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PDF Editor FAQ

My psychiatrist is leaving the hospital to another hospital should I follow up with him? But also my psychologist has to be changed as she is still in the same hospital. So what should I do who is more important?

This is something to decide based on the quality of care each has offered you, how much you rely on meds versus counseling, how successful you feel each respective method has been for you, and other factors like that.It is something you should discuss with both of them before making a decision, especially because one might have better replacements in mind if you absolutely have to switch at least one of them.Having a doctor who is both competent and understanding of your personal history (with illness as well as treatment) is ideal, and I suggest seeing your new practitioner before you no longer have access to the professional he or she is replacing so you can begin the process of mutual familiarizing while still having the resources of their predecessor available to you in the short term.Make sure your records are transferred in full (you will have to sign a HIPAA release form, if you are in the US), and have a conversation with your new doctor(s) about their treatment philosophies and how they might apply to what they have read from your records.

Can a person’s medical records be subpoenaed? Or is that information protected like attorney-client privilege?

Yes, and yes (sort of).The courts, or state legislatures in many cases, have recognised a longstanding physician-patient privilege that does work similarly to the attorney-client privilege, although it isn’t quite as absolute and has been questioned by some policy advocates.¹ It has been supplemented by other legislation that dictates a duty of confidentiality, such as the “Health Insurance Portability and Accountability Act of 1996” also known as HIPAA, that requires medical providers to have safeguards on the disclosure of “protected health information” as that concept is defined in the statute. However, confidentiality is not the same as privilege, and HIPAA contains an explicit exception for records that are to be produced by court order.²In general, the person in whose favour the privilege works may object to the production or admission of privileged evidence. In other words, privileged evidence is inadmissible in the ordinary circumstance. Privilege is for the benefit of the client, not the professional.³ Privilege is said to exist in order to foster unhindered communication between people in order to obtain proper professional service, so the privilege only attaches to communications made in furtherance of that goal. The professional who received the privileged communication may also object to to being asked to furnish the information, but this objection will be overruled if the patient/client consents to the disclosure or if good cause not to honour the privilege is found.In other situations, privilege may be deemed waived, even without the consent of the client. In a legal malpractice action, for instance, the plaintiff loses any expectation of privilege between them and their ex-lawyer defendant—it is not appropriate to put the substance of the representation at issue and then preclude the defendant from offering their own side of the story. In a medical malpractice action, the same. If attorney’s fees are claimed as a form of relief, some evidence of the amount of fees incurred would be needed and thus billing records, otherwise privileged, might be discoverable by the defendant.⁴ Likewise, medical records may be relevant, especially in negligence or other civil cases in which a plaintiff puts a personal injury claim at issue—after all, the extent of the injury and its causation are critical elements to such a claim—but also occasionally in family cases where earning capacity or ability to take care of children is an issue.⁵ If the court finds the privilege inapplicable, the information may be used at trial like any other relevant evidence.Thus, the answer to the question as broadly stated is yes, medical records—or, for that matter, attorneys’ files—can be subpoenaed.⁶ If potentially privileged or confidential information is subpoenaed, both the party whose information it is and the provider subject to the privilege would be granted standing to seek what is called a protective order—an order either quashing the subpoena, imposing limitations on the scope of the information sought, or requiring that the production be done in a confidential way that preserves legal privilege later, or some combination of the above.⁷ In the event someone filed a motion to quash or for a protective order or a motion in limine,⁸ the court would rule on the question prior to requiring the evidence be produced or allowing its use in the case.So while physician-patient privilege does usually exist, it’s not always preclusive of the use of medical evidence, and while other methods of obtaining this information can be and are used when necessary, it is possible to subpoena medical records, at least in the United States⁹ As usual, for advice relating to a specific case, local legal advice is essential.Notes:¹ For more on the history of the privilege, see this article: https://scholar.smu.edu/cgi/viewcontent.cgi?article=3315&context=smulr² 45 C.F.R. § 164.512(e). 45 CFR 164.512 - Uses and disclosures for which an authorization or opportunity to agree or object is not required.³ Notably, privilege is a narrower concept than “confidentiality,” see also these answers:https://www.quora.com/Do-judges-lawyers-and-legal-community-applaud-if-a-defense-attorney-reveals-his-clients-privileged-information-to-prevent-the-client-from-receiving-a-lesser-sentence-than-he-deserved-and-ensure-justice/answer/John-GragsonJohn Gragson's answer to If you are a friend and and a client of a lawyer, does attorney client privilege still applied when you are socialing among friends at a gathering?John Gragson's answer to Is an attorney allowed to break client confidentiality when making a plea bargain for themself?However, privilege may also be compromised in order to avoid a greater harm. An attorney or physician may reveal a privileged communication in order to prevent imminent harm to the client/patient or to a third party, for instance. Medical providers may even be mandated reporters in cases of child or family abuse. That is presumably not the situation presented by this question, though.⁴ See also John Gragson's answer to Is it part of the discovery process for opposing counsel to ask for all "attorneys fees paid out to date"?⁵ We see this a lot in the child support cases that are my primary line of work—people claim that they are “medically unable to work” and thus should be excused form paying support. Although this provision is not often invoked, we did have one case where the physician in question was summoned for a deposition. See Pa. R.C.P. No. 1910.29(b). 231 Pa. Code Rule 1910.29. Evidence in Support Matters.⁶ Probably more often than not, in pre-trial discovery proceedings, the party seeking the medical records will just demand them from the party whose records they are rather than involving the medical provider. The court may, in that case, if it decides the records ought to be produced, order the party to execute a HIPAA release instead of directly ordering the medical provider to comply. Another device available to parties in this sort of case is the “independent medical examination”—a party seeking to put the opposing party’s medical situation into evidence may move the court for leave to conduct their own examination in lieu of or in addition to obtaining medical records through discovery. If this is found appropriate, the court will direct the respondent to cooperate with a medical professional engaged by the movant.⁷ Cf. Fed.R.Civ.P. 26(c); most states have equivalent local provisions. I discussed Rule 26(c) in John Gragson's answer to If a collection agency is sued for violations of the Fair Credit Reporting Act, does discovery require them to turn over their case notes and recordings of specific telephone conversations? Or can they limit their documents to the debt details only?⁸ A motion to quash is usually filed by the target of a subpoena; a motion for a protective order by the party who owns the information, and a motion in limine is used immediately before trial to obtain a ruling on admissibility of evidence, in this case whether or not privilege exists. The substance of the inquiry would, however, be similar, regardless of how the matter ends up before the judge.

Why is HIPAA relevant to the practice of professional counseling?

It is relevant, and crucial, because it guarantees the privacy of medical records except in a number of specified situations. Your information cannot released except with your express permission, usually in the form of a signed release, and when the information is transmitted to insurers or possible members of the treatment team, it must be done in a secure manner. It protects you with a nationwide law, regardless of who pays for your care, and it is extremely comprehensive.

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