ITEMS ON THIS PAGE:
1. CDCR Memorandum about new Health Care policy
2. Inmate FACT SHEET
3. Policy & Procedure
4. Link to Form 7385 (Authorization for Release of Medical Information)
5. Link to Form 7421 (Advance Health Care Directive) PENDING
1. Memorandum about new Health Care policy
1. CDCR Memorandum about new Health Care policy
2. Inmate FACT SHEET
3. Policy & Procedure
4. Link to Form 7385 (Authorization for Release of Medical Information)
5. Link to Form 7421 (Advance Health Care Directive) PENDING
1. Memorandum about new Health Care policy
STATE OF CALIFORNIA
PRISON HEALTH CARE SERVICES
Memorandum (facisimile)
To: Health Care Managers
Chief Medical Officers
Directors of Nursing
Health Information Services Supervisors
From: Dwight Winslow, M.D., Chief Physician Executive,
California Prison Health Care Services
Subject: RELEASE OF PATIENT-INMATE HEALTH INFORMATION
This memorandum and attached procedure is being issued to clarify the California Prison Health Care Services (CPHCS) requirements concerning the release of a patient-inmate's health care information.
As you are aware, the relase of a person's health information is a serious matter due to the confidential/privileged nature of the information. The release of health information is the responsibility of health care staff, not custody.
Please see the attached procedure entitled "Release of Patient-Inmate Health Information" and supporting forms and documents. The attached procedure needs to be shared with inmates; their friends and families so please do the following at each institution:
Identify a specific person and phone number for people to call to request a patient-inmate's health information.
Post the contact phone number in the inmate visitor's rooms.
Share the attached procedure with the Men's/Women's Advisory Councils.
The implementation date for this procedure is no later than January 30, 2009. Should you have any questions or concerns, please contact your appropriate regional leader.
Attachments:
Release of Patient-Inmate Health Information Procedure
CPHCS Form 7385 Authorization for Release of Information
CDCR Form 7421 Advance Health Care Directive
Inmate Fact Sheet, Authoriztion for Release of Information
cc: Terry Hill, M.D., Chief Executive Officer
Tim Rougeux, Chief Operating Officer
Betsy Chang-Ha, Chief Nurse Executive
Karen Rea, Director of Nursing Operations
Regional Medical Directors
Regional Directors of Nursing
Regional Administrators
Suzan Hubbard, Director, DAI
Associate Directors
Wardens
PRISON HEALTH CARE SERVICES
Memorandum (facisimile)
To: Health Care Managers
Chief Medical Officers
Directors of Nursing
Health Information Services Supervisors
From: Dwight Winslow, M.D., Chief Physician Executive,
California Prison Health Care Services
Subject: RELEASE OF PATIENT-INMATE HEALTH INFORMATION
This memorandum and attached procedure is being issued to clarify the California Prison Health Care Services (CPHCS) requirements concerning the release of a patient-inmate's health care information.
As you are aware, the relase of a person's health information is a serious matter due to the confidential/privileged nature of the information. The release of health information is the responsibility of health care staff, not custody.
Please see the attached procedure entitled "Release of Patient-Inmate Health Information" and supporting forms and documents. The attached procedure needs to be shared with inmates; their friends and families so please do the following at each institution:
Identify a specific person and phone number for people to call to request a patient-inmate's health information.
Post the contact phone number in the inmate visitor's rooms.
Share the attached procedure with the Men's/Women's Advisory Councils.The implementation date for this procedure is no later than January 30, 2009. Should you have any questions or concerns, please contact your appropriate regional leader.
Attachments:
Release of Patient-Inmate Health Information Procedure
CPHCS Form 7385 Authorization for Release of Information
CDCR Form 7421 Advance Health Care Directive
Inmate Fact Sheet, Authoriztion for Release of Informationcc: Terry Hill, M.D., Chief Executive Officer
Tim Rougeux, Chief Operating Officer
Betsy Chang-Ha, Chief Nurse Executive
Karen Rea, Director of Nursing Operations
Regional Medical Directors
Regional Directors of Nursing
Regional Administrators
Suzan Hubbard, Director, DAI
Associate Directors
Wardens
P.O. Box 4038 Sacramento, CA 95812-4038
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2. INMATE FACT SHEET
(We encourage you to print this out and send it to your loved one, in case she has not received the information.)
2. INMATE FACT SHEET
(We encourage you to print this out and send it to your loved one, in case she has not received the information.)
