Confidentiality

• The patient may waive the right to confidentiality
• If the patient loses capacity, health information should be disclosed according to the patient's best interest (e.g., the physician will disclose relevant health information to friends, family, or the health care proxy to help guide medical decisions).
  • Only the minimum necessary information should be released.
• Health care providers should make their best efforts to ensure the safety of patient information (e.g., patient information should not be discussed in public areas, even within the hospital setting)

Exceptions to confidentiality

• Suspected child, disabled person, or elder abuse (reporting laws for spousal abuse vary by state)
• Knife or gunshot wounds
• Diagnosis of a reportable communicable disease
  • In most states, the physician does not have the right to inform third parties without the patient's consent.
• Threats to harm self or others and reasonable ability to carry out the threat in the near future

Health Insurance Portability and Accountability Act (HIPAA)

• It is not necessary to gain the patient's consent for disclosure to the following parties:
  • Health care workers and service providers that are immediately involved in the patient's care (e.g., as required for a referral to another health care provider or requesting a consultation)
    • Any other requests by health care workers to share information should be denied.
  • Parties that process health care payments
  • Health care operations providers (e.g., audits, legal services, administrative activities)
• The patient should give informal permission for the disclosure of their health information for the following unless the patient is incapacitated, in an emergency situation, or unavailable:
  • Information about the patient's health status and location in the health care facility for anyone who asks for them by name
  • If a patient doesn't want their family/friends to know their health status or that they are in the hospital, the physician should not disclose any information or attempt to contact them.
  • Notification of authorities in case of disaster if doing so would aid relief efforts