CORRECTIVE REPRINT
PRINTING PLANT ERROR
PRIOR PRINTER'S NO. 1971 PRINTER'S NO. 2006
No. 1651 Session of 1989
INTRODUCED BY CALTAGIRONE, HALUSKA, TRELLO AND MELIO,
JUNE 6, 1989
REFERRED TO COMMITTEE ON HEALTH AND WELFARE, JUNE 6, 1989
AN ACT
1 Regulating disclosure of health care information; and
2 prescribing penalties.
3 TABLE OF CONTENTS
4 Chapter 1. General Provisions
5 Section 101. Short title.
6 Section 102. Legislative findings.
7 Chapter 2. Disclosure of Health Care Information
8 Section 201. Disclosures by health care providers.
9 Section 202. Patient authorization to health care provider
10 for disclosure.
11 Section 203. Patient revocation of authorization for
12 disclosure.
13 Section 204. Disclosures without patient authorization.
14 Section 205. Compulsory process.
15 Chapter 3. Examination and Copying of Records
16 Section 301. Requirements and procedures for patient
1 examination and copying.
2 Section 302. Denial of examination and copying.
3 Chapter 4. Correction and Amendment of Records
4 Section 401. Requests for correction or amendment.
5 Section 402. Procedures for adding corrections or amendments
6 or statements of disagreement.
7 Section 403. Dissemination of corrected or amended information
8 or statements of disagreement.
9 Chapter 5. Notice of Information Practices
10 Section 501. Content and dissemination of notice.
11 Chapter 6. Persons Authorized to Act for Patients
12 Section 601. Health care representatives.
13 Section 602. Representatives of deceased patients.
14 Chapter 7. Security Safeguards and Record Retention
15 Section 701. Duty to adopt security safeguards.
16 Section 702. Retention of records.
17 Chapter 8. Civil Remedies and Criminal Sanctions
18 Section 801. Criminal penalty.
19 Section 802. Civil enforcement.
20 Section 803. Civil remedies.
21 Chapter 9. Miscellaneous Provisions
22 Section 901. Severability.
23 Section 902. Conflicting laws.
24 Section 903. Effective date.
25 The General Assembly of the Commonwealth of Pennsylvania
26 hereby enacts as follows:
27 CHAPTER 1
28 GENERAL PROVISIONS
29 Section 101. Short title.
30 This act shall be known and may be cited as the Uniform
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1 Health Care Information Act.
2 Section 102. Legislative findings.
3 The General Assembly finds and declares as follows:
4 (1) Health care information is personal and sensitive
5 information that, if improperly used or released, may do
6 significant harm to patient privacy interests, patient health
7 care interests and other patient interests.
8 (2) Patients need to be able to obtain access to their
9 own health care information as a matter of fairness to enable
10 them to make informed decisions about their health care and
11 to permit them to correct inaccurate or incomplete
12 information about themselves.
13 (3) In order to retain the full trust and confidence of
14 patients, health care providers have an interest in assuring
15 that health care information is not improperly disclosed and
16 in having clear and certain rules for the disclosure of
17 health care information.
18 (4) Nonhealth care providers obtain, use and disclose
19 health record information in many different contexts and for
20 many different purposes. Although this act does not regulate
21 the use and disclosure of health care information by
22 nonhealth care providers, it is the public policy of the
23 Commonwealth that a patient's interest in the proper use and
24 disclosure of that patient's health care information survives
25 even when this information is held by nonhealth care
26 providers.
27 (5) The movement of patients and their health care
28 information across state lines, access to and exchange of
29 health care information from automated data banks and the
30 emergence of multistate health care providers creates a
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1 compelling need for uniform law, rules and procedures
2 governing the use and disclosure of health care information.
3 CHAPTER 2
4 DISCLOSURE OF HEALTH CARE INFORMATION
5 Section 201. Disclosures by health care providers.
6 (a) Disclosure.--Except as authorized in section 204, a
7 health care provider, individuals who assist the health care
8 provider in the delivery of health care, and agents and
9 employees of a health care provider may not disclose health care
10 information about a patient to any other person without the
11 patient's written authorization. Disclosure made under the
12 patient's written authorization must conform to the
13 authorization.