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INMATE FACT SHEET CPHCS Form 7385 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION WHAT You have the right to have your health information shared with people and organizations of your choice.You have the right to restrict the health information that is shared.
If you choose not to complete CPHCS Form 7385, your health information WILL NOT be released to your family or representative.
WHEN A health care staff member will counsel you regarding your right to complete CPHCS Form 7385, aslo known as the
"Authorization for Release of Information":  During the health care staff/patient appointment that takes place within 14 days of your arrival at an institutionUpon admission into a healthcare housing setting, e.g., CTC, OHU, GACH, HospiceAt clinic appointments
You may change or cancel your CPHCS Form 7385 at any time.
WHERE Request a CPHCS Form 7385 from institution medical records or any CPHCS medical clinic, CTC, hospice or hospital.
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3. POLICY and PROCEDURE
(for CPHCS 'RELEASE OF PATIENT-INMATE HEALTH INFORMATION')
(for CPHCS 'RELEASE OF PATIENT-INMATE HEALTH INFORMATION')
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CALIFORNIA PRISON HEALTH CARE SERVICES Plata Support Division Office of Procurement Services |
Policy and Procedure # _______:
Approval Date:
RELEASE OF PATIENT- INMATE HEALTH INFORMATION |
I. PURPOSE:
This document is being issued to clarify California Prison Health Care Services (CPHCS) procedures concerning the release of a patient-inmate's health care information.
II. DIRECTIVE AND OBJECTIVE:
Patient-inmates have a fundamental right to authorize the release of their medical information. Patients may elect to have all, or portions, of their health records released to persons or organizations of their own choosing. One reason patients may choose to release their medical record is to ensure that family members or other authorized persons are able to receive updates on a patient's medical condition.
CPHCS Form 7385 documents a patient's desires regarding the release of medical information. Health care staff shall inform patients of the option to release medical information and shall provide patients the opportunity to complete a CPHCS Form 7385 at the following times:
During the initial health care screening that takes place within 14 days of the patient's arrival at an institution.
Upon admission to a health care housing setting, such as a Correctional Tratement Center (CTC), Outpatient Housing Unity (OHU), Hospice, or CPHCS general acute care hospital (GACH).
Patients can elect at any time to complete, amend and/or rescind a CPHCS Form 7385.
A. CPHCS FORM 7385 and CALIFORNIA ADVANCE HEALTH CARE DIRECTIVE FORM 7421
Patients may also elect to complete a "California Advance Health Care Directive" in which the patient may appoint a Power of Attorney for Health Care to make health care decisions for them. The California Advance Health Care Directive only becomes effective if the patient becomes incapable of making health care decisions for him/herself, unless the directive stipulates otherwise. As such, appointing a Power of Attorney for Health Care in the California Advance Care Directive form differs from CPHCS Form 7385 in two ways:
The CPHCS Form 7385 authorizes the release of the patient's haelth care information immediately rather than upon the incapacitation of the patient; and
The CPHCS Form 7385 permits the release of the patient's health care information but does not grant decision-making authority to the person receiving medical information.
The California Advance Care Directive form allows a person to appoint an agent with Power of Attorney for Health Care and state instructions for future healthcare decisions.
Because the California Advance Health Care Directive Form and CPHCS Form 7385 accomplish separate goals, patients must be given the opportunity to fill out both forms. Both these forms can be found in the Law Library, clinic offices and in each healthcare setting, i.e., CTC, OHU, Hospice, and GACH.
III. PROCEDURE:
A. The patient's written authorization is required for any release of medical information to family members or other designees, as permitted by law.
B. To authorize the release of medical information, the patient must complete a CPHCS Form 7385. The CPHCS Form 7385 is used to authorize the release of medical information to persons both listed and not listed on a patient's CDCR Form 127, Notification of Inmate Death or Serious Illness, which is located in his/her C File.
C. The CPHCS Form 7385 along with instructions on how to complete it can be obtained from the Law Library and any healthcare clinic. The patient can contact the clinic staff for help in completing the form and shall not be charged a copayment for this assistance. Once completed, the CPHCS Form 7385 can be given to clinic staff or forwarded to Health Information Services (HIS) for inclusion in the patient's Unit Health Record (UHR).
D. Any CPHCS Form 7385 authorization can be updated, changed, or revoked by written request of the patient at any time. All updates and/or changes must be sent to the HIS for inclusion into the UHR.
