, which will include an interview and training session to be
followed within one week by a formal recorded audition.
Mandatory Workshops

Whenever deemed necessary by the program coordinator, Standardized Patients will
be required to attend mandatory workshops to improve skills. These workshops are
unpaid and will focus on remediation and teaching of new skills. If SPs do not
participate, they will not be eligible to serve until they have completed the
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workshop. SPs that complete the workshop and/or training process will be eligible
to participate for the entire semester or until he or she is deemed ineligible for some
other reason.
Confidentiality

CONFIDENTIALITY is very important to this program; on-site and off-site.
a) Student confidentiality: No student performances are to be discussed with anyone by name
or identifying specifics other than with the Coordinator and/or Program Directors.
Confidentiality for the students must be maintained at all times.
b) SP/PM confidentiality: Any observations of other SP/PM performance during training or
quality assurance/reliability sessions are to be kept in the strictest confidence. Discussion of
SP/PM performance is to be limited to LMU-DCOM faculty/staff.
c) Confidential materials: The cases/checklists used for training are the copyright property of
LMU-DCOM. These cases/checklists are used exclusively by the LMU-DCOM SP/PM
Program. Unauthorized use or discussion of these cases/checklists will result in expulsion
from the program.
Hygiene:

Exceptional hygiene is not only expected, it is mandatory.

A clean well-kept appearance with no body odor or pungent smoke smell is necessary for
undistracted learning. You will be in close proximity with student in the clinic room. Be
mindful to shower before your arrival.
In Role:

For the SP/SC/PM program to work effectively there are certain expectations of the part-time
employees, please review these expectations. Remain consistent from one Student to the next.
Stay in Character throughout the entire interaction.

Know your role, role expectations, and be able to present them clearly.

Stay focused on your role as an effective SP/SC by staying in character, do not speak with the
students “out of role” before, during or after the simulation.

If, for any reason, you must exit the room, please do not speak with the students even if they
speak with you first. Students are working on their notes and it could disturb or disrupt other
students. Students should not ask questions once out of the exam room.

During sessions, the door should remain closed if you are inside the room and should be left
open when you exit the room.

Remember, the videotapes are recording – even when the students leave the room. Do not
make gestures (rolling eyes, thumbs down, etc) or make comments about the students at any
time. The video will be seen by faculty and the student at a later date. At the end of the
encounter, simply complete checklists as prompted on the computer monitor inside the room.
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
As a Standardized Patient you will be provided a cloth gown for most of the clinical
encounters you participate in. You are asked to also wear clothing underneath your gown
that is suitable for an examination such as sports bra and shorts.

As a Patient Model you will be provided with paper gowns and are encouraged to bring a
bathrobe or “quick change” of clothing with you so that you can use them during your breaks.

It is also okay to bring a book, crossword or other entertainment source for the breaks
between students.
Assessments:

Student Assessment: You must pay very close attention to the students you are assessing, as
part of their grade may depend on your assessment. You will need to check over each
form/checklist for correctness. The use of a computer mouse and/or keyboard may be
necessary to complete some checklists.

SP/SC/PM Assessment - Feedback forms may be given to all faculty and students with
whom you have interacted during your session, as well as to the faculty member grading the
students. These forms will allow us to give feedback to you on your performance. These will
be available for your review at any time. Additionally, you may be asked to review your
performance and/or that of one of your peers (bearing in mind that confidentiality is very
important). The coordinator may also periodically review your performance.
Quality Assurance:
* IT IS IMPORTANT TO RETAIN A HIGH QUALITY SIMULATION
AT ALL TIMES.

Distractions may effect concentration and overall exam performance of the student.
Remain in your exam room until announcement of test completion is made. There will
be a brief break between the end of one exam and the start of the next exam for
restroom or other needs.

Only give the student the information that they gather themselves. Do not reveal, tell, or
portray any patient information to the student until they ask or find it during the examination
process.

Do not sidetrack the student physician interview with unnecessary conversation other than
what is necessary in portraying your patient character naturally.