14 (b) Receipt recorded.--A health care provider shall
15 maintain, in conjunction with the patient's recorded health care
16 information, a record of all persons who have received or
17 examined, in whole or in part, the recorded health care
18 information during the preceding three years, except for persons
19 who have examined the recorded health care information under
20 section 204(a)(1) or (2). The disclosure record shall include
21 the name, address and institutional affiliation, if any, of each
22 person receiving or examining the recorded health care
23 information; the date of the receipt or examination; and, to the
24 extent practicable, a description of the information disclosed.
25 Section 202. Patient authorization to health care provider for
26 disclosure.
27 (a) Patient authorization.--A patient may authorize a health
28 care provider to disclose the patient's health care information.
29 A health care provider shall honor an authorization and provide
30 a copy of the recorded health care information, if requested,
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1 except in those situations in which a health care provider may
2 deny a patient access to health care information under section
3 302. A health care provider may charge a fee, not to exceed the
4 health care provider's actual cost, for providing the health
5 care information and is not required to honor the authorization
6 until the fee is paid.
7 (b) Contents.--To be valid, a disclosure authorization to a
8 health care provider must comply with all of the following:
9 (1) Be in writing, dated and signed by the patient.
10 (2) Identify the nature of the information to be
11 disclosed.
12 (3) Identify the person to whom the information is to be
13 disclosed.
14 (c) Authorization no waiver.--Except as provided by this
15 act, the signing of an authorization by a patient does not
16 constitute a waiver of rights a patient has under other
17 statutes, the rules of evidence or common law.
18 (d) Record retention.--A health care provider shall retain
19 authorizations or revocations in conjunction with the health
20 care information from which disclosures were made.
21 (e) Limitation.--Except for authorizations to provide
22 information to third-party health care payors, no authorization
23 may permit the release of health care information relating to
24 future health care that the patient receives more than six
25 months after the authorization was signed.
26 (f) Validity.--An authorization in effect on the effective
27 date of this act remains valid for a period of 30 months after
28 the effective date of this act unless an earlier date is
29 specified or unless it is revoked under section 204. Health care
30 information disclosed under an authorization is otherwise
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1 subject to this act. An authorization written after the
2 effective date of this act becomes invalid after the expiration
3 date contained in the authorization, which (date) may not be
4 more than 30 months after issue. If the authorization does not
5 contain an expiration date, it expires six months after the date
6 it is signed.
7 Section 203. Patient revocation of authorization for
8 disclosure.
9 A patient may revoke a disclosure authorization to a health
10 care provider at any time unless disclosure is required to
11 effectuate payments for health care that has been provided or
12 unless other substantial action has been taken in reliance on
13 the authorization. A patient may not maintain an action against
14 the health care provider for disclosures made in good faith
15 reliance on an authorization if the health care provider has no
16 notice of the revocation of the authorization.
17 Section 204. Disclosures without patient authorization.
18 (a) Limited disclosure.--A health care provider may disclose
19 health care information about a patient without the patient's
20 authorization to the extent the recipient needs to know the
21 information, if any of the following apply:
22 (1) The disclosure is to persons who are providing
23 health care to the patient.
24 (2) The disclosure is to other persons who require
25 health care information for health care education; to provide
26 planning, quality assurance, peer review, administrative,
27 legal, financial or actuarial services to the health care
28 provider; or for assisting the health care provider in the
29 delivery of health care. This paragraph only applies if the
30 health care provider reasonably believes that these persons:
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1 (i) will not use or disclose the health care
2 information for any other purpose; and
3 (ii) will take appropriate steps to assure that the
4 health care information is protected.
5 (3) The disclosure is to other health care providers who
6 have previously provided health care to the patient, to the
7 extent necessary to provide health care to the patient,
8 unless the patient has instructed the health care provider
9 not to make the disclosure.
10 (4) The health care provider reasonably believes that
11 disclosure will avoid or minimize an imminent danger to the
12 health or safety of the patient or any other individual.
13 (5) The disclosure is to immediate family members of the
14 patient, or any other individual with whom the patient is
15 known to have a close personal relationship and is made in
16 accordance with good medical or other professional practice.
17 This paragraph does not apply if the patient has instructed
18 the health care provider not to make the disclosure.
