What can a healthcare provider discuss with family or other caregivers without permission from a patient who's not incapacitated?
Keeping close tabs on the health of the person in your care while also respecting his privacy can be difficult. Congress stepped into this balancing act by passing the Health Insurance Portability and Accountability Act (HIPAA). HIPAA sets guidelines for doctors and other medical providers about what kinds of information about their patients they can discuss or divulge, under what circumstances, and to whom.
Here are the basics from those guidelines.
Asking the patient's permission
If someone seeks information from a healthcare provider, or if the provider feels it might be a good idea to provide some information to the caregiver or family, normally the provider will ask the patient's permission, which gives the patient a chance to object. And if a patient objects to a provider giving information, either in a specific instance or in general, the provider may not discuss the patient's health status, even briefly.
If the patient does not expressly forbid it, a provider may discuss a certain amount of health information with a caregiver or family members, or with friends who are directly involved in caregiving. But the healthcare provider may discuss only information that you need to know about the patient's care.
In these circumstances, the healthcare provider uses professional judgment in deciding whether it's in the patient's best interest to discuss his health information, and how much information to provide.
Situations for discussion
Here are some examples of instances when a healthcare provider may or may not discuss medical information when no objection has been made. These examples are adapted from the Health and Human Services' online brochure, A Patient's Guide to the HIPAA Privacy Rule.
- An emergency room doctor may discuss a patient's treatment in front of a family member or caregiver whom the patient has asked to come into the treatment room.
- A doctor may discuss a patient's present condition with a spouse or adult child while the patient is recovering from an emergency, surgery, or other treatment.
- A hospital may discuss a patient's bill with a family member who is with the patient at the hospital and has questions about the charges.
- A doctor may talk to someone who is driving a patient home from the hospital or doctor's office about how the patient needs to be cared for during the ride and immediately upon arriving at home.
- A doctor may discuss drugs a patient needs to take, and side effects to watch out for, with the family member or caregiver who has come with the patient to an appointment.
- A doctor or other provider may not discuss either previous health history or long-term prognosis without specific permission from the patient.
If the person in my care wants her healthcare providers to share information with me, can I ensure that they'll do it?
Under HIPAA rules, an older adult can give any kind of oral or written permission to healthcare providers for them to discuss her condition or care with anyone she chooses. There is no magic set of words or single all-purpose HIPAA form that has to be used. Many doctors, hospitals, and other healthcare providers have their own forms that they prefer to have patients sign before giving information.
The safest course of action is for you and the person in your care to contact all the doctors' offices and other medical providers she visits and ask for a copy of their specific HIPAA forms. Fill out each form, have her sign each one (in front of witnesses or a notary, if required on the form), keep one copy each for yourself and the person you're caring for, and return the signed forms to the providers' offices. Anytime the patient is about to enter a hospital or visit a new doctor, repeat this process with the new provider.
Can I get information if the person in my care is unconscious or otherwise unable to give or refuse permission?
Even if she has completed HIPAA forms with some medical providers, a situation may arise -- a medical emergency, a new provider entering the picture -- in which no prior consent has been given and the patient is unable to give permission. In these circumstances, a healthcare provider may discuss health information with immediate family members, or with others whom the provider knows are directly involved in the patient's care, if the provider believes that doing so is in the patient's best interest.
The healthcare provider may only share information that the family member or other person needs to know, even if a patient is permanently incapacitated. In other words, providers will not throw open the patient's entire lifetime medical history but only those parts of it that relate to the current situation.