Appendix E

Confidentiality of Information

1. Purpose:
   The purpose of the protection, use, and release of personal information policy is to protect the confidentiality of information of individuals who are blind, visually impaired, and deaf-blind being served by DBVI. The policies and procedures of DBVI for the proper dissemination of information comply with the statutes of the Code of Virginia, Virginia Freedom of Information Act, Government Data Collection and Dissemination Practices Act, and all applicable Federal laws. Any questions concerning policy should be directed to the Vocational Rehabilitation Director.  The Confidentiality of Information applies to all DBVI employees, consultants, affiliates, and volunteers.
2. Policies:  DBVI will comply with all state and federal statutes when releasing any information regarding the clients it serves as follows:
1. Upon written consent of the individual or, if appropriate, the individual's representative, DBVI may release personal information to another agency or organization for its program purposes only to the extent that the information may be released to the involved individual or the individual's representative and only to the extent that the other agency or organization demonstrates that the information is necessary for its program.
2. Medical or psychological information that DBVI determines may be harmful to the individual may be released if the other agency or organization assures DBVI that the information will be used only for the purpose for which it is being provided and that it will not be further released to the individual.
3. Upon the request of the U.S. Secretary of Education or his designee, DBVI shall release to the Governor or his designee a complete and certified copy of the case record including transcripts of the fair hearing decision for the purpose of the Governor's review of the final decision.
4. Personal information obtained by DBVI from another agency or organization may be released only by, or under conditions established by, the other agency or organization.
5. Release for audit, evaluation, and research.  DBVI may release personal information to an organization, agency, or individual engaged in audit, evaluation, or research only for purposes directly connected with the administration of the vocational rehabilitation program, or for purposes that would significantly improve the quality of life for applicants and eligible individuals and only if the organization, agency, or individual assures that the information will be used only for the purposes for which it is being provided;  the information will be released only to persons officially connected with the audit, evaluation, or research; the information will not be released to the involved individual; the information will be managed in a manner to safeguard confidentiality; and, the final product will not reveal any identifying personal information without the informed written consent of the involved individual or the individual's representative.
6. Disclosing information and/or records to adults (18 years old or older), except:
1. When the client has been legally declared as incompetent and the right to access information has been granted to the individual or committee who has been appointed as guardian, authorized agent(s) or representative(s).
2. When the treating physician has written on mental or medical record information such as "confidential" or "In my opinion a review of such records by the patient/client would be injurious to the client's physical or mental health or well-being." The treating physician is the only professional who, by statute, has the authority to label and deny access to a medical or mental record by the client. This does not preclude access to that report by authorized agents or representatives.
3. When the individual is a minor (less than 18 years of age) information can only be released to the parent or guardian.
7. All DBVI staff shall follow procedures to ensure that all records and other personal identifying data are treated as confidential information as follows:
8. No expressed personal or documented information shall be released to a third party without the written, informed consent of the client or his/her authorized agent or by court order.
1. DBVI staff will obtain and document only that information which is necessary to plan and deliver DBVI services.
2. All DBVI staff will acknowledge written requests for information which are identified and occur after a client's application for services.
3. Records are kept in offices unless, in accordance with a court order, statute, or by special authorization from the DBVI Commissioner or designee.
3. Procedures for Disclosing Information:

1.      Each request to disclose information will be handled during normal business hours.

2.      Each written request will receive a response within five working days.

3.      Before a DBVI staff worker releases information to an individual or organization, other than those identified on the access list, a written release must be given by the client or the authorized representative.

4.      Any DBVI worker, who releases information after informed consent is obtained, must document/update the Disclosure List Form (Word) (DBVI-70-012). These statements are also documented when the record has been reviewed by or copied for the client or his/her representative.