19 (6) The disclosure is to a health care provider who is
20 the successor in interest to the health care provider
21 maintaining the health care information.
22 (7) The disclosure is for use in a research project that
23 an institutional review board has determined:
24 (i) is of sufficient importance to outweigh the
25 intrusion into the privacy of the patient that would
26 result from the disclosure;
27 (ii) is impracticable without the use or disclosure
28 of the health care information in individually
29 identifiable form;
30 (iii) contains reasonable safeguards to protect the
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1 information from redisclosure;
2 (iv) contains reasonable safeguards to protect
3 against identifying, directly or indirectly, a patient in
4 a report of the research project; and
5 (v) contains procedures to remove or destroy, at the
6 earliest opportunity, consistent with the purposes of the
7 project, information that would enable the patient to be
8 identified, unless an institutional review board
9 authorizes retention of identifying information for
10 purposes of another research project.
11 (8) The disclosure is to a person who obtains
12 information for purposes of an audit. This paragraph only
13 applies if the person agrees in writing:
14 (i) to remove or destroy, at the earliest
15 opportunity, consistent with the purpose of the audit,
16 information that would enable the patient to be
17 identified; and
18 (ii) not to further disclose the information, except
19 to accomplish the audit or to report unlawful or improper
20 conduct involving health care payment fraud by a health
21 care provider or patient or to report other unlawful
22 conduct by the health care provider.
23 (9) The disclosure is to officials of penal or other
24 custodial institutions while the patient is detained.
25 (b) Allowable disclosure.--A health care provider may
26 disclose health care information about a patient without the
27 patient's authorization if the disclosure is any of the
28 following:
29 (1) Directory information. This paragraph does not apply
30 if the patient has instructed the health care provider not to
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1 make the disclosure.
2 (2) To Federal, State or local public health
3 authorities, to the extent that the health care provider is
4 required by law to report health care information or that the
5 disclosure is needed to protect the public health.
6 (3) To Federal, State or local law enforcement
7 authorities to the extent required by law.
8 (4) Pursuant to compulsory process in accordance with
9 section 205.
10 Section 205. Compulsory process.
11 (a) Official proceedings.--Health care information shall not
12 be disclosed by a health care provider pursuant to compulsory
13 legal process or discovery in any judicial, legislative or
14 administrative proceeding unless any of the following apply:
15 (1) The patient has consented in writing to the release
16 of the health care information in response to compulsory
17 process or a discovery request.
18 (2) The patient has waived the right to claim
19 confidentiality for the health care information sought.
20 (3) The patient is a party to the proceeding and has
21 placed the patient's physical or mental condition at issue.
22 (4) The patient's physical or mental condition is
23 relevant to the execution or witnessing of a will.
24 (5) The physical or mental condition of a deceased
25 patient is placed in issue by a person claiming or defending
26 through or as a beneficiary of the patient.
27 (6) A patient's health care information is to be used in
28 the patient's commitment proceeding.
29 (7) The health care information is for use in a law
30 enforcement proceeding or investigation in which a health
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1 care provider is the subject or is a party. Health care
2 information obtained under this paragraph may not be used in
3 a proceeding against the patient unless the matter relates to
4 payment for the patient's health care.
5 (8) The health care information is relevant to a
6 proceeding brought under chapter 8.
7 (9) A court has determined that particular health care
8 information should be subject to compulsory legal process or
9 discovery because the party seeking the information has
10 demonstrated that the interest in access outweighs the
11 patient's privacy interest.
12 (b) Notice.--If health care information is sought under
13 subsection (a)(2), (4) or (5) or in a civil proceeding or
14 investigation under subsection (a)(9), the person seeking
15 discovery or compulsory process shall mail a notice, by first-
16 class mail to the patient or the patient's attorney of record,
17 of the compulsory process or discovery request at least ten days
18 before presenting the certificate required under subsection (c)
19 to the health care provider. The court may, for good cause
20 shown, determine that the notification should be waived or
21 modified.
