PRINCIPLE 1A. AVAILABILITY AND ACCESSIBILITY
The doctor of chiropractic should make himself/herself available, but more importantly, be accessible to patients in need of his/her professional services. The doctor of chiropractic shall, to the best of his/her ability and immediate circumstantial limitations, render all possible assistance to any patient(s) in emergency health care situations. Except in emergency situations, a doctor of chiropractic has the right to accept or reject a particular patient.
PRINCIPLE 1B. CONFIDENTIALITY
The doctor of chiropractic is obliged to keep the trust and confidence of the patient and the patient's family. The following rules should be adhered to:
- The doctor of chiropractic shall not discuss patient information with one patient about another patient.
- The doctor of chiropractic shall not discuss any patient information with relatives or friends of the patient without the consent of the patient, preferable in writing.
- The doctor of chiropractic shall not discuss any patient information with visitors to the office or hospital.
- Patient information should not, under any circumstances, be discussed with the news media without written patient consent.
- The doctor of chiropractic shall not discuss patient information with other employees, except in conference and/or consultation. Discussion about patients should be avoided in patient areas. A patient's privacy should be respected at times. When consulting another doctor of chiropractic or health care provider, it should be done privately and out of range of the patient's hearing.
- The doctor of chiropractic shall not discuss patient information with his/her own relatives or friends.
- The doctor of chiropractic shall not discuss any patient information over the telephone with anyone without the patient's consent, preferably in writing.
MEDICAL/HEALTH RECORDS
The Joint Commission on Accreditation of Hospital (JCAH) Stipulates the following minimum standards in assessing hospital accreditation compliance with medical record-taking and confidentiality of the information contained therein. The ICA endorses the JCAH standards in principle:
Medical records are confidential, secured, current, authenticated, legible, and complete.
The medical record is the property of the hospital or clinic and maintained for the benefit of the patient, the medical staff, and the hospital.
The hospital or clinic is responsible for safeguarding both the records and its informational content against loss, defacement, tampering, and from use by unauthorized individuals.
Written consent of the patient or his legally qualified representative is required for the release of medical information to persons not otherwise authorized to receive the information.
Where certain portions of the medical record are so confidential that extraordinary means are necessary to preserve their privacy such as in the care of some psychiatric disorders, these portions may be stored separately, provided that the complete record is readily available when required for current medical care or follow-up, review functions, or use in quality assurance activities.
PRINCIPLE 1C. RELEASE OF CONFIDENTIAL PATIENT RECORDS
The doctor of chiropractic shall comply with a patient's written authorization to provide records or copies of records to individuals the patient designates to inspect or receive all or part of said records. Further, doctors of chiropractic shall abide by general standards for patient records confidentiality and release promulgated by the American Medical Records Association (AMRA). The AMRA standards, listed below, are endorsed by the International Chiropractors Association and henceforth are an integral part of the ICA Code of Professional Ethics:
All requests for health records or health information shall be referred to the health records department of a hospital or clinic.
Release of health information to the patient shall be carried out in accordance with all applicable legal requirements and written institutional policy. A properly completed and signed authorization is required.
Subject only to specific contraindications described below, and to any legal constraints such as those governing minors and those adjudicated as incomplete, a patient or his representative may have access to his own health record for review, upon written request with reasonable notice. A patient may have access to records of his/her care during or after discharge from care. A copy of the requested health information will be provided after completion and upon written request by the patient and payment of a reasonable fee.
The health care provider is not required to permit the patient access to his/her health record if the provider reasonable concludes that:
Knowledge of the health care information would be injurious to the health of the patient, or
Knowledge of the health care information could reasonable be expected to cause danger to the life or safety of any person.
If the health care provider denies a patient's request to see or copy, in whole or in part, his/her health record based on the above grounds, the provider must either:
Provide a summary of the health record, according to the requirements of this section. If the health care provider chooses to prepare such a summary of the record rather than allow access to the entire record, he or she shall make such a summary of the records available to the patient within ten (10) working days from the date of the patient's request. However, if more time is needed because the record is extraordinary in length or because the patient was discharged from a licensed health facility within the last ten (10) days, the health care provider shall notify the patient of this fact and the date that the summary will be completed, but in no case shall more than thirty (30) days elapse between the request by the patient and the delivery of the summary. In preparing the summary of the record, the health care provider shall not be obligated to include information which is not contained in the original record; or
The provider must permit inspection by, or provide copies of, the health record to another health care practitioner who is licensed to care for the same condition as the health care provider and who has been so designated, in writing, by the patient. The health care provider shall inform the patient of the provider's refusal to permit him/her to inspect or obtain copies of the requested records and inform the patient of the right to require the provider to permit inspection by, or provide copies to another health care practitioner who is licensed to care for the same condition as the health care provider and who has been so designated, in writing, by the patient.
