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Thread Title: Is this a HIPPA violation?
Created On Wed May 07, 2003 9:34 PM


HOPEFULEMT
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Wed May 07, 2003 9:34 PM

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I've got a question. I work at an ambulance service that does both 911 and transfers. While on a scheduled transfer today, my partner and I picked a patient up at the hospital to bring back to the patient's nursing home. The hospital, as usual, gave us an envelope that had the patient's records in it. Also given to us was a face sheet. The envelope was sealed but my partner opened it because we needed information that was only included in the envelope to complete our run sheet. This info. happened to be medications taken, medical hx, and allergies, as well as a DNR. When we got to the nursing home, the nurse practically damned us to heck for opening the envelope. She stated it was a HIPPA violation and that we should have gotten that info. from the patient's nurse at the hospital. I was under the impression that that information was open to any medical professional that was directly caring for the patient which would include me. And what would be the difference between getting that info from the nurse or from the paperwork? It's the same info.

Kelly EMT-B

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And on the 8th day, God created EMTs. And it was good.

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GABRIELA
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Thu May 08, 2003 2:00 AM

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I really dont think that would be a HIPPA violation, once the pt. is in your care, they are YOUR pt. and you can't treat them properly if you dont have all the info, even if it is just a transfer , at least that's what I was taught. It sounds like that particular nurse needs to learn how to deal with people, she should NOT have yelled at you, if she had a problem she should have taken it up with you in a calm manner. I would definately talk to my supervisor if I were you, ask about the HIPPA AND the nurses behavior. It's my guess that she just doesn't see EMT's as medical prof. and feels that they shouldn't know all the facts on a pt., in that case, she should be educated.

Gabi

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Gabi EMT-B

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EOVFD503
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Thu May 08, 2003 7:04 AM

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HOPEFULEMT, y'all did nothing wrong. Appearently the nurse needs to have some inservice on HIPPA regulations. The "minimum necessary" rule limits access to people that have patient care duties, billing, and QA/QI. You have full access to that pt info since you had pt care duties. Knowing that information was impairative for good pt care (esp. the DNR and the meds. in case something happened during transport). I would suggest talking to your supervisor and have he/she talk to the nursing supervisor at that facility about the incident and explain that you do have a right to see that information.

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JONPMEDIC
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Thu May 08, 2003 8:05 AM

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You had every right and it is your responsibility to open the sealed envelope for patient information. It is necessary to have all the patients pertinent information to treat them if there condition should deteriote, which can and does happen on routine BLS transports.
Tell that nurse to go F--- herself. or do the smart thing and report it to your superior and follow it up, this way it does not occur again.

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MAJESTIC12
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Fri May 09, 2003 8:52 AM

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That's it Johhny. Just as I would.

Sorry, I'm trying to type and read this thread while laughing my t%ts off. I cannot beleive the unnecessary fear created. Which is worse HIPPA or SARS?

Once upon atime we had to sign the envelope we open for all the details talked about. Now i just tear the envelope open!
I find the lack of a handover from a LMO who's left the scene or someone who can't give me a decent handover doesn't deserve me holding onto a seled envelope like I'm the pony express! I need details as already lited by other replies.

This is another example of a pathetic attempt at personal information potection when there is government computers having the potential to track anything typed on U.S. web sites or emails or telephone calls etc.

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bortaS bIr jablu'DI', reH QaQqu' nay'
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HOPEFULEMT
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Fri May 09, 2003 12:27 PM

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I thought I would give everyone a head's up on what happened. The nurse ended up calling my supervisor to complain. My supervisor laughed and told her that it would have been a HIPPA violation if they had not allowed me that information. He explained to her that as EMTs we are medical professionals and we are privy to any and all patient info as long as we are giving the patient care. Get this. This Registered Nurse was unaware that any EMT was a medical professional and she wasn't going to be convinced by my supervisor. She told him she was going to call the state board and file a complaint. However, as you all know, EMTs get the last laugh in this case. I wish I could be there to see her face when she receives the response from the board. Thanks for all your help.

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And on the 8th day, God created EMTs. And it was good.

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WKT75
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Fri May 09, 2003 4:15 PM

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Clearly this nurse does not fully understand what HIPAA is about. Per federal law, you as a direct provider of the patients care have a right to view information regarding the patients care, including PMHX, meds, and information required for billing. I would not be suprised by the nurses lack of knowledge regarding this subject. Expect more where that came from!!!

