ANSWERS
Health Insurance Portability and Accountability Act (HIPAA)
provides a legal framework for handling client information
-HIPAA rules help protect the privacy of the client's identifiable health information while
facilitating communication among providers and other entities
• ensure information is available for treatment and other purposes such as insurance
benefits
-health professionals may be held legally liable by state and federal law for breaching
confidentiality
Release of Information
-HIPAA guides the PMHNP in making decisions about when to share information based
on their professional judgment to prevent harm
• may be necessary for providers to share mental and behavioral health information to
enhance treatment or ensure the health and safety of the client and others
-PMHNPs are mandatory reporters in cases of suspected child abuse
Duty to Warn
exception to requirements for confidentiality
-Most states have laws that allow mental health professionals to share information
about clients who may become violent
-several states, it is even mandatory for providers to report when clients may pose a
danger to themselves or others
John is a 36-year-old with a diagnosis of schizophrenia. He lives with his mother.
His symptoms are currently well managed by medications; however, he
sometimes forgets to take them. At the visit with the PMHNP, John asks the
PMHNP to go over his medication regimen with his mother.
Is this allowed under HIPAA?
Yes
Rationale: In situations where the client is given the opportunity and does not object,
, HIPAA allows the provider to share or discuss the client's mental health information with
family members or other persons involved in the client's care or payment for care.
John's sister calls the PMHNP to discuss her concerns that John is under a lot of
stress and may be showing signs of psychosis. John has not permitted the
PMHNP to speak with his sister as they are estranged, and John has asked the
PMHNP not to share information.
Is it acceptable for the PMHNP to share information about John's status with his
sister?
No
Rationale: The HIPAA Privacy Rule permits a health care provider to disclose
information to the family members of an adult client who has the capacity and indicates
that he or she does not want the disclosure made, only to the extent that the provider
perceives a serious and imminent threat to the health or safety of the client or others
and the family members are in a position to lessen the threat. Otherwise, under HIPAA,
the provider must respect the wishes of the adult client who objects to the disclosure.
Is it permissible for the PMHNP to listen to the sister's concerns without sharing
information?
Yes
Rationale: HIPAA in no way prevents health care providers from listening to family
members or other caregivers who may have concerns about the health.
John's mother recently had a stroke and is in the neuro intensive care unit (ICU).
With his mother out of the home, John has forgotten to take his medications for
over a week. He begins to experience hallucinations and paranoia. At his
appointment with the PMHNP, he threatens to harm his sister.
To whom should the PMHNP disclose this information (select all that apply):
-John's sister
-John's mother's nurse in the neuro ICU
-Law enforcement near the sister's home