22 (c) Written certification.--
23 (1) Service of compulsory process or discovery requests
24 upon a health care provider must be accompanied by a written
25 certification, signed by the person seeking to obtain health
26 care information or an authorized representative and
27 identifying at least one paragraph of subsection (a) under
28 which compulsory process or discovery is being sought. The
29 certification must also state, in the case of information
30 sought under subsection (a)(2), (4) or (5) or in a civil
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1 proceeding under subsection (a)(9), that the notice
2 provisions of subsection (b) have been complied with. A
3 person shall sign the certification only if the person
4 reasonably believes that the paragraph of subsection (a)
5 identified in the certification provides an appropriate basis
6 for the use of discovery or compulsory process.
7 (2) Unless otherwise ordered by the court, the health
8 care provider shall maintain a copy of the process and the
9 written certification as a permanent part of a patient's
10 health care information.
11 (d) No waiver.--Production of health care information under
12 this section, in and of itself, does not constitute a waiver of
13 a privilege, objection or defense existing under other law.
14 CHAPTER 3
15 EXAMINATION AND COPYING OF RECORDS
16 Section 301. Requirements and procedures for patient
17 examination and copying.
18 (a) Information provided.--Upon receipt of a written request
19 from a patient to examine or copy all or part of the patient's
20 recorded health care information, a health care provider, as
21 promptly as required under the circumstances but no later than
22 ten days after receiving the request, shall do one of the
23 following:
24 (1) Make the information available for examination
25 during regular business hours and provide a copy, if
26 requested, to the patient.
27 (2) If the information does not exist or cannot be
28 found, inform the patient.
29 (3) If the health care provider does not maintain the
30 information, inform the patient and provide the name and
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1 address, if known, of the health care provider who maintains
2 the information.
3 (4) If the information is in use or unusual
4 circumstances have delayed handling the request, inform the
5 patient and specify in writing the reasons for the delay and
6 the earliest date, not later than 21 days after receipt of
7 the request, when the information will be available for
8 examination or copying or when the request will be otherwise
9 disposed of.
10 (5) Deny the request, in whole or in part, under section
11 302 and inform the patient.
12 (b) Implementation.--In implementing this section:
13 (1) Upon request, the health care provider shall provide
14 an explanation of any code or abbreviation used in the health
15 care information.
16 (2) If the particular health care information requested
17 is not maintained by the health care provider in the
18 requested form, the health care provider is not required to
19 create a new record or reformulate an existing record to make
20 the health care information available in the requested form.
21 (3) The health care provider may charge a fee, not to
22 exceed the health care provider's actual cost, for providing
23 the health care information and is not required to permit
24 examination or copying until the fee is paid.
25 Section 302. Denial of examination and copying.
26 (a) Access denial.--A health care provider may deny access
27 to health care information by the patient if the health care
28 provider reasonably concludes that any of the following apply:
29 (1) Knowledge of the health care information would be
30 injurious to the health of the patient.
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1 (2) Knowledge of the health care information could
2 reasonably be expected to lead to the patient's
3 identification of an individual who provided the information
4 in confidence and under circumstances in which
5 confidentiality was appropriate.
6 (3) Knowledge of the health care information could
7 reasonably be expected to cause danger to the life or safety
8 of an individual.
9 (4) The health care information was compiled and is used
10 solely for litigation, quality assurance, peer review or
11 administrative purposes.
12 (5) Access to the health care information is otherwise
13 prohibited by law.
14 (b) Separate access.--If a health care provider denies an
15 examination and copying request under this section, the
16 provider, to the extent possible, shall segregate health care
17 information for which access has been denied under subsection
18 (a) from information for which access may not be denied and
19 permit the patient to examine or copy the disclosable
20 information.
21 (c) Alternate selection.--If a health care provider denies a
22 patient's request for examination and copying, in whole or in
23 part, under subsection (a)(1) or (3), the provider shall permit
24 examination and copying of the record by another health care
25 provider who is selected by the patient and who is licensed,
26 certified or otherwise authorized under the laws of this
27 Commonwealth to treat the patient for the same condition as the
28 original health care provider. The health care provider
29 maintaining the health care information shall inform the patient
30 of the patient's right to select another health care provider
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1 for this purpose.
2 CHAPTER 4
3 CORRECTION AND AMENDMENT OF RECORDS
4 Section 401. Requests for correction or amendment.
5 (a) Correction.--For purposes of accuracy or completeness, a
6 patient may request in writing that a health care provider
7 correct or amend the patient's health care information to which
8 a patient has access under section 301.
