Fact Sheet: HOW TO FILE A HEALTH INFORMATION PRIVACY COMPLAINT WITH THE OFFICE FOR CIVIL RIGHTS

Transcript

1 A H EALTH ARE P ROVIDER ’ S C G HIPAA P RIVACY R UIDE TO THE : ULE Communicating with a Patient’s Family, Friends, or Others Involved in the Patient’s Care U.S. Department of Health and Huma n Services • Office for Civil Rights This guide explains when a health care provider is a llowed to share a patie nt’s health information with the by the patient as involved in patient’s family members, friends, or others identified care under the the patient’s Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privac y Rule. HIPAA is a Federal law health care providers are that sets national standards for how health plans, health care clearinghouses, and most 1 to protect the privacy of a patient’s health information. Even though HIPAA requires health care providers to pr rs are permitted, in most otect patient privacy, provide circumstances, to communicate with the patient’s family, friends, or others involved in their care or payment for care. This guide is intended to clarify these HIP AA requirements so that health care providers do not unnecessarily withhold a patient’s health information from these pers ons. This guide includes common 2 questions and a table that summar izes the relevant requirements. COMMON QUESTIONS ABOUT HIPAA 1. If the patient is present and has the capacity to ma ke health care decisions, when does HIPAA allow a health care provider to discuss the patient’s health information with the patient’s family, friends, or others involved in the patient’s care or payment for care? health care decisions, a health care provider may If the patient is present and has the capacity to make other person if the patient agrees discuss the patient’s health informa tion with a family member, friend, or or, when given the opportunity, does not object. A health care provide r also may share information with these persons if, using profe ssional judgment, he or she decides that the patient does not object. In either share or discuss only the informati on that the person involved needs to case, the health care provider may know about the patient’s care or payment for care. Here are some examples: • An emergency room doctor may discuss a patient’s tr eatment in front of the patient’s friend if the patient asks that her friend come into the treatment room. A doctor’s office may discuss a patie nt’s bill with the patient’s a dult daughter who is with the • patient at the patient’s medical appointme nt and has questions about the charges. • take with the patient’s health aide who has A doctor may discuss the drugs a patient needs to accompanied the patient to a medical appointment. • A doctor may give information about a patient’s m obility limitations to the pa tient’s sister who is driving the patient home from the hospital. 1 ealth care providers that tran The HIPAA Privacy Rule applies to those h smit any health information in electronic form in connection ,” and . See the definitions of “covered entity,” “health care provider with certain standard transactions, such as health care claims “transaction” at 45 C.F.R. § 160.103. 2 are The full text of these requirements can be found at 45 C.F.R. § 164.510(b). Note that this guide does not apply to a health c provider’s disclosure of psychotherapy notes, which generally requires a patient’s written authorization. See 45 C.F.R. § 164.508(a)(2).