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BOBNIXON
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Fri May 09, 2003 4:18 PM

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Thanks for the update on the incident. Having just jumped into this forum, I thought I might add a comment or two. I agree with the writer who commented about the HIPAA vs SARS scare and which is worse.

Too many hospitals and their staff are under-informed about HIPAA and the information that can be given to EMS. Per HIPAA, no consent is necessary to disclose PHI to other healthcare providers for the purpose of treatment.

I s'pose that the nurse may think EMS is not a healthcare provider, but...! IMO and from what I have read in the rule, there is NOTHING that would preclude our viewing the file for pertinent medical info. Now, if the call was nn-urgent or non-emergent, perhaps the crew could stand at the desk asking about the patient's history of present illness, past medical history, meds, allergies, etc. and refuse to transport until the information is given. Hmmmmm! <evil grin>

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power1
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Fri May 09, 2003 7:15 PM

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The facility which you dealt with must not have read a HIPPA form or anything. Basically, you are advising the patient of their privacy RIGHTS, but they sign a paper authorizing the release of that information. Does that "healthcare provider" actually think that a sealed envelope is private?! That if some villian wanted to obtain sacred info about another that they wouldn't formulate the thought to open the envelope, and replace all the documents in another envelope? Boy....those "healthcare providers" sure are sneaky! Perhaps your boss should remind the complaintant that if they feel you are in fact not a medical provider COVERED under HIPPA and the release of info, then they must find another way of obtaining this info themselves. This may include a staff member of the nursing home driving to the hospital to pick up the papers! An envelope is not an appropriate security device.

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TRAININGATOEMS
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Fri May 09, 2003 8:33 PM

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Hi HopefulEMT,

Simply put, you were right, the nurse was wrong. You (and your partner) were directly responsible for the care of that patient while he was on your stretcher and in your ambulance. In order to be able to provide proper care, you have to have access to the patient's medical information and that might sometimes mean opening sealed envelopes. It seems to me that this is just the same old story of "nurse vs 'ambulance driver'" as in "Why do those ambulance drivers need to know anything?" Forget about it...take care of your patients, use common sense when giving reports, and gain the information that you need to provide proper patient care.

Peace Always,
RG

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HOPEFULEMT
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Fri May 09, 2003 9:50 PM

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Hey. Thanks for all of the back up guys and gals. Deep down, I knew we were in the right, but I just needed that extra umph from others. The problem is that I know this is going to happen again and again and again. My partner, as a joke, went and pinned the HIPPA regulation that states that EMTs are medical professionals and are privy to that information to his uniform shirt and wore it around the station for a day. We all got a bunch of laughs out of it, but it made me think. How much longer are EMTs going to have to put up with all this stuff? If this nurse believed what she said, how many others do too? It just goes to show how effective some training and education is. If she got training at all.

Kelly EMT-B

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And on the 8th day, God created EMTs. And it was good.

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SHORTHAIREDPUNK
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Sat May 10, 2003 5:53 PM

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I hate Hippa. But last nite i realized it does have its advantages possibly, which could also be a disadvantage. We picked up a underage kid who was drunk, when it was all said and done I imagine the police have charged him, but when i went in to get the signature from the parent I did point out to them that they have the right under the new regs to restrict who has acces to medical info, INCLUDING POLICE. So a lawyer who was contacted before police get our reports from us and that is interested in challenging new law could suggest the family send the hospital as well as us a restriction naming court and police, limiting the available evidence against the kid. Nice end run of the law, new loophole potential, as hippa is newer regulation than any law on the books it will carry more weight in appeals courts.
Now in hospitals where DUI suspects blood alchohol levels are required to be given to he police, if a patient refuses to let the hospital share it they could walk due to lack of evidence.
I have not read the actual HIPPA regulations as worded by the feds, but unless this is directly addressed in its content then it will stand to be a viable defense method.
America is a beautiful place where the loopholes are abundant, and the individuals rights are more important than what is right.
I just wish I had gotten fat from mcdonalds so I could get in on some of that money too.
Im also thinking if a guy specified he didnt want his info shared with lawyers, creditors or himself then how would a hospital bill him? We just got free healthcare lol.

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Look at them, cattle waiting for slaughter.

Yes, I work for a private, I am sorry.

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HOPEFULEMT
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Sat May 10, 2003 6:42 PM

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Well, if I understand HIPPA correctly, billing, including creditors, are allowed your medical info. for billing purposes. I don't think the patient has any control over that. If what you said was the case, a lot of us should kiss our jobs goodbye. Either that, or the medical professionals themselves would have to put the medical bills together. Imagine having to take accounting classes in order to be an EMT. Interesting...

