[ Tuesday, March 04, 2008 ]


Another reader question:

I recently brought my daughter to the emergency room. They gave me several
forms to sign. One form stated "Please sign below to acknowledge that you HAVE
RECIEVED...." and basically listed the Hipaa statement and the Patient Bill of
Rights. The young woman was trying to force me to sign and never gave me the
information. When I told her that she hadn't given them to me she said "Don't
worry about it". I refused to sign until she provided the documents. One month
later my son had surgery. Much the same scenario, same hospital name, but in a
different buidling in a different part of town. Again, I refused to sign until
they provided the documents. It took them half an hour to provide me with the
HIPAA statements. I recieved the other form prior to leaving the hospital a
while later. They told me that they never gave the documents to anyone. The
admissions clerk who handled us said that she had NEVER even SEEN those
documents before even though she was trying to force me to sign the documents
before my son could have his surgery. The surgeon eventually made them bring my
son back without signed documents.

So here are the questions: 1.) Are the hospitals required to provide
the Hipaa privacy rule etc during the admissions process? 2.) Can they refuse
treatment if I refuse to sign the documents on the basis that they are forcing
me to sign a document stating that I have recieved the HIPAA information, when
in fact I haven't.

Thank you,

Sick of IT.

Answer: I don't think the IT department had anything to do with this, so don't be sick of them. Covered entities like hospitals are supposed to provide patients (or in cases like this where the patient is a minor, the patient's representative) with a copy of a document called their "Notice of Privacy Practices," or NoPP. There are specific requirements in HIPAA about what has to be in the NoPP, and most of them look pretty much the same. The NoPP is designed to inform the patient of the basic uses and disclosures the covered entity will make (with some specific examples), the patient's rights, and other general information, such as who to contact in case of a complaint. The covered entity is required to get the signature of the patient (or representative) on a receipt indicating that he/she received the NoPP. That's what they were asking you to sign.

Frankly, there's a lot of wasted paper in handing out NoPPs, so some covered entities keep reusable copies that they allow patients to review before signing the receipt; the covered entity then keeps the reusable copy for the next patient. If the patient wants to keep a copy, the covered entity will usually have extra take-home versions of the NoPP to provide the patient. Since most patients don't even read the NoPP, much less want extra paperwork to take with them, this is a good system (saves money, saves paper waste, etc.).

But I've never heard of a covered entity not actually letting the patient see the NoPP prior to signing a receipt. I'd guess the clerk didn't know what he/she was doing. You should have a copy to review, and a copy to keep if you want it, before signing the reciept. The covered entity can't refuse to treat you for not signing a receipt, even if you get a copy of the NoPP (the covered entity is only required to use good faith efforts to get the receipt signed, and isn't punished if the patient unreasonably refuses to sign). And generally, a covered entity can't refuse treatment to a patient simply because the patient is exercising his/her HIPAA rights, or refuses to sign an authorization (unless the authorization is necessary, such as in connection with participating in a research study).

Jeff [10:39 AM]

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