HIPPA Policy
Delta State University
Notice of Privacy Practices

Effective August 1, 2003

This notice describes how medical information about you may be used and disclosed. Please review it carefully. If you have any questions, please contact our Head Athletic Trainer at the address or telephone number at the bottom of this Notice.

The Delta State University Athletic Department provides health care to our student-athletes in partnership with physicians and other professionals and organizations. The information privacy practices in this Notice will be followed by all departments and all employed associates, staff or volunteer. In addition, we are a clinically integrated care setting, and we have many doctors and other providers giving care to student-athletes. For convenience of our student-athletes by the Athletic Department, the University Health Center, all members of our medical staff and all other health care professionals who treat you at any of our medical facilities. The health care providers covered by this "organized health care arrangement" ("OHCA") will share protected health information with each other, as necessary to carry out your treatment, payment for treatment, and health care operations relating to OHCA. This arrangement does not mean that the persons participating in the OHCA are involved in a joint business arrangement, or that they are responsible for the acts of one another.

As a student-athlete at DSU, you have the right to privacy concerning your medical plan of care. Medical record information and your relationship with your medical staff are considered private. Your diagnosis and course of treatment are available only to those directly involved with your care. Unless you tell us otherwise, we will make every effort to give your medical updates as appropriate. We create a record of the care and services you every effort to give your family medical updates as appropriate. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This Notice applies to all of the records of your care that we maintain, whether created by our medical staff or your doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's office. We are required by law to keep medical information about you private, give you this Notice of our legal duties and privacy practices with respect to medical information about you and follow the terms of the Notice that is currently in effect.

We may use and disclose medical information about you for treatment (such as sending medical information about you to a specialist as part as a referral); to obtain payment for treatment (such as sending billing information to your insurance company or Medicare); and to support our health care operations (such as comparing patient data to improve treatment methods). We may disclose medical information and/or participation status to athletic coaches and strength and conditioning coaches for your health and safety. We may disclose information to university administrators and academic counselors to support your academic progress. We may release information to sports information staff and members of the media regarding your participation status.

Regarding your medical information, you have the right to look at or get a copy of medical information that we use to make decisions about your care. You have the right to a personal representative to assist you in reviewing your medical information. If you believe that information in your records is incorrect or incomplete, you have the right to request that we amend the records. You have the right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, health care operations or where you specifically authorized a disclosure. You may request, in writing, that we do not use or disclose medical information about you for specific cases or circumstances.
We reserve the right to change the terms of this Notice at any time. Changes will apply to medical information we already hold, as well as new information we receive after the change occurs. If we change our Notice, we will post the new Notice in our athletic training facilities and on our Web site at www.gostatesmen.com. You can receive a copy of the current Notice at any time. The effective date is listed just below the title above. You will also be asked to acknowledge in writing your receipt of this Notice on our Student-Athlete Authorization/Consent for Disclosure of Protected Health Information.

If you have questions regarding your privacy rights, you may contact our Athletic Department at this address: Box A-3 DSU, Cleveland, MS 38733 or call at (662) 846-4300.