2 N THE C ’ S F AMILY , F RIENDS , OR O THERS I NVOLVED I ATIENT P ATIENT ’ S C ARE OMMUNICATING WITH A P • A nurse may discuss a patient’s health status with the patient’s brother if she informs the patient she is going to do so and the patient does not object. BUT: discuss a patient’s condition with the patient’s brother af ter the patient has stated • A nurse may not she does not want her family to know about her condition. 2. If the patient is not present or is incapacitated, may a health care provider still share the patient’s health information with family, friends, or others involved in the patient’s care or payment for care? Yes. If the patient is not present or is incapac r may share the patient’s itated, a health care provide information with family, friends, or others as l ong as the health care provider determines, based on professional judgment, that it is in the best interest of the patient. When someone other than a friend or family member is involved, the health care provider mu st be reasonably sure that the patient asked the person to be involved in his or her ca re or payment for care. The health care provider may discuss only the information that the person involved needs to know about the patient’s care or payment. Here are some examples: A surgeon who did emergency surgery on a patient may tell the patient’s s • pouse about the patient’s condition while the patient is unconscious. A pharmacist may give a prescription to a patient’ s friend who the patient has sent to pick up the • prescription. A hospital may discuss a patient’s bill with her adu lt son who calls the hospital with questions about • charges to his mother’s account. • A health care provider may give information rega rding a patient’s drug dosage to the patient’s health aide who calls the pr ovider with questions about the particular prescription. BUT: • A nurse may not tell a patient’s friend about a past medical problem that is unrelat ed to the patient’s current condition. required by HIPAA to share a patient’s information when the patient is • A health care provider is not not present or is incapac tient has an opportunity to agree to itated, and can choose to wait until the pa the dis closure. 3. Does HIPAA require that a health care provider docu ment a patient’s decision to allow the provider to share his or her health information with a fam ily member, friend, or other person involved in the patient’s care or payment for care? No. HIPAA does not require that a health care provider document the patient’s agreement or lack of objection. However, a health care provi patient’s agreement, or lack of der is free to obtain or document the ple, a provider may choose to document a patient’s objection, in writing, if he or she prefers. For exam agreement to share information with a family me mber with a note in the patient’s medical file. 4. May a health care provider discuss a patient’s heal th information over the phone with the patient’s the patient’s care or payment for care? family, friends, or others involved in health information with a person, Yes. Where a health care provider is allowed to share a patient’s -face, over the phone, or in writing. information may be shared face-to Communicating With a Patient’s Family, Friends, or Page 2 of 5 Others Involved in the Patient’s Care

3 NVOLVED C ’ S F AMILY , F RIENDS , OR O THERS I ATIENT I N THE P ATIENT ’ S C ARE OMMUNICATING WITH A P 5. If a patient’s family member, friend, or other person involved in the patient’s care or payment for , does HIPAA require the health care calls a health care provider to ask about the patient’s condition care provider to obtain proof of who the person is before speaking with them? No. If the caller states that he or the patient, or is involved in the she is a family member or friend of quire proof of identity in patient’s care or payment for care, then HIPAA doesn’t re this case. However, a health care provider may establish his or her own rules for verifying who is on the phone. In addition, when someone other than a friend or family member is involved, the health care provider must be reasonably sure that the patient asked the pers on to be involved in his or her care or payment for care. her person pick up a filled prescription, medical 6. Can a patient have a family member, friend, or ot supplies, X-rays, or other similar forms of patient information, for the patient? Yes. HIPAA allows health care pr oviders to use professional judgment a nd experience to decide if it is in the patient’s best interest to allo w another person to pick up a prescr iption, medical supp lies, X-rays, or other similar forms of information for the patient. For example, the fact that a relative or friend a rrives at a pharmacy and asks to pick up a specific prescription for a patient effectively ve rifies that he or she is involved in the patient’s care. HIPAA allows lative or friend. The patient does not need to provide the pharmacist to give the filled prescription to the re the pharmacist with their names in advance. information with an interpreter to communicate 7. May a health care provider share a patient’s health with the patient or with the patient’s family, friends, or others in volved in the patient’s care or payment for care? Yes. HIPAA allows covered health care providers to sh are a patient’s health inform ation with an interpreter without the patient’s writte wing circumstances: n authorization under the follo • A health care provider may share information with an interpreter who works for the provider (e.g., a bilingual employee, a contract interp reter on staff, or a volunteer). e information about an incapacitated patient’s For example, an emergency room doctor may shar ys the information to the patient’s family. condition with an interpreter on staff who rela A health care provider may share information with an interpreter who is acting on its behalf (but is not a • member of the provider’s workforce) if the heal th care provider has a writ ten contract or other agreement with the interpreter th at meets HIPAA’s business associate contract requirements. For example, many providers are re quired under Title VI of the Civil Rights Act of 1964 to take reasonable steps to provide meaningful access to persons with limited English proficiency. These ies, community-based orga nizations, or telephone providers often have contracts with private compan ese arrangements must comply with interpreter service lines to provide language interpreter services. Th the HIPAA business associate agreemen t requirements at 45 C.F.R. 164.504(e). interpreter who is the patient’s family member, • A health care provider may share information with an if the patient agrees, or does not friend, or other person identified by the patient as his or her interpreter, his or her professional judgment, that the patient object, or the health care provider determines, using does not object. Communicating With a Patient’s Family, Friends, or Page 3 of 5 Others Involved in the Patient’s Care

