Re: Rel. of Information - Secondary release (fwd)

[James Brady <jbrady@freenet.columbus.oh.us>]

  Bernice typing at all.
  
  ---------- Forwarded message ----------
  Date: Mon, 5 Aug 1996 18:39:01 -0500
  From: Bernice Childs <102366.1174@CompuServe.COM>
  To: jbrady@freenet.columbus.oh.us
  Subject: Re: Rel. of Information - Secondary release
  
  Elizabeth,
  
  The safest way to handle re-release of information is as follows:
  
  1.	The patient may request release of anything in his/her record that  was
  generated in your facility. (except such records that are governed by internal
  or external regulations.)
  2.	Information from another facility that is attached to the record is
  attached only for the convenience of the health care provider. It is not part of
  the facility's medical record.  It would not be sent to Court in response to a
  subpoena for "the entire medical record", nor does it have any purpose other
  than a convenient method of retention in the event of future need by your
  facility's health care providers.
  3.	I know how insistent patients can be--sometimes rightfully so.  My advice
  has alway been to:
  	a.	If the patient is seeing a practitioner outside the facility and
  needs the records for his/her impending appointment, then (1) offer to have
  someone read the information to the new physician over the telephone (2) offer
  to call the facility that shared the information with you, explain the
  situation, and mail or FAX the patient's authorization for release of the
  information to the new facility--then make a copy and and release the
  information.
  	b.	If the patient  is moving out of town and needs the records, have
  him/her write to the other facility and ask for copies to be sent to the new
  doctor.  If the patient says that he/she does not have a doctor in the new area
  yet, have him/her contact the first facility as soon as the new doctor is
  found..  At that point, the new doctor may choose to write for the other
  records.  Anything urgent can be handled over the phone so that patient care
  will not be interrupted.   Your facility, in my opinion, is out of the loop for
  release of the first facility's records.
  
  	c.	If the patient initially brought the copies to your facility upon
  his/her arrival and now wants to take them on to another location, these copies
  do belong to him/her and were given to him/her by the first facility knowing
  that they were being carried about, so I would give the copies back to the
  patient.  (After all, you only stored them as a convenience to the health care
  provider.)   
  
  	d.	However, if your facility sent for the copies, then they were
  entrusted to your care, and they should not be re-released without approval from
  the original facility.  We all want to know where copies of our records are, and
  we need to know which pages have been copied, so they cannot be written upon or
  altered inadvertently..     (That is one good reason for marking every page that
  is photocopied.)
  
  I have used the above P & P in both the acute care and ambulatory care setting.
  I may have the entire P & P
  somewhere and will be glad to look for it, if it will be of help.  It is always
  safer to have staff say"no" to a request, and if there are extenuating
  circumstances, you can override the "no" with a few minor modifications to the
  request, , than it is to have someone say "yes" and  leave your facility open to
  wrongful release of information.     This principle worked for me.
  
  Good luck!
  
  Bernice L. Childs, RRA