ROWAN UNIVERSITY POLICY

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1 ROWAN UNIVERSITY POLICY Title: Authorization for Release of Information and Providing Patients with Copy of Medical Records Subject: IRT Clinical Systems Policy No: Applies: School of Osteopathic Medicine Wide Issuing Authority: President (signature) Responsible Officer: Clinical Systems Assistant Director Adopted: 09/17/2012 Amended: 09/05/2014 Last Revision: 09/05/2014 I. PURPOSE To create a consistent method to record the patient s authorization to release and/or obtain a copy of their medical records in a paper or electronic format from the RowanSOM Electronic Health Record (EHR) II. ACCOUNTABILITY Department Administrator III. APPLICABILITY All Clinical Faculty Practices IV. DEFINITIONS Authorization for Release of Information Form The new consolidated release form created for use by all FPP medical practices which include new sections to govern the ability to provide both paper and/or electronic copies with the implementation of our EHR and to meet Meaningful Use standards. Meaningful Use Guidelines established by the Federal Government to meet their requirements for financial subsidy and reporting for entities who establish electronic health records CCD (Continuity of Care Document) Workflow The guidelines and workflow established to instruct the staff on how to make an electronic copy of the patient s medical record onto a CD. Authorization for Release of Information and Providing Patients with Copy of Medical Records 1

2 V. POLICY The clinical practices will provide patient medical records in a standard, electronic and legal manner to meet the needs of the FPP and the patient. VI. PROCEDURE When a patient arrives and requests a copy of their medical records, this procedure is required to ensure that we obtain authorization and correctly identify the type of copy they receive and ensure it is documented into our EHR System. Attachments 1. Utilize the new consolidated Authorization for Release of Information form (Attachment #1). i. Ask the patient to complete this form, indicate the type of copy they wish to obtain (paper vs. electronic). ii. Explain their responsibility for protecting this information under HIPAA regulations and have them check off that box indicating their acceptance. iii. Have the patient sign and date the request and establish timeline expectations for when they can expect their copy (Keep in mind that we are obligated, under the Meaningful Use guidelines, to provide an electronic copy within three (3) days of the signed request). 2. Once the form is completed then the staff will scan it into the EHR as a Record Release/Patient Authorization document type. 3. The staff will then go into the EHR and locate the Patient Authorization encounter type and complete the form in its entirety as indicated in Attachment # 2 or in the training manual. 4. After completing the above steps, and if the patient selected to receive an electronic copy of their medical records, then the staff can utilize the IRT CCD Chart Summary Workflow as guidance to copy the records onto a writeable CD (Attachment #3) or the Release of Paper Record workflow (Attachment #4). 5. Prior to release of medical records to patient, collect the appropriate fee and post transaction in Centricity Business. To post in Centricity Business use the code below: i. For each page use CPT code S9982 with a charge of $1 for each page. (use the units field to indicate the number of pages) 6. If an outside vendor is making your medical record copies, the previous steps still need to be completed by a RowanSOM staff. 1. Authorization for Release of Information 2. Patient Authorization Required Fields 3. IS&T CCD Chart Summary Workflow 4. Release of Paper Record By Direction of the CIO: Mira Lalovic-Hand, VP and Chief Information Officer Authorization for Release of Information and Providing Patients with Copy of Medical Records 2

3 Attachment #1 Authorization For Release of Information PLEASE COMPLETE THIS FORM IN ITS ENTIRETY Patient Name: Birth Date: Social Security Number: I hereby request and authorize RowanSOM Department of disclose to: Name: (person to whom disclosure is made) Address: my medical records to the following extent: to (treatment date, RowanSOM health care unit in which treatment was provided, type of records to be excluded, if any) for (purpose of disclosure) I understand that this authorization includes permission to release information related to the history, diagnosis and/or treatment of any psychiatric problems, mental illness, drug abuse, alcoholism, sexually transmitted or communicable disease, AIDS, or test for infections with human immunodeficiency virus (HIV), that my signing this document authorizes the Rowan University to release that information. I acknowledge and am aware that New Jersey has a statutory privilege accorded to confidential communications between a patient and a licensed physician or psychologist and that my signing this form waives this privilege. A check here indicated that I believe my medical records may contain DNA test results or other genetic information. Such information is specially protected by New Jersey law, and I will be contacted for separate, specific consent prior to release of this information. I understand the nature of the authorization and that this authorization can be revoked at any time by the person giving authorization, with a written and dated notice, except to the extent that disclosure made in good faith has already been made prior to receipt of the revocation. I understand that this authorization is specific for release only to the above party and expires (90) days following the date of signature. A check here indicated that I, the undersigned, understand that I assume full responsibility for the protection of this patient information provided via electronic file/cd under HIPAA laws. Identify method of copy: Paper Electronic/CD (Must check above box also) Rowan University will not make decisions concerning treatment, payment, enrollment or eligibility for benefits based on signing, refusing to sign or revoking this authorization. I understand that I can be charged for obtaining copies of my records according to the fee schedule established in the New Jersey Administrative Code. I understand if this authorization is for marketing purposes that Rowan may receive direct or indirect compensation. Printed Name of Patient or Guardian: Signature of Patient or Guardian: Date: Authorization for Release of Information and Providing Patients with Copy of Medical Records 3