Do not break character by laughing or speaking to the student outside of your prescribed role

Be believable in your role, careful to present the illness as naturally as possible.

Stay focused on your role as an effective, efficient, and consistent Standardized
Patient/Client.

Quality of the SP/SC/PM’s performance is a priority. Quality assurance will be maintained
using several methods:
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
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Direct observation during training
Direct/scheduled observation during sessions
Direct/random observations during sessions
Video review
Video review by SP/SC
Video review by SP/SC peer
Student review
(Feedback may be provided. This may be verbal, written or both.)

If at any time you feel you are in need of a review, or if you have questions or concerns with
the simulation, please contact the Coordinator.

Program Quality Performance is also a priority. Please complete the SP/SC/PM feedback
survey for the previous semester in which your services were utilized. The packet may be
attached to your general information packet at the beginning of the semester. The
information you provide will allow us to continue positive practices and identify those that
need improvement.
Assignment to an OSCE/Patient Modeling Session


You may be provided a list of potential dates at the beginning of the semester to determine
availability for upcoming dates. It is not a list of assigned days.

Days are assigned as follows:

You will receive a letter, telephone call, text, or email asking if you are available for
specified dates.

If a message is left, you must return it within 48 hours in order to confirm your
availability for upcoming dates. If you fail to confirm, you will not be scheduled for the
assignment.

If you confirm availability, you will receive participation confirmation dates scheduled.

You may be scheduled for a longer period of time than will be needed. If you are
released to leave, you will be compensated only for the time you are here.

If possible, a standby is scheduled for each exam. If you are scheduled as a standby or if you
are replaced by the standby, you may be released to leave after an hour if no problems arise.
As a standby, you may be asked to do live peer review during your wait time.

No SP/SC will be required to participate in an activity or session or be penalized for choosing
not to participate. However, if you do consent to an activity or session, we will assume you
will demonstrate responsibility and arrive at the scheduled time.

Scheduling notice: Please give the Coordinator as much notice as you can so a replacement
can be found. If you are available on an “emergency basis,” contact the Coordinator.
You will be scheduled 30 minutes prior to your first student. This paid time is for room
preparation, review of format and any last minute instructions from the LMU-DCOM staff.
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
Arrive 30 min early; no later than 15 minutes early
CANCELLATIONS:

In the event circumstances prevent you from coming to a scheduled session, please notify the
coordinator as soon as possible. A pattern of last-minute cancellations will likely prevent you
from being called to participate in the future.

Cancellations must be made with the Coordinator. Although we appreciate your
conscientiousness, please do not directly contact a replacement SP/SC/PM on your own.

SP/SC cancellations must be reported to the coordinator within 24 hours.

The medical school (LMU-DCOM) operates on the University Schedule. In the case of
inclement weather, please tune to the local radio/television station to see whether Lincoln
Memorial University has cancelled classes. If classes have not been cancelled, the SP/SC/PM
encounters will go forward as planned

If you cannot make it due to weather conditions, please call the Coordinator as soon as
possible.
Training

All training will be provided by the Center for Simulation and Training staff in
conjunction with LMU-DCOM and MSN faculty.

Basic SP/SC Training procedures and resources:
1. Initial training session to discuss case & checklist
2. Trainings to interpret and assess the humanistic traits of students
3. Standardized Patient Essentials Black Board website
*Training procedures may be modified for the client/event if necessary. Assessments will require more training times.

Basic PM Training procedures:
1. Initial meeting to discuss overview and orientation of requirements
2. Initial physical examination by a physician
*Training procedures may be modified for the client/event if necessary. Assessments will require more training times.

If a SP/SC does not attend the training session, they will not be permitted to participate in the
event. If there are mitigating circumstances that require re-scheduling the training, please
contact the coordinator as soon as possible.

All cases, checklists and training materials are developed by LMU-DCOM or LMU Nursing
faculty and the property of Lincoln Memorial University. These cases, checklists and all
written materials are to be used exclusively by SP/SC/PM volunteers of the SP/SC/PM
Program.
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
The SP/SC/PM Program recognizes the different learning styles of the SP/SC/PMs. If an
individual SP/SC/PM develops materials that assist them in the learning of the case/checklist
etc. and feels it would assist others in the training, they must submit the materials to the
program coordinator. Please do not distribute materials without prior review by the
coordinator.

