Use and Disclosure of Protected Health Information: Difference between revisions

===Disclosures to the Patient===

Nebraska Medicine/UNMC may disclose PHI to the patient or his/her Personal Representative.   

The patient has a right to see and obtain copies of PHI maintained in the patient’s designated record set. Information, including billing information, may be sent to a minor for treatment to which the minor appropriately consented. (See UNMC Policy No. 6059, [https://wiki.unmc.edu/index.php/Access_to_Designated_Record_Set Access and Amendment of Designated Record Set].

#For Other Disclosures to Patient

##When disclosing to the patient, appropriate safeguards should be taken to reduce the risk that people other than the patient or people permitted by the patient will hear the disclosure. Examples of such safeguards would include:

###Asking the patient if the patient would prefer to talk in a more private location.

###Confirming with the patient that it is okay to proceed with the conversation while friends, relatives or others are present.

###Pulling the dividers or partitions between the patient and other patients or visitors.

#The minimum necessary standard does not apply to disclosures to the patient.

Nebraska Medicine/UNMC may include limited information about an Individual in the facility directory or census and may disclose that information to people who ask about the patient by name, or to members of the clergy, in accordance with applicable policies. (See Private Designation policy, for additional details.) '''need Nebr Med policy #'''

====Disclosures with Patient’s Permission====

#You may disclose PHI to the patient in the presence of others if the patient is asked and consents or is given a chance to object and does not verbally object to such disclosure and you reasonably infer from the circumstances that the patient does not object. Disclosures of sensitive information, such as mental health or sexually transmitted disease diagnoses, should only be disclosed with the permission of the patient.

#When relying on this authority, disclose only the minimum amount of information needed to achieve the purpose of the disclosure, unless you know that the individuals present are all involved in the patient's care or [https://wiki.unmc.edu/index.php/Use_and_Disclosure_of_Protected_Health_Information#Payment_2 Payment] for care.

#Remember – people who are present when a disclosure of PHI is made may be mere friends, visitors or onlookers. They may have no role in the patient’s care. They may simply be visiting the patient. Therefore, try to give the patient every opportunity to agree or object to a disclosure of his or her PHI when it will otherwise be made in their presence.

#Do not rely on this authority if the patient is incapacitated or otherwise unable to agree or object to such disclosure.

##Follow this policy when disclosing PHI to a person other than a Personal Representative whom you believe plays a role in the patient’s health care (or [https://wiki.unmc.edu/index.php/Use_and_Disclosure_of_Protected_Health_Information#Payment_2 Payment] for health care). For example, follow this policy when you:

##Talk to the patient’s child, other relative, or friend who customarily drives the patient to appointments to confirm the date and time of the next appointment.

##Give an involved family member the patient’s prescription, so the family member can fill it for the patient.

##Talk to the patient’s spouse to obtain information necessary to file a claim through the spouse’s group plan.

##Talk to a family member or friend when the patient indicates you can or should do so, e.g., if the person accompanies the patient for an appointment or procedure, or is invited and present at admission or discharge.

#If the patient is available prior to a disclosure and has the capacity to make health care decisions, explain the proposed disclosure and do one of the following:

##Obtain the patient’s consent to such disclosure;

##Provide the patient with an opportunity to object, and disclose only if the patient does not object; or

##Reasonably infer from the circumstances, based on the exercise of professional judgment, that the patient does not object.

#If the patient is not available prior to the disclosure, use and document professional judgment to determine whether the disclosure would be in the best interest of the patient. If so, disclose only the PHI directly relevant to the recipient’s involvement in the Individual’s health care. A code or password should not be used as a substitute for use of professional judgement to determine an Individual’s involvement in the patient's care to disclose information relevant to the Individual’s involvement. <br />

Nebraska Medicine/UNMC may disclose PHI about a patient in order to notify family, friends or others of the patient’s whereabouts, general condition or death. In these cases, Nebraska Medicine/UNMC may not know the details of the involvement of others in the patient’s care or payment for care. Therefore, in these cases, try to follow these steps:

#Ask the patient, if possible, whether they consent to such disclosure and rely on what the patient says.#

#If the patient is not able or available, make an effort to determine from the record the identity of others who may be Personal Representatives or involved in the patient’s care, and make an effort to limit contact to them.

#When the patient has been deemed not competent, and is not expected to regain competence, and no family or friend has been located to act on the patient’s behalf, Care Transitions and/or Pastoral Services staff may reach out to resources, such as the patient’s landlord or employer (if known), agencies contracted for such purposes with the assistance of Legal Services, or local enforcement. In all such cases, the disclosure of PHI shall be limited solely to the patient’s name and date of birth unless permission has been obtained from the [mailto:privacy@nebraskamed.com Privacy Office] to disclosure additional information.