4. Accessing Information for Specific Situations:

0.      When client requests a review of his/her case folder:

a.       The individual should be referred to the Regional Manager or his/her designee. This employee is responsible for confirming the client's age and competency status to access information in his/her own behalf.

b.      For those clients who are under age 18 or who have been declared incompetent, the DBVI worker shall explain right-to-access and assist the client by coordinating the desire review with parent or authorized agent.

c.       For clients who have the right-to-access information, the Agency shall obtain the case folder and review contents to learn if there are any mental or medical records which a treating physician has identified as not to be reviewed. These are the only reports which can and must be removed before access.

d.      The Agency may give the client his/her case folder, and the Regional Manager or his/her designee is available throughout the review to interpret reports or to assist the client who may wish to seek additional information regarding contents. The client may choose to review his/her case record without interpretation.

1.      Access by parents/guardians or authorized agents may be obtained:

 .        When a client is a minor or has been legally declared as incompetent, the parent/guardian or authorized agent is expected to furnish personal identification and sign a statement regarding their relationship to the client.

a.       When a client is 18 years or older and there is a parent who wants to review information or accompany the client to a client-oriented meeting, the client must sign a Consent to Release Information Form (Word) prior to disclosure.

2.      Access by "significant others" (other family members or friends):

 .        When a client is a minor or has been legally declared as incompetent, the parent/guardian or authorized agent must give written, informed consent prior to disclosure.

a.       When a client is 18 years or older, he/she shall give written, informed consent prior to disclosure.

3.      Access by third parties:

 .        Unless required by law, no disclosure shall be made to third parties without written, informed consent from the client or the legally authorized representative, or the completion of the Consent to Release Information Form.

a.       Upon disclosure, third parties shall be advised to maintain confidentiality with no redisclosure of information.

b.      Except for public events, no data shall be released to the news media without the written, informed consent of the client or the authorized representative.

c.       No information shall be released to law enforcement officers without the written, informed consent of the client or the authorized agent, or without judicial order.

d.      Audio tapes, video tapes, photographs, computerized data, or other media reproduction are considered as confidential records and shall be treated like written material.

4.      Medical Emergencies:

 .        Telephone and face-to-face disclosure may be made to any person for an emergency when it is reasonable to believe that a delay shall result in serious bodily injury, death, or deterioration of the physical or mental condition of client.
Disclosure can be provided under the following circumstances:

1. An emergency admission or commitment to a hospital
2. An inquiry from an acute-care hospital where data is limited to answers for specific information from the client's case record.
3. An inquiry by law enforcement officials regarding an emergency situation. Information is limited to that which is necessary to deal with the emergency.

a.       When it becomes necessary to release information in these circumstances, the responsible Agency party shall enter the following in the client's case record:

1. The date the information was released.
2. The person to whom information was released.
3. The reason the information was released.
4. The reason written, informed consent could not be obtained.
5. The specific information which was released.
4. DBVI -Disclosures:
   The following information is either required by law, cooperative agreements, or permitted by the mission of the Agency and will be disclosed without the client's permission:

0.      DBVI staff shall be given information which is relevant to case management or research requirements.

1.      The Agency's medical consultants may release information to another physician for consultation or hospitalization purposes.

2.      Organizations and agencies that have cooperative agreements with DBVI can release information according to the terms of those agreements and in accordance with all applicable federal and state laws. Refer to the appropriate Program Manual for a listing of these agreements. For example, the VR Manual has a list of these agreements in Chapter XI.

3.      Court orders and subpoena information by court orders shall be processed by the client's workers unless there is some question about the need for legal advice. In those situations, the Executive Assistant shall decide if contact needs to be made with the Agency's Assistant Attorney General Office prior to compliance. This contact shall be made by the Commissioner's designee.

4.      The Virginia Department of Social Services shall be given, upon written request, information about the location, income, and property of clients who have abandoned, deserted, or failed to support children and their caretakers who are receiving public assistance. No other information may be released.

5.      The Virginia Department of Health shall be given access upon written request to medical records or abstracts in the course of an investigation, research, or studies of diseases or deaths which are of public health importance. Abstracts may include the name, address, sex, race, and any other medical information required by law. Information may also be released, as requested, for a formal investigation to the Virginia Department of Health, State Medical Examiner.

