Dr. Ihab Nada DOE, MSKMC

 The information a patient reveals to a health care provider is private and has limits on how and when it can be disclosed to a third party.  The ethical principle or legal right that a healthcare provider will hold secret all information relating to a patient, unless the patient gives consent permitting disclosure

 Protects human rights  Creates trust between the clinician and the patient  Encourages full disclosure of information from the patient

 Healthcare personnel directly involved in a patient's care or treatment generally have access to the medical record.  Even if the patient has not expressly authorized disclosure of his or her medical record, such consent is implied from the patient's acceptance of treatment or hospitalization.

 A breach of confidentiality is a disclosure to a third party, without patient consent or court order, of private information  Disclosure can be oral or written, by telephone or fax, or electronically, for example, via or health information networks

 The patient's express authorization is required before the medical records can be released to any third party

 The patient, if a competent adult  A legal guardian or parent if the patient is incompetent or a minor child;

 If there is a reasonable probability that a patient will inflict serious bodily harm on another person, for example, the physician should take precautions to protect the intended victim and notify law enforcement authorities.  If there is cause to believe that a child, elderly person or disabled person has been or may be abused or neglected,  Communicable diseases and gunshot and knife wounds

 Any breach in confidentiality— even one that seems minor—can result in mistrust and, possibly, a lawsuit and/or disciplinary action.

DO NOT:  Discuss matters related to the people in their care outside the clinical setting  Discuss a case with colleagues in public where they may be overheard  Leave records unattended where they may be read by unauthorized persons.  Release information over the phone

DO:  Keep all information out of public view  Cover all patient information  Restrict access to the nurse’s station  Keep all medical records secure  Sign off the computer when you are not using it  Keep telephone discussions private  Use a cover sheet and confidentiality note for all faxes

 If a healthcare worker identifies a risk or breach of confidentiality they must raise their concerns with someone in authority (the immediate supervisor)  Try to correct the problem and record that it was corrected.