9 (b) Amendment.--As promptly as required under the
10 circumstances, but no later than ten days after receiving a
11 request from a patient to correct or amend the patient's health
12 care information, the health care provider shall do one of the
13 following:
14 (1) Make the requested correction or amendment and
15 inform the patient of the action and of the patient's right
16 to have the correction or amendment sent to previous
17 recipients of the health care information in question.
18 (2) If the record no longer exists or cannot be found,
19 inform the patient.
20 (3) If the health care provider does not maintain the
21 record, inform the patient and provide the patient with the
22 name and address, if known, of the person who maintains the
23 record.
24 (4) If the record is in use or unusual circumstances
25 have delayed the handling of the correction or amendment
26 request, inform the patient and specify in writing the
27 earliest date, not later than 21 days after receipt of the
28 request, when the correction or amendment will be made or
29 when the request will otherwise be disposed of.
30 (5) Inform the patient in writing of the provider's
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1 refusal to correct or amend the record as requested, the
2 reason for the refusal and the patient's right to add a
3 statement of disagreement and to have that statement sent to
4 previous recipients of the disputed health care information.
5 Section 402. Procedures for adding corrections or amendments or
6 statements of disagreement.
7 (a) Marking.--In making any correction or amendment, the
8 health care provider shall:
9 (1) Add the amending information as a part of the health
10 record.
11 (2) Mark the challenged entries as corrected or amended
12 entries and indicate the place in the record where the
13 corrected or amended information is located, in a manner
14 practicable under the circumstances.
15 (b) Refusal.--If the health care provider maintaining the
16 health care information refuses to make a patient's proposed
17 correction or amendment, the provider shall:
18 (1) Permit the patient to file, as a part of the health
19 care information, a concise statement of the correction or
20 amendment requested and the reasons for it.
21 (2) Mark the challenged entry to indicate that the
22 patient claims the entry is inaccurate or incomplete and
23 indicate the place in the record where the statement of
24 disagreement is located, in a manner practicable under the
25 circumstances.
26 Section 403. Dissemination of corrected or amended information
27 or statements of disagreement.
28 (a) Persons designated.--A health care provider, upon
29 request of the patient, shall take reasonable steps to provide
30 copies of corrected or amended information or of the statement
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1 of disagreement to all persons designated by the patient who are
2 identified in the health care information as having examined or
3 received copies of the information sought to be corrected or
4 amended.
5 (b) Fee.--A health care provider may charge the patient for
6 the provider's actual cost in distributing corrected or amended
7 information or the statement of disagreement, unless the
8 provider's error necessitated the correction or amendment.
9 CHAPTER 5
10 NOTICE OF INFORMATION PRACTICES
11 Section 501. Content and dissemination of notice.
12 (a) Notice.--A health care provider who provides health care
13 at a health care facility that the provider operates and who
14 maintains health care information shall create a notice of
15 information practices that contains substantially the following:
16 Notice
17 We keep records of the health care services we provide
18 you. You may ask us to see and copy those records that we
19 maintain. You may also ask us to correct those records.
20 We will not disclose your records to others unless you
21 direct us to do so, or unless the law authorizes or
22 compels us to do so. You may see your records, or get
23 more information about them, at _________________.
24 (b) Posted copy.--The health care provider shall post a copy
25 of the provider's notice of information practices in a
26 conspicuous place in the health care facility and, upon request,
27 provide patients or prospective patients with a copy of the
28 notice.
29 CHAPTER 6
30 PERSONS AUTHORIZED TO ACT FOR PATIENTS
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1 Section 601. Health care representatives.
2 (a) Agency.--A person authorized to consent to health care
3 for another may exercise the rights of that person under this
4 act to the extent necessary to effectuate the terms or purposes
5 of the grant of authority. A patient who is a minor and who is
6 authorized to consent to health care without parental consent
7 under the laws of this Commonwealth may exclusively exercise the
8 rights of a patient under this act as to information pertaining
9 to health care to which the minor lawfully consented.
10 (b) Good faith.--A person authorized to act for a patient
11 shall act in good faith to represent the best interests of the
12 patient.
