This page outlines the differences between anonymous and confidential services and explains how, why, and by whom your medical records can be opened. It also answers some other frequently asked questions.
Section 1: The differences between confidential and anonymous medical care.
What is the difference between anonymous and confidential medical services?
When can my confidential medical records be opened against my will?
Is there a national database of medical records?
What do health
care facilities have a right to ask me? And what do I have to tell them?
The differences between confidential and anonymous medical care.
What is the difference between anonymous and confidential medical services?
Confidential Services
Most of the time
medical care is “confidential”, this means that a clinic might have the
names and other kinds of identifying information on file but, by law, they
cannot release that information to anyone without the consent of the client.
This absolute confidentiality is called “doctor client privilege”. This
privilege extends to any health care provider, not just doctors, including
those of us here at the Berkeley Free Clinic.
“Anonymous” Services
Anonymous service
should mean that the facility does not collect any identifying information
about the client, and the records kept are limited to numbers, pseudonyms,
or special codes. HIV is the most common disease that is tested anonymously
and numbers are given at test sights that must be brought back by the clients
in order for them to pick up their results.
The Up Side and
the Down Side:
The up side to having
anonymous testing is that no one can see what is in your records for any
reason because records of treatment for that specific person do not exist.
An anonymous clients records can never be demanded by the courts or insurance
companies, nor can these results be reported to the public health department
in any identifying way (though anonymous results are recorded). It also
means that there is no record of their ever having received care, so the
client can't use them to prove that they have been tested or immunized,
or in the event that they might need them for other medical treatments
at a later date.
How your medical records can be accessed.
When can my confidential medical records be opened against my will?
In certain cases the “doctor client privilege” must be foregone and information about your medical history, including your test results, must be released. These “special circumstances” include:
“California Morbidity
Reporting Law” or CMR.
City and county
health departments keep track of who gets sick by requiring that all facilities
that test for certain diseases report positive test results to them. Health
departments use this information so that they can track outbreaks of disease
and respond to them as quickly as possible. This kind of reporting falls
under a set of California State laws called “California Morbidity Reporting
Law” or CMR. Diseases under the CMR laws include: TB, syphilis, gonorrhea,
chlamydia, viral hepatitis and other communicable diseases, like rubella,
and cholera.
In most cases these results are recorded and use for epidemiological data so that disease outbreaks can be tracked and restrained.
However some positive test results mean that a public health nurse will contact the recipient of a positive result to make sure they receive follow up care. TB, syphilis, and Hep B and C are some of the diseases that require the follow-up of public health nurses.
At the same time clients should be reassured that having a public health nurse contact them does not mean that the health department can tell anyone about those results or anything else in ones medical records. They cannot. Anyone besides the public health nurse or the facility where a client receives care must have a court order or the patient's permission for them to release such information and health care workers can lose their licenses or be sued if they release information that is confidential.
Subpoenaed Information
Another time medical
records can be opened without the clients consent is when records are “subpoenaed”,
or demanded by the courts. This happens mostly if a client is accused of
committing a crime, or if medical records might be evidence of a crime.
Rarely insurance companies also subpoena medical records through the courts
if they suspect they are being defrauded. If that happens, and records
have been falsified, then the insurance company can deny coverage to the
person and may sue them or press criminal charges.
Mandatory Reporting
The only other time
when doctor-client privilege might be broken is in the case of mandatory
reporting. The guidelines for mandatory reporting include:
· If an elderly
person or a child might be the subject of abuse
· If injuries
may have been sustained in the commission of a crime, such as rape or assault.
· If someone
makes a statement that they might be a threat to the safety of themselves
or another person.
Confidential records
mean that the client, and their other health providers, have access to
their records in case they need them for other medical care or to prove
that they have gotten medical care or been vaccinated.
Counseling Information
When do I have to give my permission for my medical records to be opened?
On some occasions you can be asked to give your medical records to various outside sources. These situations include:
Health insurers often use this information to deny people coverage due to "pre-existing conditions". A "pre existing condition" is any long-term (chronic) condition or illness or short-term (acute) illness or condition that hasn't resolved by the time you begin to be covered your insurance. The conditions that make one ineligible for insurance vary from company to company, and from state to state. The list of reasons or conditions that you may be denied coverage are long but include; HIV or AIDS, being significantly overweight, a history of cancer, a history of drug or alcohol abuse, a history of heart disease, a history of mental illness, current pregnancy, or any condition or illness that might result in significant cost to the insurer.
The reason why insurance companies can and do deny coverage to people is because they are money making businesses with assets to protect. Their argument is that they cannot afford to extend coverage to those people who are at-risk of being costly investments.
Life insurance works in much the same way- insurers deny coverage to those people who they suspect will die sooner than other people because the longer it takes you to die the longer you will have to give them money.
When you apply for insurance you are not required to open you medical records to potential insurers but they may deny you coverage if you refuse. Also medical insurers can cancel you at any time if they find out that you did not fully disclose your medical history. They also have the right to press charges against you is they believe that you were being intentionally fraudulent; though this rarely happens.
Applying for government
subsidies.
When you apply for
government programs, or subsidies you will sometimes be asked to give information
regarding your health history. The subsidies that may ask for your medical
records include:
Applying for certain
kinds of work.
Certain kinds of
work require that you be in top physical shape. Jobs that might request
information about your medical history include:
If you lie about your medical records and one of these employers finds out you can lose your job after you have already been employed.
Is there a national database of medical records?
As of today there is no national database of health or medical records. Most people have recieved healthcare from a number of sources and these records are not yet held in any central location. But this is changing please see the related article on medical privacy issues from Consumer Reports Magazine by clicking here.
What do health care facilities have a right to ask me? And what do I have to tell them?
Healthcare facilities may ask for any information they deem necessary BUT you are not obligated to tell them anything.
Who is supposed to have access to my medical records?
Your doctor, insurers, and any consulting lab professionals or medical personal have access to parts of your medical records.
The law states that no-one may see all of your records without your express consent ar a subpeona except public health officials who may have access to certain test results under morbidity reporting guidelines (see above).
Who actually sees them?
In reality a lot of people may see your records in any given medical office. Nurses, doctors, records people, or administrative personal may all have access to your records. However telling others about what they know or have seen in your medical records is strictly forbidden.