Feedback & Basic skill training and review is mandatory. There are no exceptions. If you
are used as a Standardized Patient or Standardized Client, you will receive peer review,
faculty review, supervisor review and/or student review.

Training for a specific exam will be provided prior to the scheduled exam. This may be
several days to a week prior to the exam. You will be notified of details in a written letter or
email.

A debriefing post encounter may be requested. Please plan to stay 15 minutes after the
event for this debriefing. Your verbal or written observations and comments are always
welcome.
Professionalism – Preparation & Punctuality

PROFESSIONAL PREPARATION – It is your professional obligation to arrive at the session
prepared. This includes knowing the details of the case, checklist, and format. Details about
training days and OSCE days will be included in the confirmation letter or email. Please read
this carefully. If you have any questions, please contact the program coordinator.

PUNCTUALITY is of dire importance. You must be available for the full time requested,
unless an arrangement has been made with the coordinator. It is mandatory that you arrive
on time for the exam or training. If you are asked to arrive 15-30 minutes early for the
session, you will be compensated for this time. Early arrival helps us give you time to prepare
yourself for the upcoming session. It also allows for last minute communications between
you and LMU-DCOM staff and faculty.

You will be required to sign in upon your arrival and before your departure.

Arriving late –Unforeseen circumstances arise for everyone, but punctuality is a professional
courtesy for our students. If you are late more than twice without a valid excuse, you will not
be asked to return.

If you are scheduled to be here and you fail to call and you do not show up, you will not be
asked to return.
Volunteer status, Payment, & Performance Criteria

Employment Status: As a SP/SC/PM at LMU-DCOM, you are a part-time employee of
Lincoln Memorial University. You do not qualify for full time employee benefits

You will be evaluated periodically as to your performance as an employee. As a part-time
employee LMU-DCOM is not required to provide a certain amount of hours per pay period.
There may be pay periods that zero hours of part-time employment will be available for the
SP/SC/PM.
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
As an SP/SC gains experience, knowledge and expertise he/she will be assessed using the
following criteria:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Ease of training & time training for a high quality performance: As experience increases for
the SP/SC, training time is more efficient & effective.
Quality of Feedback: Review of feedback forms from student/faculty/coordinator/self/peers,
quality and detail of feedback verbally and written. Written and verbal feedback is accurate and
consistent in quality.
General attendance/lateness: Consistently arrives on time or provided notice when late.
Preparation: Prepared with case details, knowledge of checklist and feedback.
Working with staff, students & peers: Works well with LMU-DCOM staff/faculty, students and
peers.
Flexibility: Ability to adapt to quick changes and working with changes.
Ability to receive feedback & integrate feedback: Integrates feedback readily and
consistently.
Consistently performing a high quality job: Understanding details necessary to portray cases
& document student performance.
Contributes positively to the attitude and morale of peers: Consistently contributes to
program morale and attitude. Does not contribute or spread malicious gossip or rumors
Checklist accuracy & reliability : Consistent checklist accuracy and reliability
Professionalism: Represents Program professionally at all times.
Confidentiality: Maintains required confidentiality at all times.
10.
11.
12.
13. Knowledge: knows the facts of the case
14. Presentation: Presents the symptoms as trained and maintains the symptoms throughout
the exercise
15. Believable acting: Is the SP/SC believable as the actual patient

Lunch Breaks: LMU-DCOM does not pay for lunch breaks (unless specified).
Fee schedule:
Training:
SP/SC training/control room assistance
PM training
SP/SC Exam day
PM Exam day
$10.00/hour
$10.00/hour
$15.00/hour
$30.00/hour

You must complete a W-4 form upon hire; you will receive a W-2 form at the end of the year.

You must sign in and out in order to get compensated. You must also sign the Employee
Timesheet before it can be submitted to Human Resources.