Kelly EMT-B

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And on the 8th day, God created EMTs. And it was good.

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MBMEDIC911
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Sat May 10, 2003 6:56 PM

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I used to work for a private service that did routine transports quite often. I now work for a 911 service, but have found that it doesn't matter where you work...we're all treated like we don't do anything other than drive! HOPEFULEMT, I'm glad that you and your partner are able to laugh about the incident. Just remember that this HIPPA stuff is "new" to a lot of people though it's been around for a long time. It just recently became a criminal violation, whereas before it was only a civil violation. There is going to be a rough period to go through before everyone gets the hang of what is and isn't a violation. Unfortunately, we really can't say FOR SURE what those are until some poor sole becomes the classic "example" case in the court system. There are a lot of questions out there beyond looking at patient records during a transport. Here's something to laugh at: A day after our service personnel were trained on HIPPA, I called to obtain a fellow employee phonenumber from one of our stations (yes, I needed it right then and there and didn't have the time to go look at the employee roster myself). My co-worker quickly informed me that I couldn't have the number because it would be a HIPPA violation. Obviously, this isn't the case! So, just grin and bear it. Keep doing a good job like you are, and be patient while those "slow" to learn figure this all out.

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MEDIC366
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Sun May 11, 2003 7:16 AM

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Hello everyone,

HIPAA (Health Insurance Portability and Accountability Act) can be read at http://cms.gov/regulations/hipaa/cms0003-5/0049f-econ-ofr-2-12-03.pdf.

Has your regional ems considered developing a medical facilities transfer form? This would be designed for EMS providers which would contain all the needed information for you to treat and transfer the patient without having to muddle through countless nurses notes to get information on your patient. Nurses (even those with years of service who may not have been up-dated) would feel more comfortable and cooperative with you.

Use this as an opportunity to improve working relationships with other health care agencies and personnel. It ultimately benefits the patient.

Joe.

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Trauma44004
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Sun May 11, 2003 10:35 AM

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My experience yesterday....
I work for a 911/transfer service in Northeast Ohio, yesterday I was called to a long term care facility for Acute onset of Altered Mental Status. I had cared for this pt. before and this was not his norm, he was confused, Oriented to himself only and could'nt walk. I asked the nurse for his history, meds etc. because I wanted to get moving and she told me I was not authorized to recieve pt. information, I have never been so agitated in my life. She would'nt even give me a history to find out if he was a diabetic. After a few seconds of arguing I asked her to call the E.D. with the information which she did not.

I received a professional spanking when I gave my radio report to the ED nurse and had to have a debriefing with the medical director and ER director who were both waiting for me in the ED. Very embarassing to say the least.

They went through the roof which I don't blame them, My Medical director educated the nurse and the supervisor in not so many words.

They delayed the treatment of the pt. in the ED and with myself, I feel that they neglected this pt. and I'm still pretty hot about the whole thing.

People need educated about what is and is not a violation. Come to find out he was a DNR-CC.

All I can say is when your able to, stand your ground, you need the information to care for your pt.

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BJ. Kirk FF1/EMT-B
Trauma44004@hotmail.com

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MEDICCHICK
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Sun May 11, 2003 12:36 PM

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Hi all. Most has been said about HIPPA in this thread, but I'll add my two cents anyway. You are entitled to information in order to treat your pts. The transfer service I work for made up a sheet that says as such. If we are refused information, we can refuse the pt. The 911 service I work for doesn't really have any problems with getting the info.

SHP, It is my understanding that the police can have the information on scene, but once the pt haas been transported, they are no longer a "covered entity". They can get the info without the pt permission if they have a court order.

Things will not be totally clear until there is a sacrifical lamb, so to speak. Until then, I shred anything that has PHI on it and if I do discuss a case, it is without ANY identifiers and I speak in the vaugest terms possible about the pt.

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In Loving Memory of William "Joe" Vick II who took his life on 1/10/2007~You will forever be in my heart.

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JONPMEDIC
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Sun May 11, 2003 6:06 PM

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No matter what education we can give these extended care facilites or centers for "optional" care, as I unaffectionately call them, there will be RN's and LPN's (Let's Play Nurses) who will consider us nothing more then drivers. We all have to remember what is important, the best interest of the patient. If a facility outright refuses to issue you the necessary information, treat the patient as you have found them alone in a private home, and document, document, document to fully record your reasons for treatment and follow up with subsequent incident reports to your superiors.