E. Verbal requests, including telephone inquiries, from the patient's family members and friends for confidential patient health information shall be referred to the HIS Supervisor or designee. The request must specify the requestor's name, relationship to the patient, and telephone number where they may be reached during regular business hourse, and must give the patient's full name and CDCR identification number.
F. The HIS Supervisor, or designee, shall retrieve all messages (including telephone messages) requesting medical information, once a day and shall check the UHR for signed authorization for each specific requestor.
G. If there is no authorization on file for the person requesting medical information, the HIS Supervisor, or designee, shall return the call within one business day and explain the procedure necessary to release information as stated above.
H. If there is a signed authorization for that person, the HIS Supervisor, or designee, shall discuss with the Chief Physician and Surgeon or Chief Medical Officer in order to appoint the appropriate person to return the call. Calls shall be returned within one business day.
I. Inmate fact sheets (see SECTION 2. above) are to be distributed to all inmates during admission/placement into any CDCR healthcare setting, including CTC, Hospice, GACH, and OHU by the medical staff. Inmate fact sheet copies also must be displayed in all CDCR healthcare settings, including Clinics, CTCs, Hospices, GACH, and OHU.
J. When verbally releasing medical information, the HIS Supervisor or designee must ensure that only the specific medical information that the patient has authorized to be released is given. No non-medically related information may be released. Specifically, information regarding the patient's location shall not be given by health care staff.
K. The decision to disclose patient health related information shall be in compliance with federal laws and requirements, state statutes and regulations, and CPHCS policies and procedures.
IV. REFERENCES:
Health Insurance Portability and Accountability Act (HIPAA); California Code of Regulations (CCR), Title 22, Sections 79803, Health Record Services, and 79807, Inmate-Patient Health Record Availablity; California Department of Corrections and Rehabilitation (CDCR), Health Care Services Division (HCSD), Inmate Medical Services and Procedures (IMSPP), Volume 6, Chapters 36-42, inclusive.
V. APPROVAL AND REVIEW:
This procedure was approved by the Chief Physician Executive, California Prison Health Care Services and shall be reviewed annually.
VI. RESPONSIBILITY:
The HIS Supervisor, or designee, is responsible for reviewing and processing requests for the release of information. The Health Care Manager (HCM), or designee, is responsible for releasing medical information to authorized people as permitted by law.
The health information will only be released once patients have authorized the release of their private medical information by filling out a CPHCS Form 7385 (Release of Inmate Health Information) and/or the California Advance Care Directive Form.
Reviewed and Approved By:
Chief Physician Executive, California Prison Health Care Services:
Dwight Winslow, MD, 12/23/08
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4. Link to Form 7385 (Authorization for Release of Health Information)
Click button to download Form 7385 'Authorization for Release of Health Information'.
Sample Form Only!!!
5. Link to Form 7421 (Advance Health Care Directive) PENDING
Pending Pending Pending
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Return to VSPW HomePage
Return to CIW HomePage
This document is being issued to clarify California Prison Health Care Services (CPHCS) procedures concerning the release of a patient-inmate's health care information.
II. DIRECTIVE AND OBJECTIVE:
Patient-inmates have a fundamental right to authorize the release of their medical information. Patients may elect to have all, or portions, of their health records released to persons or organizations of their own choosing. One reason patients may choose to release their medical record is to ensure that family members or other authorized persons are able to receive updates on a patient's medical condition.
CPHCS Form 7385 documents a patient's desires regarding the release of medical information. Health care staff shall inform patients of the option to release medical information and shall provide patients the opportunity to complete a CPHCS Form 7385 at the following times:
During the initial health care screening that takes place within 14 days of the patient's arrival at an institution.Upon admission to a health care housing setting, such as a Correctional Tratement Center (CTC), Outpatient Housing Unity (OHU), Hospice, or CPHCS general acute care hospital (GACH).Patients can elect at any time to complete, amend and/or rescind a CPHCS Form 7385.
A. CPHCS FORM 7385 and CALIFORNIA ADVANCE HEALTH CARE DIRECTIVE FORM 7421
Patients may also elect to complete a "California Advance Health Care Directive" in which the patient may appoint a Power of Attorney for Health Care to make health care decisions for them. The California Advance Health Care Directive only becomes effective if the patient becomes incapable of making health care decisions for him/herself, unless the directive stipulates otherwise. As such, appointing a Power of Attorney for Health Care in the California Advance Care Directive form differs from CPHCS Form 7385 in two ways:
The CPHCS Form 7385 authorizes the release of the patient's haelth care information immediately rather than upon the incapacitation of the patient; andThe CPHCS Form 7385 permits the release of the patient's health care information but does not grant decision-making authority to the person receiving medical information.The California Advance Care Directive form allows a person to appoint an agent with Power of Attorney for Health Care and state instructions for future healthcare decisions.Because the California Advance Health Care Directive Form and CPHCS Form 7385 accomplish separate goals, patients must be given the opportunity to fill out both forms. Both these forms can be found in the Law Library, clinic offices and in each healthcare setting, i.e., CTC, OHU, Hospice, and GACH.
