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HIPAA and Law Enforcement Guidelines

HIPAA and Law Enforcement Guidelines - Departments & Programs, UW Hospital and Clinics, Compliance, Privacy, HIPAA

Focus

Circumstances under which PHI CAN be provided to Law Enforcement Officers WITHOUT Written Consent or Court Order
  1. Reporting Crimes on Premises: If a crime occurs on our premises, UWHC staff may disclose facts to UW Police and Security who may involve area law enforcement officers.
  2. Information to Security or Corrections Officers: UWHC staff may disclose only that information which is necessary to guard or transport the patient safely. Discharge instructions and other documents containing PHI must be placed in a sealed envelope and then given to the guard.
  3. Sharing Information with Prison/Jail Medical Staff: UWHC staff are permitted to share or disclose information about a prisoner directly with prison or jail medical staff (e.g., nurse), but not the guards or sheriffs unless necessary for the safe transport/guarding of the patient.
  4. Calls to Confirm Presence/Condition Reports:UWHC staff can confirm the presence and general condition of a patient if the law enforcement officer provides the first and last name of the patient. UWHC staff must verify that the person requesting the information is a law enforcement officer (ask for badge number, call back number, etc.). If the law enforcement officer is not known to the UWHC staff, UWHC staff will contact the appropriate police agency/district and verify the badge number or telephone the call back number to verify the identity of the law enforcement officer.
    1. Note: if the patient is listed as CONFIDENTIAL (CF) a court order must be presented before sharing any information regarding a CF patient (via telephone and/or in person).
  5. Calls to Confirm Discharge Date and Time:Law enforcement agencies occasionally request that UWHC staff notify them in advance of a patient’s discharge so that officials can be present to arrest or detain the patient. Complying with such requests involves disclosure of a patient’s protected health information (PHI). Generally, UWHC may only disclose PHI without prior authorization for purposes related to treatment, payment and operations, however HIPAA also allows limited disclosures for law enforcement purposes “to identify or locate a suspect, fugitive, material witness or missing person.” It is UWHC’s position that staff may, under this provision, legally disclose the anticipated discharge date and time of a patient to law enforcement personnel. If law enforcement personnel request notification of a patient’s anticipated discharge UWHC staff must:
    1. Confirm that the requestor is a law enforcement official (see #4 above).
    2. Provide the requestor with only:
      1. Patient’s name;
      2. Patient’s location within the facility;
      3. Patient’s anticipated date and approximate time of discharge
      4. Information necessary to ensure safe transport (if applicable).
    3. Document the disclosure of PHI using UWHC’s “Accounting for Disclosures” form.
  6. Calls to look for a Patient by Particular Physical Description: If law enforcement calls trying to locate a suspect, material witness or victim of a crime, UWHC staff is permitted to confirm the presence and/or disclose general physical characteristics, time of treatment, or death, after confirming the identity of the law enforcement officer (see #4 above).
  7. Reporting/Responding to Requests about Child Abuse: UWHC staff should coordinate with social work to report and/or respond to investigations of suspected child abuse (see Policy 4.52 “Abuse, Neglect and Domestic Violence”). UWHC staff is permitted to disclose PHI necessary for the police, sheriff or district attorney in connection with the investigation or prosecution of child abuse or neglect (whether or not the report was made by UWHC staff), if law enforcement identifies the subject of the investigation by name. Disclosures must be documented using UWHC’s “Accounting of Disclosures” form. If copies of medical records are requested, law enforcement must be directed to Health Information – Release of Information, (608) 263-6030.
  8. Patient Threatens to Harm Self or Others or Poses a Threat to the Public: UWHC staff may contact law enforcement to report a patient who poses a threat to themselves or others. UWHC staff may release that medical information which is necessary for law enforcement to provide appropriate services to protect the patient, UWHC staff and the public.
  9. Mandatory/Permitted Reports to Law Enforcement:
    1. Wounds and Burns – UWHC staff may report or respond to requests about injuries that occurred as a result of a crime. The information provided must be limited to demographic information and details about the “wound.” UWHC staff is not permitted to release information related to the treatment plan or underlying medical conditions.
    2. Child Abuse (see #7 above)
    3. Coroners Deaths – UWHC staff is permitted to report and respond to inquiries about deaths to law enforcement officers for deaths that qualify as “coroners” cases (see UWHC policy 4.20 “Death Reports to Coroner”).
    4. Patient presents harm to self or others (see #8 above).
    5. Crime on premises (see #1 above)
  10. Gathering Evidence: Law enforcement officers are permitted to gather evidence as needed to investigate crime (photographs, bullets, etc.). The clinical status and safety of the patient plays an important role in determining the best circumstances under which law enforcement officers are permitted to gather evidence. UWHC staff should generally not release items in the patient’s possession to law enforcement officers unless the patient is in custody, law enforcement has a search warrant or court order, the patient consents or the patient is an unconscious victim of a crime.
  11. Detox/Emergency Detention: UWHC staff may provide to law enforcement officers only the PHI that is necessary to place a person in Detox or emergency detention. For more information on the legal procedures that must be used to place a person in Detox or emergency detention, see UWHC policies 8.09 “Protective Custody, Emergency and Involuntary Commitment for Persons Intoxicated and Incapacitated by Alcohol” and 10.14 “Emergency Detention-State Mental Health Act.”

Circumstances under which PHI CANNOT be provided to Law Enforcement Officers WITHOUT Written Consent or Court Order

  1. Requests for Blood Draws:
    1. At the request of a law enforcement officer – see policy 4.12 “Drawing of Blood at Police Request.”
    2. Requests for results of a blood sample – UWHC staff may not release results of blood samples drawn for medical purposes without a court order or the patient’s written authorization (exception – making Detox determination).
  2. Requests for Extent of Injuries/Medical Treatment Plan (etc.): UWHC staff is permitted to report or disclose medical information related to a wound, but only if the wound appears to be a result of a crime. Requests for more detailed information regarding an underlying medical condition, treatment plan, etc. cannot be disclosed without the patient’s written authorization or a court order. For example, UWHC staff cannot reveal an underlying medical condition such as epilepsy, or disclose the fact that the person smelled like alcohol without the patient’s written authorization or a court order.
  3. Other: Request for information by law enforcement not otherwise permitted above requires written authorization by the patient or a court order.