Privacy Policy

Cayuga Sports Medicine (CSM)

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THAT INFORMATION.

POLICY STATEMENT

CSM is committed to maintaining the privacy of your protected health information ("PHI"), which includes information about your medical condition and the care and treatment you receive from CSM and other health care providers. This Notice details how your PHI may be used and disclosed to third parties for purposes of your care, payment for your care, health care operations of CSM, and for other purposes permitted or required by law. This Notice also details your rights regarding your PHI.

USE OR DISCLOSURE OF PHI

CSM may use and/or disclose your PHI for purposes related to your care, payment for your care, and health care operations of the Practice. The following are examples of the types of uses and/or disclosures of your PHI that may occur. These examples are not meant to include all possible types of use and/or disclosure.

(a) Treatment - In order to provide, coordinate and manage your care, CSM will provide your PHI to those health care professionals directly involved in your care so that they may understand your medical condition and needs and provide advice or treatment. For example, a physician treating you for a condition such as arthritis may need to know what medications have been prescribed for you by CSM.

(b) Payment - In order to get paid for some or all of the health care provided by the CSM, we may provide your PHI, directly or through a billing service, to appropriate third party payers, pursuant to their billing and payment requirements. For example, CSM may need to provide your health insurance carrier or, if you are over 62, the Medicare program with information about health care services that you received from CSM so that we can be properly reimbursed.

(c) Health Care Operations - In order for CSM to operate in accordance with applicable law and insurance requirements and in order for CSM to provide quality and efficient care, it may be necessary for CSM to compile, use and/or disclose your PHI. For example, CSM may use your PHI in order to evaluate the performance of CSM’s personnel in providing care to you.

(d) Appointment Reminder- CSM may contact you as a reminder that you have an appointment for treatment or medical care.

(e)Treatment Alternatives- CSM may contact you about treatment alternatives, or other health benefits or services that may be of interest to you.

SPECIAL SITUATIONS

CSM may use and/or disclose your PHI, without a written authorization from you, in the following instances:

(a) De-identified Information - Your PHI is altered so that it does not identify you and, even without your name, cannot be used to identify you.

(b) Business Associate - To a business associate, which is someone who CSM contracts with to provide a service necessary for your treatment, payment for your treatment and health care operations (~ billing service or transcription service). CSM will obtain satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI.

(c) Personal Representative - To a person who, under applicable law, has the authority to represent you in making decisions related to your health care.

(d) Public Health Activities - Such activities include, for example, information collected by a public health authority, as authorized by law, to prevent or control disease, injury or disability. This includes reports of child abuse or neglect.

(e) Federal Drug Administration - If required by the Food and Drug Administration to report adverse events, product defects or problems or biological product deviations, or to track products, or to enable product recalls, repairs or replacements, or to conduct post marketing surveillance.

(f) Abuse, Neglect, or Domestic Violence - To a government authority if CSM is required by law to make such disclosure. If CSM is authorized by law to make such a disclosure, it will do so if it believes that the disclosure is necessary to prevent serious harm or if we believe that you have been the victim of abuse, neglect or domestic violence. Any such disclosure will be made in accordance with the requirements of law, which may also involve notice to you of the disclosure.

(g) Health Oversight Activities - Such activities, which must be required by law, involve government agencies involved in oversight activities that relate to the health care system, government benefit programs, government regulatory programs and civil rights law. Those activities include, for example, criminal investigations, audits, disciplinary actions, or general oversight activities relating to the community's health care system.

(h) Judicial and Administrative Proceeding- For example, CSM may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.

(i) Law Enforcement Purposes - In certain instances, your PHI may have to be disclosed to a law enforcement official for law enforcement purposes. Law enforcement purposes include: (1) complying with a legal process (i.e., subpoena) or as required by law; (2) information for identification and location purposes; (3) information regarding a person who is or is suspected to be a crime victim; (4) in situations where the death of an individual may have resulted from criminal conduct; (5) in the event of a crime occurring on the premises of CSM; and (6) a medical emergency (not on CSM’s premises) has occurred, and it appears that a crime has occurred.

j) Coroner or Medical Examiner - CSM may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death, or to a funeral director as permitted by law and as necessary to carry out its duties.

(k) Organ and Tissue Donation - If you are an organ donor, CSM may disclose your PHI to the entity to whom you have agreed to donate your organs.

(l) Research - If CSM is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI such as approval of the research by an institutional review board and the requirement that protocols must be followed.

(m) Avert a Threat to Health or Safety - CSM may disclose your PHI if it believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.

(n) Specialized Government Functions - When the appropriate conditions apply, CSM may use PHI of individuals who are Armed Forces personnel: (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veteran Affairs of eligibility for benefits; or (3) to a foreign military authority if you are a member of that foreign military service. CSM may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities including the provision of protective services to the President or others legally authorized.

(o) Inmates - CSM may disclose your PHI to a correctional institution or a law enforcement official if you are an inmate of that correctional facility and your PHI is necessary to provide care and treatment to you or is necessary for the health and safety of other individuals or inmates.

(p) Workers' Compensation - If you are involved in a Workers' Compensation claim, CSM may be required to disclose your PHI to an individual or entity that is part of the Workers' Compensation system.

(q) Disaster Relief Efforts - CSM may use or disclose your PHI to a public or private entity authorized to assist in disaster relief efforts.

(r) Required by Law - If otherwise required by law, but such use or disclosure will be made in compliance with the law and limited to the requirements of the law.

