IDAHO STATE UNIVERSITY POLICIES AND PROCEDURES (ISUPP) HIPAA Privacy Use and Disclosure of PHI With Authorization 10120

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1 IDAHO STATE UNIVERSITY POLICIES AND PROCEDURES (ISUPP) HIPAA Privacy Use and Disclosure of PHI With Authorization POLICY INFORMATION Major Functional Area (MFA): MFA X - Office of General Counsel & Compliance Policy Title: Use and Disclosure of PHI With Authorization Responsible Executive (RE): General Counsel Sponsoring Organization (SO): Office of General Counsel Dates: Effective Date: Revised: Annual Review: I. POLICY STATEMENT: In accordance with 45 CFR ISU adopts and implements this policy in order to: A. Describe the uses and disclosures of protected health information (PHI) that require written authorization prior to the use or disclosure; B. Establish guidelines for obtaining and properly documenting an individual s written authorization for any use and/or disclosure of PHI that requires prior authorization; and C. Identify the elements of a valid authorization. II. AUTHORITY AND RESPONSIBILITIES: ISU is a hybrid entity in accordance with ISU s HIPPA Privacy Policy Only the health care component (i.e., the covered functions) of ISU must comply with this policy. All references in this policy to ISU shall be construed to refer only to the health care component of ISU. III. DEFINITIONS: See HIPAA Privacy Policy IV. PROCEDURES TO IMPLEMENT ISU may not use or disclose PHI without a valid authorization signed by the patient or his/her personal representative unless this Policy, in compliance with then-current HIPAA privacy regulations, permits such use or disclosure of PHI without written authorization. See the Special Considerations section below for references to other Policies related to use and disclosure of PHI. A. Authorization Requirements: 1. A valid authorization to release PHI must include all of the following core elements and required statements: HIPAA Privacy Use and Disclosure of PHI With Authorization Page 1 of 7

2 a. Description of PHI Disclosed Every authorization must contain a description of the information to be used or disclosed that identifies the information in a specific and meaningful manner. b. Name of Person(s)/Class Permitted to Send PHI The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure. c. Name of Person(s)/Class Permitted to Receive PHI The name or other specific identification of the person(s), or class of persons, to whom the covered entity may make the requested use or disclosure. d. Purpose for Disclosure A description of each purpose of the requested use of disclosure. The statement at the request of the individual is a sufficient description of the purpose when an individual initiates the authorization and does not, or elects not to, provide a statement of the purpose. e. Expiration Date An expiration date or an expiration event that relates to the patient or the purpose of the use or disclosure. The statement end of the research study, none, or similar language is sufficient if the authorization is for a use or disclosure of PHI for research, including the creation and maintenance of a research database or research repository (see HIPAA Privacy Policy Use and Disclosure of PHI for Research). f. Statement Regarding Right to Revoke A statement of the individual s right to revoke the authorization in writing and either: i. The exceptions to the right to revoke, together with a description of how the individual may revoke the authorization; or ii. To the extent that the information regarding the right to revoke the authorization is included in the ISU Notice of Privacy Practices, a reference to the Notice of Privacy Practices. g. Statement Regarding Conditions to Authorization The authorization must contain a statement concerning the ability or inability of the covered entity seeking the authorization to condition treatment, payment, enrollment or eligibility for benefits on the authorization, by stating either: i. The covered entity may not condition treatment, payment, enrollment or eligibility for benefits on whether the individual signs the authorization when the conditioning is prohibited by HIPAA as discussed in the section below entitled Prohibition on Conditioning of Authorizations; or ii. The consequences to the patient of a refusal to sign the authorization when, in accordance with the section below entitled Prohibition on Conditioning of Authorizations, the covered entity can condition treatment, enrollment, in the health plan, or eligibility for benefits on failure to obtain such authorization. h. Redisclosure of PHI The authorization must contain a statement that information disclosed pursuant to the authorization may be subject to redisclosure by the recipient and no longer protected by HIPAA. i. Signed by Patient or Patient Representative The authorization must be signed and dated by the patient, or where appropriate, the patient s personal representative. j. Description of Representative s Authority If the authorization is signed by a personal representative of the patient, the authorization must contain a description of the representative right or authority under state law to act for the patient. 2. In addition to the above core elements and required statements, the authorization must be written in plain language HIPAA Privacy Use and Disclosure of PHI With Authorization Page 2 of 7