You should receive your compensation check by mail, payment is set on a biweekly schedule
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Lincoln Memorial University-DeBusk College of Osteopathic Medicine
Parking:

SP/SC/PM should park in visitor parking at the LMU-DCOM building.

Visitor parking is at the north entrance (facing Campus)
Control room conduct:

When in the Control Room, maintain silence so that others can listen and concentrate. By
maintaining silence student concentration may be maintained as well because Control Room is
not sound proof.

Beverages are not allowed in the control room unless in covered containers such as travel mugs
with lids. You may bring your own container for this.

Privacy is critical. You may be observing (or may be observed by) another SP/SC for training or
evaluation purposes. If the examination is sensitive every effort will be made to protect your
privacy by the staff. Alternatively, it is important for you to be sensitive to the activities on the
monitors. It is essential that you restrict your viewing to the monitor you are assigned to watch.
Exam Rooms & Housekeeping:

Should you have a problem or a question during an encounter with a student, please remain in the
room until the student has exited. You may then quietly exit the room and go to the control room
to ask for assistance.

Personal items should be stored under the sink in the assigned room.

Do not leave your confidential materials (case/checklists/instructions) or any other material lying
around.

Please keep all personal items with you. The University is not responsible for lost or stolen items.

Gowns- A paper gown will be issued to Patient Models and a cloth gown will be issued to
Standardized Patients for each examination. Please ensure that you are wearing modest
underwear. You may wish to bring a bathrobe to use between students and during breaks.

Rooms are cleaned daily by the housekeeping staff but each SP/SC/PM is responsible for
changing the table paper and putting all trash in the bins. Place the gown(s) in the appropriate
container.
Selection of SP/SC/PM:
The SP/SC/PM is selected for events using a combination of the following criteria.
Selection Criteria

Client specifications (case, age, gender, ethnicity, physical characteristics, etc.)
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
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Case requirements (affect to be portrayed, case difficulty, knowledge base needed to portray
case, life experience)
Role of SP/SC/PM
Level of experience in portraying case
Level of experience in teaching
Level of experience and quality of feedback (verbal and/or written)
Past training and experience with requested case
Performance history and ability to integrate feedback
Performance history and ability to maintain changes of case/feedback
Level of experience for level of learner
Client preferences (client will identify a specific SP/PM or ask NOT to send a specific
SP/SC/PM)
Development/maintenance of skills*
* The Program reserves the right to distribute work to develop/maintain SP/PM skill levels
Folders & Paperwork:

Cases & checklists - Please retain all of the cases you are trained in for future use. It is highly
recommended that you obtain a daily planner and a 3-ring binder to keep track of your schedules,
manuals, simulations, and training and pay information. Bring your cases (or the relevant case)
each time you attend.
General:

Dating or “hanging out” with Medical Students: It is our policy that SP/SC/PM does not
personally interact with the medical students they meet through the program, since you are in a
position of evaluating them. SP/SC/PM will not seek to contact students met through the
program for any reason whatsoever.

Conflicts - If you are experiencing any difficulties with simulators, faculty, staff or clients, please
address these concerns in a timely manner and in detail to the coordinator.

Telephone Numbers: It is the policy of Lincoln Memorial University-DeBusk College of
Osteopathic Medicine never to give out personal telephone numbers. If you wish to share your
telephone numbers you must do so personally.

Social Media: Avoid any contact with students on social media outlets i.e. Facebook, Twitter
accounts…etc.
Drug and Alcohol Policy

Drinking alcohol prior to or during sessions is not permitted.

Use of illegal drugs or misuse of legal drugs while acting as a Standardized Patient, Standardized
Client, or Patient Model will result in removal from the program.
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
The building and grounds of LMU-DCOM are tobacco free. Please remember if you must smoke,
you must use designated areas outside and away from buildings.
Key Terms to Know:

OSCE: Objective structured clinical exam

B-Line: Audio/Video/Assessment system used to record and capture student interactions in
the exam room

OMS I: First year osteopathic medical student

OMS II: Second year osteopathic medical student

OMS III: Third year osteopathic medical student

OMS IV: Fourth year osteopathic medical student

Osteopathic Medicine: A form of conventional medicine that emphasizes diseases arising in
the musculoskeletal system. There is an underlying belief that all of the body’s systems work
together and disturbances in one system may affect function elsewhere in the body.
Osteopathic treatment may include osteopathic manipulation, which is a full-body system of
hands-on techniques to alleviate pain, restore function, and promote health and well-being.