(s) Family and Friends- CSM may disclose to your family member, other relative, a close personal friend, or any other person identified by you, your PHI directly relevant to such person's involvement with your care or the payment for your care. CSM may also use or disclose your PHI to notify or assist in the notification (including identifying or locating) a family member, a personal representative, or another person responsible for your care, of your location, general condition or death. However, in both cases, the following conditions will apply:
(1) CSM may use or disclose your PHI if you agree, or if CSM provides you with opportunity to object and you do not object, or if CSM can reasonably infer from the circumstances, based on the exercise of its judgment, that you do not object to the use or disclosure.
(2) If you are not present, FSLM will, in the exercise of its judgment, determine whether the use or disclosure is in your best interest and, if so, disclose only the PHI that is directly relevant to the person's involvement with your care.

OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
CSM will not use or disclose your health information for any purposes other than those identified in the previous sections without your specific written authorization. We must obtain authorization separate from any consent we may have obtained from you. If you give us authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose information about you for reasons covered by your written authorization, but we cannot take back any uses or disclosures already made with your permission.

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU

You have the right to:

(a) Revoke any Authorization, in writing, at any time. To request a revocation you must submit a written request to CSM’s Privacy Officer, Andrew Getzin, MD.

(b) Request restrictions on certain use and/or disclosure of your PHI as provided by law. However, CSM is not obligated to agree to any requested restrictions. To request restrictions, you must submit a written request to CSM’s Privacy Officer. In your written request, you must inform CSM of what information you want to limit, whether you want to limit CSM's use or disclosure, or both, and to whom you want the limits to apply. If CSM agrees to your request, CSM will comply with your request unless the information is needed in order to provide you with emergency treatment.

(c) Receive confidential communications of PHI by alternative means or at alternative locations. You must make your request in writing to CSM's Privacy Officer, Andrew Getzin, MD. The Practice will accommodate all reasonable requests.

(d) Inspect and copy your PHI as provided by law. To inspect and copy your PHI, you must submit a written request to the CSM's Privacy Officer. In certain situations that are defined by law, CSM may deny your request, but you will have the right to have the denial reviewed. CSM can charge you a fee for the cost of copying, mailing or other supplies associated with your request.

(e) Amend your PHI as provided by law. To request an amendment, you must submit a written request to CSM's Privacy Officer. You must provide a reason that supports your request. CSM may deny your request if it is not in writing, if you do not provide a reason and support of your request, if the information to be amended was not created by CSM (unless the individual entity that created the information is no longer available), if the information is not part of your PHI maintained by CSM, if the information is not part of the information you would be permitted to inspect and copy, and/or if the information is accurate and complete. If you disagree with CSM's denial, you have the right to submit a written statement of disagreement.

(f) Receive an accounting of disclosures of your PHI as provided by law. To request an accounting you must submit a written request to CSM's Privacy Officer. The request must state a time period which may not be longer than six years and may not include the dates before April 14, 2003. The request should indicate in what form you want the list (such as a paper or electronic copy). The first list you request within a 12 month period will be free, but CSM may charge you for the cost of providing additional lists in that same 12 month period. CSM will notify you of the costs involved and you can decide to withdraw or modify your request before any costs are incurred.

(g) Receive a paper copy of this Privacy Notice from CSM upon request to the CSM's Privacy Officer.

(h) Complain to CSM, or to the Secretary of Health and Human Services, Office of Civil Rights, Hubert H. Humphrey Building, 200 Independence Avenue, S. W., Room 509F HHH Building, Washington, D.C. 20201. Or you may contact a regional office of the Office of Civil Rights, which can be found at www.hhs.gov. To file a complaint with CSM, you must contact the Practice's Privacy Officer. All complaints must be in writing.

(i) To obtain more information on, or have your questions about your rights answered, you may contact the CSM's Privacy Officer, Andrew Getzin, MD.

PRACTICE'S REQUIREMENTS

Cayuga Sports Medicine

(a) Is required by law to maintain the privacy of your PHI and to provide you with this Privacy Notice of the Practice's legal duties and privacy practices with respect to your PHI.

(b) Is required to abide by the terms of this Privacy Notice.

(c) Reserves the right to change the terms of this Privacy Notice and to make the new Privacy Notice provisions effective for your entire PHI that we maintain. However, CSM will only change its Privacy Notice if felt it would not jeopardize the protection of your PHI.

(f) CSM will post this Privacy Notice on our website.

(g) Will provide this Privacy Notice to you by e-mail if you so request. However, you also have the right to obtain a paper copy of this Privacy Notice.

ORIGINALLY EFFECTIVE DATE: JUNE 23, 2003
LAST REVISED: JUNE 7, 2005

INTERNET PRIVACY DISCLAIMER:

Although we have taken extensive security precautions, we cannot guarantee absolute privacy of the information submitted through the online forms on this website. You must understand that there is a risk that, in some circumstances, it may be possible for others to see the information submitted through online forms on this website.

Cayuga Sports Medicine, Dr.Getzin or the webmasters, Ravi Dhobale or Keith Kubarek is not liable under any circumstances for loss or disclosure of sensitive information submitted using online forms on www.flsportsmed.com .

If you are not comfortable with submitting the online forms, you may download printable forms. For further information, please contact us at: Cayuga Sports Medicine, 310 Taughannock Blvd., Suite 5A, Ithaca, NY 14850 Phone: (607) 252-3580, Email: csm@cnymail.com