II. RESTRICTIONS TO USE AND DISCLOSURE OF PHI
A. PROCESSING REQUESTS FOR RESTRICTIONS TO USE AND DISCLOSURE OF PHI
Federal Regulations (45 CFR §164.522) provide individuals the right to request restrictions on the use and disclosure of the protected health information in the individual’s designated record set. HCA is not required to agree to the restriction(s) requested.
HCA cannot agree to a restriction that would impede a use or disclosure required by law. If HCA agrees to a restriction, it cannot use or disclose PHI in violation of the restriction, except in an emergency treatment situation.
EXAMPLE: HCA may agree to a request not to use or disclose PHI to an individual’s private insurance with the understanding that treatment will be paid for by the individual directly.
If restricted PHI is disclosed in an emergency situation, HCA must request that the restricted information not be further used or disclosed.
45 CFR §164.522(b) provides individuals the right to request an alternative means of communication, intended to maintain the individual’s confidentiality. Such requests must be made in writing and documented in the individual’s medical record. HCA is required to agree to reasonable requests for confidential communications.
EXAMPLE: A reasonable request for alternative confidential communication might be to contact the individual via his/her cell phone, and not to call his/her home phone where family members might answer.
Processing Requests for Restrictions on Use and Disclosure of PHI
· The client or his/her personal representative must complete and sign the Request for Special Restriction on Use and Disclosure of Protected Health Information form.
· Designated program staff, working with the Custodian of Records, reviews the request and determines if the restriction request should be approved.
· The Custodian of records, using the Response to Request for Special Restriction on Use and Disclosure of Protected Health Information form, notifies the individual of the decision (whether agreed to or denied) regarding their request for special restrictions.
· The Custodian of Records and Program shall maintain a copy of the Request for Restrictions form. Program shall file its copy in the patient records.
Processing Requests to Terminate Restrictions to Use and Disclose PHI
· HCA or the individual may initiate termination of restrictions on use and disclosure of individual’s PHI.
· Termination of a special restriction must be documented on the Termination of Special Restriction form, including the method of termination (i.e. orally or in writing).
· If HCA is terminating the restriction, program staff must complete the Termination of Special Restriction form indicating that HCA is initiating this action. The signed Termination form must be provided to Custodian of Records for processing and notification to the individual.
· The affected program implements the termination effective only with respect to PHI created or received after the individual is notified of the termination.
· The Custodian of Records and program maintains copies of the Termination of Special Restrictions form. Program shall file its copy in the client’s record.
B. Requests for Restrictions on the Manner and Method of Communication
· The client or his/her personal representative must complete and sign the Request for Restriction on the Manner/Method of Confidential Communication form.
· Designated program staff reviews the request and determines if the request is reasonable and confirms that the alternative method of communication is clear.
· Documentation of the alternative communication method must be made available to all staff that may have need to communicate with the individual.
· The Custodian of Records and program maintains copies of the Request for Restrictions on the Manner/Method of Confidential Communication form. Program shall file its copy in the client’s record.
C. Documentation and Retention of Records
The State of California retention guidelines require that medical records must be maintained for seven (7) years from the last date of service for adults and for minors up to age of 19 or for seven years from the last date of service whichever is longer.
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