In either event, the health care provider shall make a written record, to be included with the health records requested, noting the date of the request and explaining the health care provider's reason for refusing to permit inspection or provide copies thereof, including a description of the specific adverse or detrimental consequences to the patient which the provider anticipates would occur if inspection or copying were permitted.
In the event that the patient wishes to correct data, it shall be done as an amendment, without change to the original entry, and shall be clearly identified as an additional document appended to the original health record at the direction of the patient.
This document shall then be regarded as an integral part of the health record. Upon request of the patient, the provider will furnish copies of the amendment to any person whom the disputed information has been properly released. Whenever health information is requested subsequent to the amendment, the copy sent shall include the amendment.
The provider will make these policies known to patients upon request.
Following authorized release of patient information, the signed authorization will be retained in the health record with notation of the specific information released, the date of release and the signature of the individual who released the information.
RELEASE OF PRIMARY RECORDS
All requests for health records or health information, including requests for information on patients currently under care, shall be directed to the health record department.
Release of information from the health record shall be carried out in accordance with all applicable legal, accrediting, and regulatory agency requirements, and in accordance with written institutional policy.
All information contained in the health records is confidential and the release of information will be closely controlled. A properly completed and signed authorization is required for release of all health information except:
As required by law;
For release to another health care provider currently involved in the care of the patient;
For medical care evaluation; or
For research and education in accordance with conditions specified below.
In keeping with the tenet of informed consent, a properly completed and signed authorization to release patient information shall include at least the following data:
Name of institution that is to release the information
Name of the individual or institution that is to receive the information
Patient's full name, address and date of birth
Purpose or need for information
Extent or nature of information to be released, with inclusive dates of care (Note: An authorization specifying "any and all information..." shall not be honored)
Specific date, event or condition upon which authorization will expire unless revoked earlier
Statement that authorization can be revoked but not retroactive to the release of information made in good faith
Date that consent is signed (Note: Date of signature must be later than the date of information to be released.),and signature of patient or legal representative (Note: In the case of care given to a minor without parental knowledge, the institution shall refrain from releasing the portion of the record relevant to this episode of care when responding to a request for information for which the signed authorization is that of the parent or guardian. An authorization by the minor shall be required in this instance)
Information released to authorized individuals or agencies shall be strictly limited to that information required to fulfill the purpose stated on the authorization. Authorizations specifying "any and all information..." or other such broadly inclusive statements shall not be honored. Release of information that is not essential to the stated purpose of the request is specifically prohibited.
Following authorized release of patient information, the signed authorization will be retained in the health record with notation of the specific information released, the date of release and the signature of the individual who released the information.
Health records shall be available for use within the facility for direct patient care by all authorized personnel as specified by the chief executive officer and documented in a policy manual.
Direct access to health records for routine administrative functions, including billing, shall not be permitted, except where the employees are instructed in policies on confidentiality to penalties arising from violation.
Health records shall be made available to authorized students enrolled in educational programs affiliated with the institution. Students must present proper identification and written permission of the instructor with their request. Data compiled in educational studies may not include patient identity or other information which could identify the patient.
Health records shall be make available for research to individuals who have obtained approval for their research projects from an institutional review board or appropriate chiropractic staff committee, administrator or other designated authority. Research projects which involve use of health records shall be conducted in accordance with institutional policies on the use of health records for research. Any research project which involves contact of the patient by the researcher must have written permission of the patient's attending doctor and/or by the chief executive officer of the facility or his/her designee, prior to contact. Institutional policy on use of medical records in research should guide these activities.
If facsimiles of health records are provided to authorized internal users, the same controls will be applied for return of these facsimiles as for return of the original health record. Wherever possible, internal users will be encouraged to use the original health record rather than obtain a facsimile.
The names, addresses, dates of admission or discharge of patients shall not be released to the news media or commercial organization without the express written consent of the patient or his/her authorized agent.
Requests for health information received via telephone will require proper identification and verification to assure that the requesting party is entitled to receive such information. A record of the request and information released will be kept.
PRINCIPLE 1D. LIMITS OF CHIROPRACTIC CARE
The doctor of chiropractic shall attend to his/her patient as often as is necessary according to his/her professional judgment to ensure the well-being of the patient and continued progress. However, a doctor of chiropractic shall scrupulously avoid unnecessary care.
The doctor of chiropractic shall neither exaggerate nor minimize the gravity of a patient's condition, nor offer any false hope or prognosis. It is also the doctor of chiropractic's duty to acquaint a close friend or relative of a patient who is incapable of caring for himself/herself with the patient's condition, the care being provided and the particular care needed by the patient.
Once committed to serving a patient, a doctor of chiropractic should not terminate his/her professional services without notice, allowing the patient reasonable time to obtain alternative professional services and giving the discharged patient all papers and documents as required by the Professional Code of Professional Ethics.
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