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HOPEFULEMT
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Sun May 11, 2003 10:16 PM

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My supervisors have told me that if the nursing home or hospital won't give me the information I need to provide care, then I can't provide care. I am to not transport the patient. This goes against all of my personal ethics, but they do have a point. Ususally, if the patient is from a nursing home, they provide us with papers to give to the hospital ED. Now, whether or not they know we're using them to get patient info. is beyond me. The situation I posted earlier was my first problem encountered with HIPPA. Hopefully, it'll be my last. (I know. I'm dreaming. Let me dream.) It's one of the most frustrating things I've gone through in my so far short EMS career.

Kelly EMT-B

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And on the 8th day, God created EMTs. And it was good.

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MEDIC126
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Mon May 12, 2003 6:57 AM

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As a HIPAA officer, a few comments:

1. The act of one health care provider (a nursing home) not sharing necessary information with another (an ambulance service, clearly a "covered entity" under HIPAA) can in and of itself be a violation of the Act. The situation here is yet another example of covered entities' procrastination of not getting their HIPAA act together and knowing the rules. Also, the "minimum necessary" requirement does not apply here.

2. Regarding the posters who state they can refuse to care for the patient if no info is given: be extremely careful here. In an emergency (i.e. a 911 call), HIPAA does not give health care entities the authority to withhold care in an emergency. In fact, if you do this you can be held liable for abandonment and failure to act statutes. Keep in mind that HIPAA applies to the entire spectrum of health care entities, not just emergency care providers. The allowances in HIPAA to withhold services to non-disclosers usually apply to the more non-urgent providers of medical care. Do not refuse to provide care to someone in an emergency!

3. Normally I ignore the Punk, but just to clear up any potential confusion- medical records are available to the police and courts under power of subpoena. HIPAA does not prohibit this. What it does say is that covered entities must have assurances that the records will only be used for that current litigation, and afterwards will either be returned or destroyed, AND the patient has been notified of the subpoena. While it is true that any of our laws can be challenged through appropriate steps in the system, to go to the patient or family and state they can use HIPAA as a defensive tool is inaccurate, not to mention way out of your responsibility as a member of the EMS team. Further, it is unlikely that challenges regarding the need for appropriate law enforcement subpoena of records would survive anyway. Nor would the police find the need to have the trip sheet on hand as evidence in an underage drinking case. Anythings possible, but it is unlikely the US Supreme Court will agree to hear an argument from an underage drinker that his HIPAA rights were violated.

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NRMEDIC44
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Mon May 12, 2003 8:25 AM

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All you had to do is say Nursing Home Nurse....... I really think that you can take a good nurse and put her/him in the Nursing Home and watch the loss of care and skills over the years. I do not wish a nursing home on anyone.... patient or Nurse!!!!!!

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ILMmedic
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Mon May 12, 2003 2:21 PM

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Dsepressing. Even fellow "Medical Professionals" think we are just ambulance drivers. Maybe a few hours ride-along on an ALS rig would teach her some respect.

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9-11-01

We will never forget...

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BRIAN11884
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Mon May 12, 2003 5:46 PM

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Have to agree with NRMEDIC44 nursing home explains it all. I do not think that is a HIPPA violation.
Stay Safe

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TAPERTOM
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Wed May 21, 2003 1:54 AM

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Hello great question to put foward. I have to say you did right in opening the envelope.I can tell that my experiance as both a bls als and inter-facility transport provider i have been in the situation were Nurse's are slow to give ambulance crews the proper report they need or access to the information. I am also a cardiac nurse RN and i try to give an transport service the same report and access to the crew taking care of one of my patients that i would to the RN releiving me at the end of my shift. Let me also say that I was required to sit through HIPAA training for all 3 of my ems jobs but none for my nursing job that included my volunter job,(yes volunter service is a job). So keep up the good work. TOM EVANS RN EMT

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FlEMT03
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Thu May 29, 2003 3:29 PM

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HopefulEMT,

In the very first paragraph of HIPPA it states that transfer of care professionals are expected to be responsible for patient info. this would include transfers, aren't you expected to transfer info to that facility about that patient? Enough said!! Just quit worrying about it you did the RIGHT thing.....There are alot of medical professionals who are over reacting and reading into HIPPA way more than was meant. I know first hand, I work at a hospital and for a service.


Keep the faith!!

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