13 Section 602. Representatives of deceased patients.
14 A personal representative of a deceased patient may exercise
15 the deceased patient's rights under this act. If there is no
16 personal representative or if the personal representative is
17 discharged, a deceased patient's rights under this act may be
18 exercised by persons who are authorized by law to act for the
19 deceased patient.
20 CHAPTER 7
21 SECURITY SAFEGUARDS AND RECORD RETENTION
22 Section 701. Duty to adopt security safeguards.
23 A health care provider shall implement reasonable security
24 safeguards for health care information it maintains.
25 Section 702. Retention of records.
26 A health care provider shall maintain existing health care
27 information for at least one year following receipt of an
28 authorization to disclose that health care information under
29 section 202 and during the pendency of a request for examination
30 and copying under section 301 or a request for correction or
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1 amendment under section 401.
2 CHAPTER 8
3 CIVIL REMEDIES AND CRIMINAL SANCTIONS
4 Section 801. Criminal penalty.
5 (a) Prohibited disclosure.--A person who, with knowledge or
6 reason to know that disclosure is prohibited, intentionally
7 discloses health care information in violation of this act
8 commits a misdemeanor of the third degree and shall, upon
9 conviction, be sentenced to pay a fine of not more than $10,000
10 or to imprisonment for not more than one year, or both.
11 (b) Misrepresentation.--A person who, by intentionally
12 misrepresenting that person's identity or purpose or entitlement
13 to health care information or by bribery, theft or trespass,
14 examines or obtains health care information maintained by a
15 health care provider to which the person would not otherwise be
16 entitled commits a misdemeanor of the third degree and shall,
17 upon conviction, be sentenced to pay a fine of not more than
18 $10,000 or to imprisonment for not more than one year, or both.
19 (c) False certification.--A person who, with knowledge that
20 a certification under section 205(c)(1) or a disclosure
21 authorization under section 202 is false, intentionally presents
22 the certification or disclosure authorization to a health care
23 provider commits a misdemeanor of the third degree and shall,
24 upon conviction, be sentenced to pay a fine of not more than
25 $10,000 or to imprisonment for not more than one year, or both.
26 Section 802. Civil enforcement.
27 The Attorney General or appropriate local law enforcement
28 official may maintain a civil action to enforce this act. The
29 court may order relief authorized by section 803.
30 Section 803. Civil remedies.
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1 (a) Action for relief.--A person aggrieved by a violation of
2 this act may maintain an action for relief as provided in this
3 section.
4 (b) Compliance.--The court may order the health care
5 provider or other person to comply with this act and may order
6 other appropriate relief.
7 (c) Good faith reliance.--A health care provider who relies
8 in good faith upon a certification under section 205(c)(1) is
9 not liable for disclosures made in reliance on that
10 certification.
11 (d) Burden of proof.--In an action by a patient alleging
12 that health care information was improperly withheld under
13 chapter 3, the burden of proof is on the health care provider to
14 establish that the information was properly withheld.
15 (e) Damages.--If the court determines that there is a
16 violation of this act, the aggrieved person is entitled to
17 recover damages for pecuniary losses sustained as a result of
18 the violation; in addition, if the violation results from
19 willful or grossly negligent conduct, the aggrieved person may
20 recover up to $5,000 as penal damages.
21 (f) Attorney fees.--If a plaintiff prevails, the court may
22 assess reasonable attorney fees and all other expenses
23 reasonably incurred in the litigation.
24 (g) Statute of limitations.--An action under this act is
25 barred unless the action is commenced within two years after the
26 cause of action relief arises.
27 CHAPTER 9
28 MISCELLANEOUS PROVISIONS
29 Section 901. Severability.
30 The provisions of this act are severable. If any provision of
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1 this act or its application to any person or circumstance is
2 held invalid, the invalidity shall not affect other provisions
3 or applications of this act which can be given effect without
4 the invalid provision or application.
5 Section 902. Conflicting laws.
6 This act does not restrict a health care provider from
7 complying with obligations imposed by Federal health care
8 payment programs or Federal law. If there is a conflict between
9 a provision of this act and a provision of the act of July 8,
10 1986 (P.L.408, No.89), known as the Health Care Cost Containment
11 Act, the Health Care Cost Containment Act shall prevail.
12 Section 903. Effective date.
13 This act shall take effect in 60 days.
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