6. Procedure for Changing A Case Folder:

0.      Revoking the release of information consent

 .        When an attorney or an authorized representative has a client sign a release which rescinds all prior releases, then this negates all previous releases. The Agency shall place this in the client's case folder.

a.       When the revocation clause appears in the record, the Agency no longer has the authority to disseminate additional information other than to those on the regular Agency Access List.

b.      If the individual is currently a client, their worker shall record any release which includes a revocation clause. This means that all routines for forwarding reports to those not on the Agency's Access List must be stopped.

c.       The Department shall acknowledge and comply with the attorney's request for information. A separate letter shall also advise the attorney that this clause denies access of information to persons or organizations which are responsible for continuing rehabilitation services. The Agency shall advise attorney of the need to be provided with an additional statement which reinstates the communication and correspondence.

1.      Reinstating consent when a satisfactory statement and new consent is received from attorney and the client, the Agency shall file the new release and inform appropriate Agency counterparts.

2.      Challenging and correcting a record by the client or agent

 .        The client or agent has a right to contest the accuracy or completeness of any personal record, except access to challenging or correcting a treating physician's mental or medical record which has been identified as not to be reviewed by the client.

a.       Individuals who are currently clients shall be instructed by their worker that any request to correct, amend, or delete information is to be done in writing, giving specific reasons why information is being contested.

b.      The counselor shall submit this statement to their immediate supervisor.

c.       Supervisor shall interview staff, as necessary, examine pertinent records, and submit a written recommendation to the appropriate Assistant Deputy Commissioner, Division for Services on his/her findings. This recommendation is to include a statement and rationale to either uphold or to change existing records.

d.      When the Assistant Deputy Commissioner, Division for Services determines that information which is being disputed is, in fact, incomplete, inaccurate, not pertinent, untimely, or unnecessary to be retained, that individual shall instruct the original writer to amend the report in question. If the originator is no longer an employee, the Assistant Deputy Commissioner, Division for Services or a designee shall prepare the amended report. A copy of the amended report shall be sent to the local office for the client's file.

e.       The Agency shall disseminate the amended version of the report to any previous recipients and as part of the record for all further requests.

f.       The Agency shall notify the client in writing of the decision. A copy of that notice is to be filed in the client's local office file.

g.      If the investigation does not change the record or resolve the dispute, the client may file a statement stating that he/she believes to be an accurate or complete version of that information. This statement becomes a permanent part of the record. The Agency shall forward a copy to all previous recipients who have access to the information being disputed.

7. Procedures of Safeguarding (Case Folders:

0.      Maintaining security of case folders

 .        (Client records are the property of the Agency and are entrusted to personnel who safeguard records from loss, defacement, or use by unauthorized persons.

a.       No record is to be defaced by marking, underlining, or entering notations by anyone other than the originator of any document.

b.      When a record is requested, either by court or a directive from the Commissioner, a certified copy of the record shall be provided by the counselor.

c.       Whoever removes records has the responsibility to assure confidentiality of content while it is out. It must never be left unattended in areas which are accessible to unauthorized individuals.

d.      Confidentiality must be maintained in work areas where casework documents are being prepared, filed, or distributed.

1.      Violating confidentiality DBVI staff who violate security standards or the confidentiality code by releasing information without obtaining or following procedures may be subject to their name being removed from the Access List and. to discipline under the Standards of Conduct.

8. DBVI Access List:
   The following have been approved to have access to the case records of clients served by the Agency:

0.      Administrative and supervisory staff engaged in dutiful performance of their job which requires access to individual client files

1.      Service delivery personnel including, but not limited to, rehabilitation counselors, IL coordinators, rehabilitation teachers, intake workers, O&M specialists, PICY workers, volunteer directors, DBVI volunteers, VRCB staff, and clerical personnel.