3 3. If ISU seeks an authorization from an individual for a use or disclosure of PHI, ISU must provide the individual with a copy of the signed authorization. 4. A valid authorization (See Attachment A Authorization for Use and/or Disclosure of Protected Health Information) must be written and delivered to ISU in person via U.S. mail, courier, facsimile, or via electronic method which meets the requirements of ISU s HIPAA Security Policies. 5. The signature and all other information on the authorization must be legible (if written), capable of being authenticated (if electronic), and verifiable in accordance with ISU s verification procedures. 6. The ISU Privacy Officer or his/her designee must review all authorizations and determine whether the authorization and the identity of the requestor are valid. a. If the ISU Privacy Officer or his/her designee has any reason to doubt the truthfulness or accuracy of the authorization, he or she may further investigate the matter prior to the disclosure of PHI. 7. An authorization is invalid or defective and will not be acted upon if any of the following are true: a. The expiration date has passed, or the expiration event is known by the covered entity to have occurred; b. The authorization has not been filled out completely, with respect to any element described above (this includes illegible authorizations); c. The covered entity knows the authorization has been revoked by the individual; d. The covered entity knows material information in the authorization is false; e. The authorization is combined with any other type of document, such as a Notice of Privacy Practices or a written voluntary consent; or f. The ISU Privacy Officer or his/her designee believes the authorization, in whole or in part, is false or fraudulent, or otherwise not properly executed. 8. If an invalid authorization is received, ISU must identify why it is invalid and return it to the requestor for completion. 9. If the authorization is valid, ISU must disclose PHI in accordance with the authorization, unless ISU is prevented from doing so by state or federal law. 10. Transition Provisions ISU may use or disclose PHI that is created or received prior to April 14, 2003, pursuant to an authorization or other express legal permission obtained from the individual, regardless of whether such authorization satisfies the requirements of this policy, provided that the authorization or other express legal permission specifically permits such use and disclosure and there is no agreed to restriction in effect. 11. Compound Authorizations Prohibited; Exceptions Generally, HIPAA authorizations may not be combined in a document with any other legal permission, except as described below. a. Examples of prohibited combined authorizations: i. A patient s informed consent to undergo a surgical procedure (unless for research as described below) may not be combined with a HIPAA authorization; ii. A patient s acknowledgment of the Notice of Privacy Practices may not be combined with a HIPAA authorization; and HIPAA Privacy Use and Disclosure of PHI With Authorization Page 3 of 7

4 iii. An authorization on which a covered entity has conditioned the provision of treatment, payment, enrollment in a health plan or eligibility for benefits may not be combined with an authorization that does not have such conditions. An authorization for use or disclosure of PHI may not be combined with any other document to create a compound authorization except as follows: b. Research Studies An authorization for the use or disclosure of PHI for a research study may be combined with any type of written permission - HIPAA authorization may be combined) (See HIPAA Privacy Policy Use and Disclosure of PHI for Research). c. Psychotherapy Notes An authorization for use or disclosure of psychotherapy notes (as defined by HIPAA) may only be combined with another authorization for the use or disclosure of psychotherapy notes (See HIPAA Privacy Policy Use and Disclosure of Psychotherapy Notes). B. Prohibition Conditioning of Authorizations; Exceptions: 1. ISU may not condition the provision of treatment, payment, enrollment in a health plan or eligibility for benefits on the provision of an authorization from the patient, except that ISU may condition the provision of research-related treatment on the provision of an authorization for the use or disclosure of PHI for research. a. ISU may condition the provision of health care that is solely for the purpose of creating PHI for disclosure to a third party on the patient signing an authorization for the disclosure of PHI to such third party. C. Who May Request Release of PHI: 1. A patient may request use and/or disclosure of his/her PHI (Note: a HIPAA authorization is not required for ISU to use and/or disclose PHI for those activities described in HIPAA Privacy Policy Use and Disclosure of PHI for Treatment, Payment and Health Care Operations and HIPAA Privacy Policy Use and Disclosure of PHI Without Authorization). 2. The individual s personal representative, as determined under state law, may authorize the use and/or disclosure of and individual s PHI. Proof of the personal representative s authority to act on behalf of the individual must be provided and verified. 3. The identity of the person signing the authorization must be validated. Methods of validation include reference to a picture ID, such as a driver s license or passport, or comparison of signatures documented in the patient s PHI records. D. Revocation of Authorizations: 1. An individual may revoke an authorization at any time. The revocation must be in writing, submitted to the ISU Privacy Officer or his/her designee, and specify which authorization is revoked. 2. The ISU Privacy Officer or his/her designee receiving the request to revoke an authorization must discontinue any further release of the patient s PHI as permitted by HIPAA Privacy Use and Disclosure of PHI With Authorization Page 4 of 7