D.O.: Doctor of Osteopathic medicine

P.A.: Physician Assistant

F.N.P.: Family Nurse Practitioner

CPE: Clinical Practice Exam; exams that take place the end of 2nd year prior to rotation

CEC: Clinical Exam Center
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Lincoln Memorial University-DeBusk College of Osteopathic Medicine
Lincoln Memorial University “Notice of Privacy Practices” for Patient
Models Volunteering in the Department of Academic Services and
Assessment
This notice describes how medical information about you may be used and disclosed. Protected
Health Information has no treatment value and if some Patient Model abnormality or
treatment concern is discovered, the Patient Model will be referred to a clinic for examination
and treatment.
A federal regulation known as the "HIPAA Privacy Rule" requires that we provide detailed notice in
writing of our privacy practices.
I.
OUR COMMITMENT TO PROTECTING HEALTH INFORMATION ABOUT YOU
In this notice, we describe the ways that we may use and disclose health information about you. The HIPAA Privacy Rule
requires that we protect the privacy of health information that identifies an individual or where there is a reasonable basis to
believe the information can be used to identify an individual. This information is called "Protected Health Information"
(PHI). This notice describes your rights and our obligations regarding the use and disclosure of PHI. We are required by law
to:
• Maintain the privacy of PHI about you;
• Give you this notice of our legal duties and privacy practices with respect to PHI; and
• Comply with the terms of our notice of privacy practices that is currently in effect.
We reserve the right to make changes to this notice and to make such changes effective for all PHI we may already
have about you. If and when this notice is changed, we will post this information and provide you with a copy of the
revised notice.
II. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
A. USES AND DISCLOSURES FOR TREATMENT, PAYMENT, HEALTH CARE OPERATIONS
The following categories describe the different ways we may use and disclose PHI for treatment, payment, or health care
operations. The examples included with each category do not list every type of use or disclosure that may fall within that
category.
Treatment: No disclosures are needed in this category since the Patient Model program is strictly an education based
program and all medical care and treatment needs will be immediately referred to a clinic setting of your choice.
Payment: No billing, collection and/or premium and eligibility Information will be required to your designated health
benefit carrier that would require PHI disclosure due to no billing being required for the strictly educational purposes of this
program. For example, if treatment were being performed, which we are not providing, then we would be required to
provide your health carrier with periodic reports showing that you are eligible for benefits and have paid your premiums for
their coverage. Again no treatment is offered in this program.
There will also be no need to disclose PHI for application to any insurance coverage that requires you to provide a medical
history because no insurance coverage is offered as you are considered contract labor on a strictly volunteer basis. We will
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not use and disclose your PHI to verify your health benefit enrollment to a health benefit carrier or health care provider
because no medical treatment or care will be sought thru this program. No medical claims of any kind will be initiated thru
this program.
Health Care Operations: We will not use and disclose your PHI in performing business operations that are called health
care operations; this is not pertinent to the program because there are no cost patterns to evaluate. For example, Entities that
provide health care operations periodically review large medical claims in detail to determine cost patterns and their impact
on our health plan costs.
Communication from Our Office: Patient Model PHI has no treatment value and if some Patient Model abnormality or
treatment concern is discovered, the PM will be referred to a clinic for examination and treatment.
B. OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION
Uses and Disclosures for Which You Have the Opportunity to Agree or Object: We may use and disclose PHI about
you in some situations where you have the opportunity to agree or object to certain uses and disclosures of PHI about you. If
you do not object, then we may use and disclose these types of PHI.
C. OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION
OR OPPORTUNITY TO AGREE OR OBJECT
We may use and disclose PHI about you in the following circumstances without your authorization or opportunity to agree
or object, provided that we comply with certain conditions that may apply.
Required By Law: LMU may use or disclose PHI as required by federal, state, or local law. Any disclosure must comply
with the law and is limited to the requirements of the law.
