Patient+Privacy

toc =Health Information Privacy= The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.

=Health Insurance Portability and Accountability Act (HIPPA)= The //Standards for Privacy of Individually Identifiable Health Information// (“Privacy Rule”) establishes, for the first time, a set of national standards for the protection of certain health information. The U.S. Department of Health and Human Services (“HHS”) issued the Privacy Rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). The Privacy Rule standards address the use and disclosure of individuals’ health information—called “protected health information” by organizations subject to the Privacy Rule — called “covered entities,” as well as standards for individuals' privacy rights to understand and control how their health information is used. Within HHS, the Office for Civil Rights (“OCR”) has responsibility for implementing and enforcing the Privacy Rule with respect to voluntary compliance activities and civil money penalties.

=**Protected Health Information (PHI)**= The Privacy Rule protects all //"individually identifiable health information"// held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)." “Individually identifiable health information” is information, including demographic data, that relates to: and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).
 * the individual’s past, present or future physical or mental health or condition,
 * the provision of health care to the individual, or
 * the past, present, or future payment for the provision of health care to the individual,

**Permitted Uses and Disclosures:**
A covered entity is permitted, but not required, to use and disclose protected health information, without an individual’s authorization, for the following purposes or situations: Covered entities may rely on professional ethics and best judgments in deciding which of these permissive uses and disclosures to make.
 * To the Individual (unless required for access or accounting of disclosures);
 * Treatment, Payment, and Health Care Operations;
 * Opportunity to Agree or Object;
 * Incident to an otherwise permitted use and disclosure;
 * Public Interest and Benefit Activities;
 * Limited Data Set for the purposes of research, public health or health care operations.

**Required Disclosures**
A covered entity must disclose protected health information in only two situations:
 * To individuals (or their personal representatives) specifically when they request access to, or an accounting of disclosures of, their protected health information;
 * To HHS when it is undertaking a compliance investigation or review or enforcement action.

More information can be obtained from the HHS website on patient privacy

=Advance Care Planning= Advance care planning document patient's values and cultural beliefs, it helps determine patient's health care preferences when patient is still relatively healthy. Patient selects a DPOA and the process continues with ongoing dialog with patient and their family

Advance Directives
Declarations by patients, made in advance of a situation in which they may be incompetent to decide about their own care, stating their treatment preferences or authorizing a third party to make decisions for them.

Medical Directive
A questionnaire that documents a patient's health care wishes which may be disease-specific (preferred) or non-specific.

Durable Power of Attorney for Healthcare
A durable power of attorney is a legal document that gives powers to an agent to act on behalf of the person who signs the document, called the "principal". It is called "durable" because unlike non-durable POA, it continues to be effective despite the mental incapacity of the principal.
 * Person assigned as decision-making proxy
 * Determined when patient cognitively intact
 * Activated if patient becomes incapacitated

Living Will
Written, witnessed declarations in which persons request that if they become disabled beyond reasonable expectation of recovery, they be allowed to die rather than be kept alive by extraordinary means. A living will does not delegate decision making power but rather leaves instructions regarding their medical care, it includes provisions for DNR/DNI and may prohibit CPR and forbid food and water. A living will is independent of an advance directive.

Provider's Orders for Life Sustaining Treatment (POLST)

 * Indicated for patients in Nursing Homes, Assisted Living, and Life Expectancy <12 months
 * Single page portable document that transfers between care systems
 * Addresses multiple medical interventions (DNR/DNI, comfort care, antibiotics, nutrition)
 * Form travels with patient and copies sent to EMR, EMS, facilities and family

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