Lecture 2 - PHIA Scenarios

Question 1

What is a trustee (4 types)?

Answer 1

• Health care professional who is licensed or registered to provide health care
• Health care facilities
• Health service agencies
• Public bodies (government, educational institutions, regional health authorities)

Question 2

Who can be declared an information manager (4)?

Answer 2

• Someone hired by a trustee to process, store, or destroy PHI
• Someone who manages IST
• Employees of a trustee
• Manages 3rd party plans

Question 3

Who has access to PHIA (3)?

Answer 3

• Individuals themselves
• Trustee
• Someone with written authorization to access (power of attorney, written/verbal consent)

Question 4

A patient storms into the pharmacy insisting that you made a mistake on his prescription that was picked up yesterday. You review the prescription and determine that it was filled incorrectly. He wants the original prescription back to take to a different pharmacy next time. Can you give the patient back his prescription?

Answer 4

• No because once it has been filled it is the pharmacies property
• You are able to transfer and cancel the prescription

Question 5

Under what circumstances can you refuse to let an individual examine his/her own personal health information/prescription?

Answer 5

If it will cause them harm

Question 6

A person phones asking what a certain medication is used for, the side effects and if there are any interactions with alcohol. You determine that the medication is for a “friend.” Are you able to provide this information to the person on the phone?

Answer 6

No, unless the friend gives written or verbal consent

Question 7

You are working in a pharmacy and a police officer approaches you at the counter. The police officer tells you that Jane Doe has been reported missing by her husband. The police officer has tracked her credit card use to your pharmacy and would like to know what she has listed as her current address. Can you give the police officer the address?

Answer 7

No, unless there is a warrant or the person is in danger

Question 8

Martin’s father is a regular patient of your pharmacy. His father is being placed in a nursing home this afternoon. The personal care home requires a copy of all his medications so Martin has come in today to ask you to prepare a list of his Dad’s medications. Can you provide Martin with a list of medications? What other method can the nursing home use to obtain this information?

Answer 8

• Only if he was power of attorney or written/verbal consent from his father
• Nursing home could call the pharmacy

Question 9

Bob comes into the pharmacy to request a print out of all his family members’ prescription expenses for income tax purposes. His family members include his spouse, a 16 year old daughter, a 6 year old son and the family dog. Are you able to provide Bob with the medication printouts for his entire family?

Answer 9

• Spouse – no because they can obtain it themselves
• Daughter – no because under PHIA a child is considered an adult at 14, so she would be able to obtain the records herself
• Son – yes because he is not considered an adult
• Dog – yes because he doesn’t have any rights under PHIA

Question 10

Jane Smith is on the phone stating that she has been given the wrong prescription. She was in earlier and did not realize until she was home that the name on the prescription is June Smith. She is very upset and wants to know if June Smith has her prescription. How can this error be resolved? Do you tell the other person that their prescription was given to someone else?

Answer 10

• Apologize and admit you made a mistake

- YES!

Question 11

Nelly, an elderly patient of yours, has a difficult time getting around with her sore hip. She phoned you today to ask you if her son could pick up her prescriptions during the winter months and until she is able to walk better. Are you able to let the son pick up his mothers prescriptions with verbal confirmation? What is the correct procedure required to implement this request?

Answer 11

• Yes

- Put a note on her file so the other works know as well

Question 12

Jim, the husband of a close friend of yours, has come to the pharmacy to buy a pregnancy test. You are excited that your friend may be pregnant and you want to call her after your shift is over. Is it a breach of PHIA if you call your friend to find out if the test is positive? Are you breaching PHIA if another customer overhears your conversation with Jim and calls his wife to congratulate her?

Answer 12

• Yes

- Not if there was no way of preventing it

Question 13

An elderly patient of yours recently passed away and his wife has come by the pharmacy to request a print out of her deceased husband’s expenses for tax purposes. Would you be able to provide the requested information to the widow?

Answer 13

Only if she can prove he is deceased, with a death certificate for example

Question 14

Sally, the wife of Tom (Tom is a diabetic patient of yours), is shopping in the cough & cold section at your pharmacy. There is a diabetic clinic coming up at your pharmacy and you would like Tom to attend the clinic. Can you ask Sally to tell Tom about the clinic? Why or why not? What is the best way to notify Tom or other patients of upcoming clinics?

Answer 14

• No
• She may not know he is diabetic
• Bag stuffers, phone call

Question 15

Whenever you make a phone call and there is no answer, can you leave a message?

Answer 15

No because of privacy purposes

Question 16

A merchandiser/security guard catches a shoplifter in your store. The shoplifter ran away but is well known to the merchandiser as a regular customer of the pharmacy. You are asked to provide the address and phone number of the shoplifter so that the police can be called and charges laid. Are you able to provide this information? How would you handle this situation?

Answer 16

• No because it is personal information

- Call the police and get a warrant

Question 17

Sherry, the daughter of Mary (an elderly patient of yours), wants you to deliver Mary’s medication to her house rather than directly to her mom’s house from now on. Mary has Alzheimer’s and has been taking her medications incorrectly lately. Sherry wants to help her mom by organizing the medications into a weekly dosette. Can you deliver Mary’s prescription to Sherry’s house? When would implied consent be considered?

Answer 17

• Yes, if she has power of attorney

- If verbal consent is given or if daughter brings in prescription

Question 18

A nurse from the emergency department phones you at the pharmacy asking what medications a patient from your pharmacy is currently taking. The patient has been brought into emergency and did not bring their list of medications with them. Would you provide the information to the nurse?

Answer 18

Yes because they are a trustee

Question 19

When would you not be able to provide information to another health care professional?

Answer 19

If it isn’t their patient

Question 20

Your friend, who is also a pharmacist, stops by to ask a favor. He and his wife have just separated and he is concerned that she is acting strange around the children at times. He is concerned about their safety and wants to know what medications she is on. Are you able to provide this information to your friend the pharmacist?

Answer 20

No because it is not his patient

Question 21

The daughter of an 87 year old resident of a personal care home phones the floor to obtain information about her fathers health and medications. Is the nurse on the floor able to provide this information to the residents daughter?

Answer 21

Only if she is power of attorney or the nurse has proof of verbal or written consent

Question 22

Define express consent

Answer 22

Explicit, clear, and direct and is given either verbally, in writing or electronically

Question 23

Define implied consent

Answer 23

When a health care custodian assumes the individual would agree to the use of PHI through signs, actions, or inaction by the person