4 ATIENT C ATIENT ’ S F AMILY , F RIENDS , OR O THERS I NVOLVED I N THE P P ’ S C ARE OMMUNICATING WITH A ee patients who speak a certain language and the For example, health care providers sometimes s contractor who can competently interpret that language. If the provider has no employee, volunteer, or provider is aware of a telephone inte rpreter service that can help, the provider may have that interpreter tell the patient that the service is available. If the provider decides, based on professional judgment, that the patient has chosen to continue using the interpreter, the provider may talk to the patient using the interpreter. 8. Where can I find additional information about HIPAA? The Office for Civil Rights, part of the Depart ment of Health and Human Services, has more information about HIPAA on its Web site. Visit http://www.hhs.gov/ocr/hipaa for a wide range of helpful inform ation, including the full text of the Privacy Rule, a HIPAA Priv acy Rule Summary, fact sheets, over 200 Frequently Asked Questions, as well as many other resources to help health care providers and others understand the law. Page 4 of 5 Communicating With a Patient’s Family, Friends, or Others Involved in the Patient’s Care

5 N THE C ATIENT ’ S F AMILY , F RIENDS , OR O THERS I NVOLVED I P P ATIENT ’ S C ARE OMMUNICATING WITH A HIPAA Privacy Rule Disclosures to a Patient’s Family, Friends, or Others Involved in the Patient’s Care or Payment for Care Other Persons Family Member or Friend Provider may disclose relevant Provider may disclose relevant information if the provider does one information if the provider does of the following: one of the following: obtains the patient’s (1) obtains the patient’s (1) Patient is present and agreement agreement has the capacity to make gives the patient the (2) (2) gives the patient an health care decisions opportunity to object and opportunity to object and the patient does not object the patient does not object (3) decides from the decides from the (3) circumstances, based on circumstances, based on professional judgment, that professional judgment, that the patient does not object the patient does not object Disclosure may be made in person, Disclosure may be made in person, over the phone, or in writing. over the phone, or in writing. Provider may disclose relevant Provider may disclose relevant information if the provider is information if, based on reasonably sure that the patient has professional judgment, the involved the person in the patient’s disclosure is in the patient’s best Patient is not present or care and in his or her professional interest. is incapacitated judgment, the provider believes the disclosure to be in the patient’s best interest. Disclosure may be made in person, Disclosure may be made in person, over the phone, or in writing. over the phone, or in writing. Provider may use professional Provider may use professional judgment and experience to decide judgment and experience to decide if it is in the patient’s best interest to if it is in the patient’s best interest allow someone to pick up filled to allow someone to pick up filled prescriptions, medical supplies, X- prescriptions, medical supplies, X- rays, or other similar forms of health rays, or other similar forms of information for the patient. health information for the patient. Communicating With a Patient’s Family, Friends, or Page 5 of 5 Others Involved in the Patient’s Care

Related documents

Guide to Privacy and Security of Electronic Health Information

Guide to Privacy and Security of Electronic Health Information

Guide to Privacy and Security of Electronic Health Information Vers ion 2.0 April 2015 information contained in this Guide is not intended to serve as legal advice nor should it substitute for legal c...

More info »
Chapter 2 Your Practice and the HIPAA Rule, Guide to Privacy and Security of Electronic Health Information

Chapter 2 Your Practice and the HIPAA Rule, Guide to Privacy and Security of Electronic Health Information

Chapter 2 Your Practice and the HIPAA Rule s Understanding Provider Responsibilities Under HIPAA Health Insurance Po The rtability and Accountability Act Where Can I Get Help or (HIPAA ) Rules provide...

More info »