4 Attachment #2 The information below is required data elements that must be completed when processing a patient authorization chart request. 1) Information Disclosed Click on the applicable chart item(s) to be disclosed, choose all applicable boxes. 2) Date Sent Enter the date each for each of the disclosed chart item(s). 3) Purpose of Disclose Choose appropriate response from the drop down menu. 4) Date Request Received Enter the date the request as received. 5) Authorized By Enter the name of the clinician that authorized the release of records. This field must contain the name of a clinician. 6) Sent Via Choose the appropriate response from the drop down menu. 7) Signed By Enter the name of person who is signing for the record release 8) Relationship to Patient - Choose the appropriate response from the drop down menu or free text the relationship to the patient. Dropdown Menus defined below: Authorization for Release of Information and Providing Patients with Copy of Medical Records 4

5 Purpose of Disclosure: Copy for Patient Referral Transition of Care Insurance Legal Other *Free Text is also accepted Authorized By: Dropdown includes all users this must the provider of the records Sent Via: Electronic Mail Fax Hand Delivered *Free Text is also accepted Relationship to Patient: Self Parent Spouse Child Guardian Healthcare Proxy *Free Text is also accepted Authorization for Release of Information and Providing Patients with Copy of Medical Records 5

6 CCD (Continuity of Care Document) Attachment #3 NOTE: The steps detailed in this workflow are based on a standard Laptop. Some of the device specific options/settings may be different for the workstation that you are using. Front Desk Clinical Staff Provider Task Centricity EMR Steps X X Patient requests electronic copy of health information 1 Follow process outlined in the Providing Patient with a Paper Copy of Health Information documentation X X Find the patient s chart 2 Go to patient s chart 3 Click on the [Summary] tab X X Generate Chart Summary 4 Click on [Action] (menu at top of screen) 5 Click on [Generate Chart Summary] X X Chart Summary Form 6 Click on drop down arrow for reason of export 7 Free text the name of the recipient 8 Make sure the box next to [Compressed File (.zip)] is unchecked 9 Click the ellipses at [Export Destination] choose the [Y:] drive 10 Click [Save] 11 Make sure the box next to [Open folder after generation] (bottom left) is checked 12 Click [OK] 13 You will get a warning if a chart summary already exists at this location 14 Click [Yes] to replace it 15 Confirmation pop-up box will display [Chart Summary generated successfully.] 16 Click [OK] 17 The [Y:] drive folder will automatically open X X Insert CD 18 Insert blank CD 19 Go to My Computer, double click on the [DVD-R Drive](usually D: drive) 20 Go back to [Y:] drive 21 Drag the [IHE_XDM] folder and [INDEX] file from the [Y:] drive to the [DVD-R Drive] 22 Once the files are in the DVD-R Drive, Click [Write these files to CD] 23 Accept all of the default in [CD Writing Wizard] 24 Click [Finish] 25 CD will eject, re-insert CD to preview data file X X Preview CD Data 26 Double click on the [INDEX] file 27 Verify that this is the proper patient data 28 Click the [X] button on the top right of the screen to close the file 29 Eject CD 30 Write patients name and date on the CD with a permanent marker 31 Hand the CD to the patient 32 End process Note: Always open the file on the CD drive prior to giving it to the patient, this process will ensure that you are providing the patient with the data they requested and not another patient s data. Authorization for Release of Information and Providing Patients with Copy of Medical Records 6

7 Attachment #4 EMR Clinical Workflow: Providing Patient with a Copy of Medical Record Staff File Clerk/Med Record Staff Provider Task Centricity EMR Steps X X Complete paper authorization form X X Scan paper Authorization form into the EMR 1 All record releases require a signed paper Authorization form, obtain a signed paper authorization form from the requester 2 Scan signed paper Authorization form (follow Single-page Scanning process) 3 In Kryptiq indexing software, select Internal Other for the Document type and Record Release /Pt Authorization in the Summary field. Note: Clinical date of the scanned document should be the date when the Patient Authorization encounter type was opened, so that the scanned paper patient authorization date can be matched up to the EMR Patient Authorization date X X Complete Patient Authorization Form in Centricity for MU 4 File Clerk/Med Record Staff logs onto Centricity EMR 5 Finds Patient 6 Start the update 7 Click on the Patient Authorization encounter type 8 On the Patient Authorization form check all appropriate fields to comply with meaningful use measures. Complete the required data elements for processing a patient authorization chart request (for appropriate fields see the policy) 9 Information Disclosed Click on the applicable chart item(s) to be disclosed, choose all applicable boxes 10 Date Sent Enter the date each for each of the disclosed chart item(s) 11 Purpose of Disclose Choose appropriate response from the drop down menu 12 Date Request Received Enter the date the request as received 13 Authorized By Enter the name of the clinician that authorized the release of records. This field must contain the name of a clinician 14 Sent Via Choose the appropriate response from the drop down menu. 15 Signed By Enter the name of person who is signing for the record release 16 Relationship to Patient - Choose the appropriate response from the drop down menu or free text the relationship to the patient 17 Close Patient Authorization Form 18 Click [End Update] 19 Sign Centricity document 20 End Process Authorization for Release of Information and Providing Patients with Copy of Medical Records 7

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