I. What's the big deal?
II. The Confidentiality Rule
Under Sec. 51.30, Stats. (exit DHS, PDF - scroll to page 21), treatment information and records are confidential. In general, they can only be released to others with the informed written consent of the individual, if competent, or the guardian. The rule covers both verbal information and treatment records.
These are the exceptions to the rule above, where certain, specific people or entities may access certain information and/or records for certain purposes without the individual's or guardian's written consent.There are 31 exceptions listed in the document Confidentiality explained (PDF, 66 KB).
- The "Need to Know" Standard
The principle of preserving confidentiality requires that disclosures between staff members are limited to the extent of the "need to know" of the person(s) the information is disclosed to. This means that you may disclose only that information which the receiver needs to know in order to perform their duties in relation to the individual. The only exceptions are where the statute specifies the information someone is entitled to or when the individual consents.
IV. Patient Access to Treatment Information / Records During Treatment
The individual must have access at any time to their records of all medications and health related treatment. However, during treatment, the facility director may restrict access to any other treatment records. To limit or deny access to records during treatment, there must be reason to believe that the benefits of allowing access to the individual are outweighed by the disadvantages of allowing access. Reasons for any such restriction must be entered into the individual's treatment record.
V. Written Informed Consent for release of information
Informed consent must be in writing and must be voluntarily given by an individual who is "substantially able to understand all information specified on the consent form". The form must contain certain data. (For state staff, department consent forms that meet all legal standards are available.)
Right to copies of disclosed information
The informed consent document must also include a statement of the individual's right to copies of disclosed information under DHS 92.05 and DHS 92.06, Wis. Admin Code.
- Refusing or Withdrawing Consent
The individual may refuse to consent or may withdraw consent at any time. If this occurs, an agency can no longer access the information (unless covered by one of the exceptions).
VI. AODA Records / HIV/AIDS Issues
These areas of treatment have special features and particularly stringent standards. Please ask for qualified assistance when applying state/ federal law to this area.
VII. When In Doubt -- Ask
The confidentiality rule is considered exceptional in its importance. Don't guess! Read the "Confidentiality explained" (PDF, 66 KB) document and ask others when a question arises. A few moments on the telephone or by e-mail could save you a great deal of time and possible trouble, later.