5 the initial authorization, but the revocation does not apply to actions previously taken by ISU in reliance on the initial authorization. 3. For insurance purposes, the revocation is not effective if the authorization was obtained as a condition of obtaining insurance coverage, and other law provides the insurer with the right to contest a claim under the policy or the policy itself. 4. As appropriate, the ISU Privacy Officer or his/her designee must notify other Clinics that may have relied upon the authorization of the individual s revocation. E. Who May Receive an Authorization and Release PHI: 1. The ISU Privacy Officer or his/her designee may receive and validate an individual s authorization to release PHI. 2. The ISU Privacy Officer or his/her designee may release PHI after receipt of a valid authorization. F. Retention of Authorizations and Revocations and Tracking of Disclosures: 1. Authorizations and revocations of authorization must be maintained for six (6) years from their last effective date, or longer if required by state law. 2. Authorizations and revocations of authorization must be filed in the patient s records. G. Special Considerations: 1. Research See HIPAA Privacy Policy Use and Disclosure of PHI for Research. 2. Marketing See HIPAA Privacy Policy Use and Disclosure of PHI for Marketing. 3. Use and Disclosure of PHI Without Authorization a. HIPAA Privacy Policy Use and Disclosure of PHI Without Authorization, for circumstances when the patient s authorization is not required; and b. HIPAA Privacy Policy Use and Disclosure of PHI for Treatment, Payment and Health Care Operations. 4. Personal Representatives A covered entity must treat a personal representative of an adult or unemancipated minor as the individual per applicable state laws. V. REFERENCES HIPAA Privacy Policies 10020, 10100, 10110, 10130, 10150, HIPAA Regulations, 45 CFR , , VI. ATTACHMENTS Attachment A Authorization for Use and/or Disclosure of Protected Health Information HIPAA Privacy Use and Disclosure of PHI With Authorization Page 5 of 7

6 PRESIDENTIAL CERTIFICATION Approved by Arthur C. Vailas President, Idaho State University Date: OGC use only: Received by OGC on by (initial). Published to ISUPP on by (initial) HIPAA Privacy Use and Disclosure of PHI With Authorization Page 6 of 7

7 Attachment A Idaho State University Authorization for Use and/or Disclosure of Protected Health Information Patient Identification Printed Name: Date of Birth: Address: Social Security #: Telephone: Information To Be Released Covering the Periods of Health Care From (date) to (date) From (date) to (date) Please check type of information to be released: Entire medical record Pathology report Discharge summary History and physical exam Consultation reports Progress notes Laboratory test results/reports X ray reports X ray films / images Operative report Emergency room record Itemized bill Other, (specify) Purpose of Request Treatment or consultation At the request of the patient Billing or claims payment Other, (specify) Person Authorized to Receive Information Name: Address: Drug and/or Alcohol Abuse and/or Psychiatric, and/or HIV/AIDS Records Release I understand that if my medical or billing record contains information in reference to drug and/or alcohol abuse, psychiatric care, sexually transmitted disease, Hepatitis B or C testing, and/or other sensitive information, I agree to its release. Check One: Yes No Initials I understand that if my medical or billing record contains information in reference to HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) testing and/or treatment, I agree to its release. Check One: Yes No Initials HIPAA Privacy Use and Disclosure of PHI With Authorization Page 7 of 7

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