Public Health Activities: We may use or disclose PHI to public health authorities or other authorized persons to carry out
certain activities related to public health, including the following:
• To prevent or control disease, injury or disability;
• To report disease, injury, birth or death;
• To report child abuse or neglect;
• To report reactions to medications or problems with products or devices regulated by the federal
Food and Drug Administration or other activities related to quality, safety, or effectiveness of FDA regulated
products or activities;
• To locate and notify persons of recalls of products they may be using;
• To notify a person who may have been exposed to a communicable disease in order to control who
may be at risk of contracting or spreading the disease; or
• To report to your employer, under limited Circumstances, information related primarily to workplace
injuries, illness, or workplace medical surveillance.
Abuse, Neglect, or Domestic Violence: We may disclose PHI in certain cases to proper government authorities if we
reasonably believe that a patient has been a victim of domestic violence, abuse, or neglect.
Health Oversight Activities: We may disclose PHI to a health oversight agency for oversight activities including, for
example, claims audits, investigations, inspections, licensure and disciplinary activities, and other activities conducted by
health oversight agencies to monitor the health care system, government health care programs, and compliance with certain
laws.
Lawsuits and Other Legal Proceedings: We may use or disclose PHI when required by a court or administrative tribunal
order. We may also disclose PHI in response to subpoenas, discovery requests, or other required legal processes when
efforts have been made to advise you of the request or to obtain an order protecting the information requested.
Law Enforcement: Under certain conditions, we may disclose PHI to law enforcement officials for the following purposes
where the disclosure is:
• About a suspected crime victim if, under certain limited circumstances, we are unable to obtain a person's
agreement because of incapacity or emergency;
•To alert law enforcement of a death that we suspect was the result of criminal conduct;
• Required by law;
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• In response to a court order, warrant, subpoena, summons, administrative agency request, or other authorized
process;
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About a crime or suspected crime committed at the workplace; or
• In response to a medical emergency not occurring at the workplace, if necessary to report a crime, including the
nature of the crime, the locations of the crime or the Victim, and the identity of the person who committed the
crime.
Coroners, Medical Examiners, Funeral Directors: We may disclose PHI to a coroner or medical examiner to identify a
deceased person and determine the cause of death. In addition, we may disclose PHI to funeral directors, as authorized by
law, so that they may do their jobs.
Organ and Tissue Donation: If you are an organ donor, we may use or disclose PHI to organizations that
help procure, locate, and transplant organs in order to facilitate an organ, eye, or tissue donation and transplantation.
Research: We may use and disclose PHI about you for research purposes under certain limited circumstances. We must
obtain a written authorization to use and disclose PHI about you for research purposes except in situations where a research
project meets specific, detailed criteria established by the HIPAA Privacy Rule to ensure the privacy of PHI.
To Avert a Serious Threat to Health or Safety: We may use or disclose PHI about you in limited circumstances when
necessary to prevent a threat to the health or safety of a person or to the public. This disclosure can be made only to a person
who is able to help prevent the threat.
Specialized Government Functions: Under certain circumstances, we may disclose PHI:
• For certain military and veteran activities, including determination of eligibility for veterans benefits and where
deemed necessary by military command authorities;
• For national security and intelligence activities;
• To help provide protective services for the president and others;
• For the health or safety of inmates and others at correctional institutions or other law enforcement custodial
situations for the general safety and health related to the facility.
Disclosures Required by HIPAA Privacy Rule: We are required to disclose PHI to the Secretary of the United States
Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA
Privacy Rule. We are also required in certain cases to disclose PHI to you upon your request to access PHI or for an
accounting of certain disclosures of PHI about you as described in
Section III of this notice.
Workers' Compensation: We may disclose PHI as authorized by workers' compensation laws or other similar programs
that provide benefits for work-related injuries or illness.
D. OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRE YOUR
AUTHORIZATION
III. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU
Under federal law, you have the following rights regarding PHI about you:
Right to Request Restrictions: You have the right to request additional restrictions on the PHI that may be used for
treatment, payment, and health care operations. You may also request additional restrictions on our disclosure of PHI to
certain individuals involved in your care or benefit coverage that otherwise are permitted by the Privacy Rule. We are not
required to agree to your request. If we do agree to your request, we are. required to comply with our agreement except in
certain cases, including where the information is needed to treat you or verify coverage in the case of an emergency. To
request restrictions, you must make your request in writing to our Privacy Official. In your request, please include (1) the
information that you want to restrict, (2) how you want to restrict the information (for example, restricting use to this office,
restricting disclosure only to persons outside this office, or restricting both), and (3) to whom you want those restrictions to
apply.
Right to Receive Confidential Communications: You have the right to request that you receive communications regarding
PHI in a certain manner or at a certain location. For example, you may request that we contact you at home, rather than at
work. You must make your request in writing to our Privacy Official. You must specify how you would like to be contacted
(for example, by regular mail to your post office box and not your home). We are required to accommodate reasonable
requests.
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Lincoln Memorial University-DeBusk College of Osteopathic Medicine
Right to Inspect and Copy: You have the right to request the opportunity to inspect and receive a copy of PHI about you in
certain records that we maintain. This includes your insurance and billing records but does not include information gathered
or prepared for a civil, criminal, or administrative proceeding. We may deny your request to inspect and copy PHI only in
limited circumstances. To inspect and copy PHI contact our Privacy Official. If you request a copy of PHI about you, we
may charge you a reasonable fee for the copying, postage, labor, and supplies used to meet your request.
Right to Amend: You have the right to request that we amend PHI about you as long as such information is kept by or for
our office. To make this type of request, you must submit your request in writing to our Privacy Official. You must also give
us a reason for your request. We may deny your request in certain cases, including ifit is not in writing or if you do not give
us a reason for the request.
Right to Receive an Accounting of Disclosures: You have the right to request an accounting of certain disclosures that we
made of PHI about you. This is a list of disclosures made by us during a specified period of up to six years except for
disclosures made:
• For treatment, payment and health care operations;
• For use in or related to a facility directory;
• To family members or friends involved in your care;
• To you directly;
• Pursuant to an authorization of you and your personal representative;
• For certain notification purposes (including national security, intelligence, correctional, and law enforcement
purposes); or
• Before April 14, 2004.
If you wish to make such a request, please contact our Privacy Official, who is identified below. The first list that you
request in a 12-month period will be free, but we may charge you for our reasonable costs of providing additional lists in the
same 12-month period. We will tell you about these costs, and you may cancel your request at any time before costs are
incurred.
Right to a Paper Copy of this Notice: You have a right to receive a paper copy of this notice at any time, even if you have
previously agreed to receive this notice electronically. To obtain a paper copy of this notice, contact the Privacy Official.
IV. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the Department
of Health and Human Services. Please contact our Privacy Official at the address and number listed below. We will not
retaliate or take action against you for filing a complaint.
V. QUESTIONS
If you have any questions about this notice, please contact our Privacy Official at the address and telephone number listed
below.
VI. PRIVACY OFFICIAL CONTACT INFORMATION
You may contact our Privacy Official at the following address and telephone number:
The Center for Simulation and Training Lincoln Memorial University - DCOM
6965 Cumberland Gap Parkway
Harrogate, TN 37752
Telephone: 423-869-6043 or 423-869-6460
Fax: 423-869-7174
Email: Jeremy Buchanan
Clinical Exam Center Manager / HIPPA Privacy Official
Interprofessional Education and Development Coordinator
423-869-6043
jeremy.buchanan@lmunet.edu
DCOM Office 208
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Lincoln Memorial University-DeBusk College of Osteopathic Medicine
Or Sue Cobb
Standardized Patient/Patient Model Coordinator / HIPPA Privacy Official
423-869-6460
sue.cobb@lmunet.edu
DCOM Office 204
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