The following describes how your personal medical information may be used and disclosed, and how you can get access to this information.

1) What is HIPAA?

HIPAA stands for Health Insurance Portability and Accountability Act. It is legislation that provides for protection of your medical and health information

2) Why is HIPAA important to me as a student athlete?

• It allows us to share medical information with health care providers involved in your treatment.
• It allows us to provide insurance companies with medical information for payment of medical bills.
• It allows us to release information to athletic department personnel when your medical condition affects your ability to practice, compete or attend classes.
• It allows us to share information with family members involved in your medical care or payment for your medical care

3) When may I be asked to sign a medical release form?

During your physical exam you will be asked to sign two forms related to the general release of medical information. If you wish to obtain a copy of your medical records or release information to an outside medical source, you must sign a release form in the Sports Medicine Office. To request medical information from health care providers outside BYU, you must sign a release form in the Sports Medicine Office.

4) Can my health information be shared without my permission?

The law requires that we share information under the following circumstances:

• To reduce or prevent a serious threat to public health and safety
• For public health activities such as reporting communicable diseases
• To protect victims of abuse, neglect or domestic violence; for lawsuits and similar proceedings
• For health oversight activities such as monitoring those who work in the health care syste
• When requested by law enforcement

5) What is BYU Sports Medicine's responsibility to me?

• Maintain the privacy of your health information
• Provide this notice that describes the way we may use and share your health information
• Follow the terms of the Notice currently in effect.

*The Sports Medicine Department reserves the right to make changes to this Notice at any time and make the new privacy practices effective for all information we maintain. Current Notice will be posted on our website at www.byucougars.com

6) What are my rights concerning HIPPA?

You have the right to:

• Inspect and obtain a copy of your personal health information. Under limited circumstances we may deny you access to a portion of your health information and you may request a review of this denial*
• Request that we use a specific telephone number or address to communicate with you*
• Request special restrictions on how we use and share your health information*
• Request an amendment to your health information*

Requesting a copy of records:

To request a record of disclosures of your health information, the list must include the date of disclosure, who received the disclosed information, a brief description of the information and why the disclosure was made.

Filing a Complaint/Violation of HIPPA:

File a complaint if you believe your privacy rights have been violated. Your complaint should be communicated in writing to:

• Lynette Newbold
• 1130 SFH, Provo, UT 84602
• (801) 422-2946
• lynette_newbold@byu.edu

You may also file a written complaint with the Office of Civil Rights of the US Department of Health and Human Services at http://www.hhs.gov/ocr/hipaa

* Requests must be made in writing.