A clinic covered by HIPAA decides what to tell someone who asks about you under its Privacy Rule, the federal privacy rule for health care providers and health plans. The rule treats your family and friends differently from your personal representative. A provider may share your information with family members and friends in some situations. Your personal representative is someone such as a person who can make health care decisions for you under a health care power of attorney, and a provider must generally let your personal representative inspect and receive a copy of the health information it keeps about you. A husband calling about results you could have discussed yourself is asking as family, and you can give the clinic your permission to talk to him.
Why a clinic can refuse your husband when you would have agreed
The clinic can turn him away because the Privacy Rule does not require a health care provider or health plan to share information with your family or friends, unless they are your personal representatives. A provider is allowed to share with family or friends if any one of these holds:
- they are involved in your health care, or in paying for it
- you tell the provider it can share
- you do not object to the sharing
- the provider, using its professional judgment, believes you do not object.
If you do not object, your doctor could talk with the friend who goes with you to the hospital, or with a family member who pays your medical bill, and if you send a friend to pick up your prescription, the pharmacist can assume you do not object to their being given it.
Each of those conditions allows sharing, and none of them requires it, so a clinic that says no is using a choice the rule gives it. On the telephone the staff may have little to base a yes on: you are not there to agree or object, and a voice on the line does not show them who is speaking or whether he helps with your care. A provider may also share when you are not there, if it seems like this would be in your best interest, but the clinic makes that judgment itself, and a caller it cannot identify gives it little to go on.
Your relatives' doctors work under the same rule. Unless you are a relative's personal representative, the relative's clinic has no duty to discuss a diagnosis with you, so when an illness in the family matters to your own care, ask the relative directly (see Medullary thyroid cancer in the family rules out one weekly injection).
How to let the clinic talk to your husband
Tell the clinic yourself that your husband may be told about your care, because telling a provider it can share your information with family or friends is one of the four conditions, and the one you can meet before he next calls the clinic. Say it at your next appointment, or call the office. Name him, say what he may be told about, such as your test results, your appointments or the treatment you are having, and ask the staff to note the permission in your chart.
Ask, in the same conversation, what he needs to say when he calls the office so the staff can match him to that note. Your permission allows the clinic to talk to him, though the clinic may still say no, so when a particular answer matters to you both, ask the question yourself.
When you are the one who cannot answer
If you are injured and cannot give your permission, a provider may share information with your family and friends if it seems like this would be in your best interest. That judgment decides only what your husband may be told, not who makes decisions for you. Who may decide is set separately, by papers you sign in advance or, without them, by the law of your state.
Those papers are advance directives, legal documents that give instructions for your medical care and only go into effect if you cannot communicate your own wishes. The one that names a person is the durable power of attorney for health care, also called a health care power of attorney. It names your health care proxy, a person who can make health care decisions for you if you are unable to communicate these yourself, and who may also be called your agent or surrogate. If a person can make health care decisions for you using a health care power of attorney, the person is your personal representative.
A provider may choose not to treat a person as your personal representative if it reasonably believes that person might endanger you in situations of domestic violence, abuse or neglect.
With no advance directive in place, and no way to make decisions on your own, the state laws where you live will determine who may make medical decisions on your behalf. That is typically your spouse, your parents if they are available, or your children if they are adults. If you are unmarried and have not named your partner as your proxy, your partner could possibly be excluded from decision-making. To find out the rules in your state, contact your state legal aid office or your state bar association.
What you agree to when you name someone
Naming a proxy gives that person decisions about your care, not only conversations about it, and your proxy can only make decisions for you if you are too sick to make them yourself. Until then your husband cannot make decisions for you under the form, even if you named him, so keep the permission in your chart for the times he calls the clinic while you are well. You set how much your proxy may decide, from a wide range of decisions down to only a few specific ones, and you can also require your proxy to talk with certain family members before making a decision.
Although they can vary by state, common responsibilities of a proxy include:
- deciding the types of medical care, procedures, treatments or services you receive
- identifying your health care providers and where you will receive care
- overseeing information about your physical or mental health and your personal affairs, including medical and hospital records.
Overseeing that information is not the same as deciding about money or the law: a health care power of attorney does not give power to anyone to make legal or financial decisions for you. A living will is a different document: it explains the care you do or do not want, and you are not able to name someone to make health care decisions for you in a living will.
In most states a health care proxy must be age 18 or older, or 19 in Alabama and Nebraska, and in all cases of sound mind. You can change your proxy at any time by filling out a new durable power of attorney for health care form and letting your family and health care team know.
To make the choice official, complete the durable power of attorney for health care form for your state, and read its directions closely, because you may need to have it witnessed or notarized. You can set up advance directives for little or no cost, and a lawyer can help but is not required. Many states have their own free form, and you might find yours by contacting your State Attorney General's office or your local Area Agency on Aging, whose number you can get from the Eldercare Locator, online or at 1-800-677-1116.
Getting the signed form to your doctors and your family
Give copies of the signed form, while you are well, to:
- your proxy, along with the names and contact information for your health care providers
- each of your health care providers, who also need your proxy's name and contact information
- your family members.
If you are in a hospital, take a copy with you and tell all the medical staff involved in your care about it.
Review it at least once each year, and update it after a major life event such as retirement, moving out of state or a significant change in your health. Whenever you change it, give the new copy to your family, your proxy and your providers.
If NicoCares arranges your weight care, your messages with your care team run through Spruce Health. Write to the team there to say who may be told about your care, ask whether they can share anything with that person and how he should get in touch, and send your proxy's name and contact information if you have named one.
