As with many things HIPAA, I suspect that it will depend on the circumstances and to whom the disclosures are made. I see three ways in which the information may be disclosable.
1. It seems pretty clear that a covered entity can disclose PHI to fulfill an obligation under a reporting law (e.g. certain wounds like gun shot wounds must be reported, and there may be mandatory reporting for suspected perscription drug abuse)but it would have to be reported to the entity required under the law or covered under the public health authority or perhaps health oversight provisions. 164.512(a)(b)(d). 2. As was noted, covered entities are allowed to respond to judicial or administrative proceedings (e.g. subpoena) and, with limitations to law enforcement, so the same information could be given to such entities in response to the appropriate request or perhaps, if the activity is criminal, under the reporting of a crime on premises provision. 164.512(c)(f). 3. Finally, under the treatment provisions, the information can probably be disclosed to other providers. Treatment includes provision, coordination, or management of health care and related services by one or more health care providers, including coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or referral...164.501. Covered Entities may use or disclose PHI for its own treatment; or for treatment activities of a health care provider. 164.506(c). Further, minimum necessary rules don't apply to disclosures by a health care provider for treatment. So in the case below, I think a pharmacy could notify appropriate authorities if there are mandatory reporting requirements or public health procedures to do so, and may be able to report it law enforcement under the "crime on premises" provision if the covered entity thinks the information constitutes evidence of a crime. I also think under the pharmacy can communicate with physicians and other pharmacists that are involved in the persons care to ensure it is providing appropriate treatment services before dispensing or refilling medication (in this case appropriate drug amounts, no interactions, etc). The pharmacist could also probably contact a public agency that maintains information on "drug seekers" and see if this person has any history prior to dispensing medication under the provision related to its own treatment. Finally, the pharmacist could also respond to an inquiry from another provider about the individual under the treatment provision. The questions start to come in about whether the pharmacy can disclose PHI, basically unsolicited, to an entire group of providers in a community that may or may not have any treatment relationship with the individual. When you read the treatment definition (provision, coordination or management of care), and the permissible disclosure (either for the CE's own treatment purposes of for another provider's treatment purposes) it appears that this could be justified, and since minimum necessary doesn't apply, any information could be included. On this last issue though, from a personal standpoint, it seems to run counter to protecting health information, if any provider can simply decide that in their opinion someone is receiving too much medication or is trying to buy drugs for illicit purposes, etc. and because of that, they can broadcast any PHI to any or all providers in a given community (or state, or?). Regards, lhc Leah Hole-Curry, JD FOX Systems, Inc. 602.708.1045 Information transmitted is confidential and may be proprietary to FOX Systems, Inc. It is intended only for the person or entity to which it is addressed. Anyone else is prohibited from disclosing, copying, or disseminating the contents or attachments. If you receive this in error, please notify sender immediately, or us at www.foxsys.com and delete from your system. >>> "Rebekah Savoie" <[EMAIL PROTECTED]> 01/15/03 12:48 PM >>> Today, a clinic that I work with received a letter from a local pharmacy about a patient that was a "Drug Seeker" as we call them. Over the course of 30 days he had been to several doctors and several pharmacies and received over 350 total pills all a controlled substance. What happens to the pharmacy's ability to do these types of things under Privacy? Clearly, pharmacist were communicated information back and forth to each other and to physicians on this person. They even sent letters to all physicians in the area. Problem? yes or no Rebekah Savoie, CCS-P Healthcare Consultant --- The WEDI SNIP listserv to which you are subscribed is not moderated. 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