III. PROCEDURE:
A. The patient's written authorization is required for any release of medical information to family members or other designees, as permitted by law.
B. To authorize the release of medical information, the patient must complete a CPHCS Form 7385. The CPHCS Form 7385 is used to authorize the release of medical information to persons both listed and not listed on a patient's CDCR Form 127, Notification of Inmate Death or Serious Illness, which is located in his/her C File.
C. The CPHCS Form 7385 along with instructions on how to complete it can be obtained from the Law Library and any healthcare clinic. The patient can contact the clinic staff for help in completing the form and shall not be charged a copayment for this assistance. Once completed, the CPHCS Form 7385 can be given to clinic staff or forwarded to Health Information Services (HIS) for inclusion in the patient's Unit Health Record (UHR).
D. Any CPHCS Form 7385 authorization can be updated, changed, or revoked by written request of the patient at any time. All updates and/or changes must be sent to the HIS for inclusion into the UHR.
E. Verbal requests, including telephone inquiries, from the patient's family members and friends for confidential patient health information shall be referred to the HIS Supervisor or designee. The request must specify the requestor's name, relationship to the patient, and telephone number where they may be reached during regular business hourse, and must give the patient's full name and CDCR identification number.
F. The HIS Supervisor, or designee, shall retrieve all messages (including telephone messages) requesting medical information, once a day and shall check the UHR for signed authorization for each specific requestor.
G. If there is no authorization on file for the person requesting medical information, the HIS Supervisor, or designee, shall return the call within one business day and explain the procedure necessary to release information as stated above.
H. If there is a signed authorization for that person, the HIS Supervisor, or designee, shall discuss with the Chief Physician and Surgeon or Chief Medical Officer in order to appoint the appropriate person to return the call. Calls shall be returned within one business day.
I. Inmate fact sheets (see SECTION 2. above) are to be distributed to all inmates during admission/placement into any CDCR healthcare setting, including CTC, Hospice, GACH, and OHU by the medical staff. Inmate fact sheet copies also must be displayed in all CDCR healthcare settings, including Clinics, CTCs, Hospices, GACH, and OHU.
J. When verbally releasing medical information, the HIS Supervisor or designee must ensure that only the specific medical information that the patient has authorized to be released is given. No non-medically related information may be released. Specifically, information regarding the patient's location shall not be given by health care staff.
K. The decision to disclose patient health related information shall be in compliance with federal laws and requirements, state statutes and regulations, and CPHCS policies and procedures.
IV. REFERENCES:
Health Insurance Portability and Accountability Act (HIPAA); California Code of Regulations (CCR), Title 22, Sections 79803, Health Record Services, and 79807, Inmate-Patient Health Record Availablity; California Department of Corrections and Rehabilitation (CDCR), Health Care Services Division (HCSD), Inmate Medical Services and Procedures (IMSPP), Volume 6, Chapters 36-42, inclusive.
V. APPROVAL AND REVIEW:
This procedure was approved by the Chief Physician Executive, California Prison Health Care Services and shall be reviewed annually.
VI. RESPONSIBILITY:
The HIS Supervisor, or designee, is responsible for reviewing and processing requests for the release of information. The Health Care Manager (HCM), or designee, is responsible for releasing medical information to authorized people as permitted by law.
The health information will only be released once patients have authorized the release of their private medical information by filling out a CPHCS Form 7385 (Release of Inmate Health Information) and/or the California Advance Care Directive Form.
Reviewed and Approved By:
Chief Physician Executive, California Prison Health Care Services:
Dwight Winslow, MD, 12/23/08
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4. Link to Form 7385 (Authorization for Release of Health Information)
Click button to download Form 7385 'Authorization for Release of Health Information'.
Sample Form Only!!!
5. Link to Form 7421 (Advance Health Care Directive) PENDING
Pending Pending Pending
Return to Top
Return to VSPW HomePage
Return to CIW HomePage