(Adapted from the Crisis Management Handbook: A Guide for Overseas
Staff, Peace Corps Volunteer Safety Council)
The guidelines provided describe the nature and extent of the confidential relationship that exists between student and medical doctor. The limitations on medical confidentiality and the extension of medical confidentiality to non-medical staff are also outlined.
The purpose of medical confidentiality is to ensure that the patient can be completely open with his or her health care provider and not withhold important information for fear that it will be released to others who do not have a need to know. Responsible handling of confidential and private medical information obtained by the health care provider during a course of diagnosis or treatment of a student is an important part of an effective student health program.
In addition to medical confidentiality, the Privacy Act protects information about individuals, which is maintained in an agency system of records. The medical information maintained about a student is a protected Privacy Act record.
C) MEDICALLY CONFIDENTIAL INFORMATION
To be covered by medical confidentiality, information must be of a medical nature about an individual student and must be held by a medical provider (except when medical confidentiality has been extended to a non-medical personnel as discussed in Section 5.) Medical information shared by a student with a non-medical staff is not medically confidential.
The following types of information are considered medically confidential:
- Medical records. All medical records must be stored in a locked file cabinet with access limited to medical unit personnel.
- Information of a medical nature obtained from the student by a health care provider.
- Cables, faxes, or telexes marked medically confidential or "Med Eyes Only."
D) SHARING NON-CONFIDENTIAL INFORMATION
The following situations are examples of cases where, without revealing the underlying medical information, the doctor would appropriately share information with the Resident Director, or designee, and others who have a programmatic need to know about a student's status.
- When a student will be absent due to illness or injury, program staff need be advised of the student's absence and projected return.
- If limitations on activity would impair the student's ability to function as a student.
- During a medical evacuation, program staff need information on the probability of return to country.
- Behavioral problems are usually of concern to all staff and can be discussed in terms of the observed behavior and potential risk to the student and others.
E) EXTENSION OF MEDICAL CONFIDENTIALITY
Medical confidentiality may be extended to non-medical personnel in any of the following circumstances. Persons with whom confidential medical information is shared are required to protect the information in the same way as medical staff.
The student has authorized in writing the release of some or all of his/her medical information.
If, in the opinion of the doctor, failure to release the information would pose a significant threat to the life or physical safety of the student or others, or if the doctor believes a student is likely to be threat to him/herself or the physical safety of others, or the program, the doctor should extend medical confidentiality to non-medical staff and share any information concerning the condition, diagnosis, or treatment of the student that is appropriate to the role and responsibilities of the other staff. Examples may include life-threatening communicable diseases, child or spouse abuse, drug abuse, or potential suicidal or violent behavior.
The Resident Director must be notified immediately when a student has been physically or sexually assaulted. This notification must include the following information,
- Type of assault.
- Date and time of day and the name of the town or city the assault occurred (and whether it occurred on the study center).
- Whether the assault was related to the program.
- Whether assailant was known.
- Whether there was more than one assailant.
- Whether a weapon (s) was involved.
- Any other information concerning the safety and security of this or other students.
The Resident Director's need to know the name of the student depends upon the situation. When the Resident Director believes that there is a need to know the name of the student, providing the name to the Resident Director is appropriate.
Staff at the study center may need to know or may be able to surmise confidential information from circumstances surrounding an incident or medevac. In such cases, they are also bound by the rules of confidentiality and privacy.
F) INQUIRIES FROM FAMILY MEMBERS AND OTHERS
When authorized by the student, confidential medical information may be released to family members or others. Written authorization should be obtained and filed in the student's health record. In cases where it is not possible to get written documentation, verbal authorization must be documented by the doctor in the health records. Even when faced with concern expressed by family and friends, confidentiality of medical information must be ensured.
Notification of a student's condition without the student's consent may be made only by Resident Director in cases where a student is incapable of providing consent and is considered to have a serious or life threatening condition. Notification is made to the individuals whom the student designated in writing for notification in case of emergency.
G) MEDICAL CONFIDENTIALIY IN COMMUNICATIONS
Cables
Communications which identify an individual student and contain medical information should receive the "Medical Eyes Only" designation.
Cables are more secure than the telephone or the fax. Telephone transmissions and fax transmission can be intercepted and understood by a third party. Cables are encrypted, so that they may not be understood if intercepted.
Fax
A cover sheet indicating that medically confidential information follows should be used in all transmissions.
Telephone
Doctors should be able to conduct telephone conversations without being overheard so that student's privacy and confidentiality can be maintained.
(Adapted from the Crisis Management Handbook: A Guide for Overseas
Staff, Peace Corps Volunteer Safety Council)
