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" *'USUS.,  _&&:(# XXOCRHIPAAPrivacy    December3,2002 r @pp6(#RevisedApril3,2003#XXR# 6)&4Hyperlink            (O$http://answers.hhs.gov/cgi-bin/hhs.cfg/php/enduser/std_alp.php?p_sid=UFo3G3Eg&p_lva=&p_li=&p_page=1&p_cat_lvl1=7&p_cat_lvl2=56&p\  `&Times New Roman*+ (_2623  ..*D+J (_25   ," <DL,23  ..  2( 4 <DL2  *A+J (_24   ) <DL)23  ..  2( 4 <DL2  *>+J (_23  ` &<<DL&23  ..  2( 4 <DL2  *;+J (_22   #DL#23  ..  2( 4 <DL2  *8+J (_21    DL 23  ..  2( 4 <DL2  *5+J (_20  h DDL23  ..  2( 4 <DL2  *2+J (_19   L23  ..  2( 4 <DL2  */+J (_18    L23  ..  2( 4 <DL2  * (_1723  Ԁ*DJ (_16   ," <DL,23  Ԁ  2( 4 <DL2  *AJ (_15   ) <DL)23  Ԁ  2( 4 <DL2  *>J (_14  ` &<<DL&23  Ԁ  2( 4 <DL2  *;J (_13   #DL#23  Ԁ  2( 4 <DL2  *8J (_12    DL 23  Ԁ  2( 4 <DL2  *5J (_11  h DDL23  Ԁ  2( 4 <DL2  *2J (_10   L23  Ԁ  2( 4 <DL2  (/J &_9    L23  Ԁ  2( 4 <DL2  ( &_823  (DJ &_7   ," <DL,23   2( 4 <DL2  (AJ &_6   ) <DL)23   2( 4 <DL2  (>J &_5  ` &<<DL&23   2( 4 <DL2  (;J &_4   #DL#23   2( 4 <DL2  (8J &_3    DL 23   2( 4 <DL2  (5J &_2  h DDL23   2( 4 <DL2  (2J &_1   L23   2( 4 <DL2  &/J $_    L23   2( 4 <DL2  ohttp://answers.hhs.gov/cgi-bin/hhs.cfg/php/enduser/std_alp.php?p_sid=K6SCZJFg&p_lva=&p_li=&p_page=1&p_cat_lvl1=7&p_cat_lvl2=29&http://answers.hhs.gov/cgi-bin/hhs.cfg/php/enduser/std_alp.php?p_sid=K6SCZJFg&p_lva=&p_li=&p_page=1&p_cat_lvl1=7&p_cat_lvl2=29&p_search_text=&p_new_search=1(-2$ !USUS.,  http://answers.hhs.gov/cgi-bin/hhs.cfg/php/enduser/std_alp.php?p_sid=f47XY6Gg&p_lva=&p_li=&p_page=1&p_cat_lvl1=7&p_cat_lvl2=%7E Level 1 Level 2 Level 3 Level 4 Level 5(-2$ !USUS.,  (-2$ !USUS.,  ($'dxdstuvwC<< c  *'USUS.,  _ @ XXR %#X#RXXRH##XXXRXg#RXXXX##9%#RXRX#R#R #RXXR#RXRXO#RXXR#RXRXCRHI#RXXR#RXRXPAA#RXXR,#RXRXPrivacy   @  @ #RXXRr#RXRXKK:%##RXXR#RXRXDecember3,2002 r  @  @  @   #RXXR>#RXRXRevisedApril3,2003 4  @  @   ?+ ` hp x %#?#RXXR##XXXRX]#RXXXX o p) (#(#(#(#USUS.,  _XXR#RXXRX##XXXRXw#RXXXXRXRX#R#Rx|WGCz h p @X@E'##!  (#(#    (#(##RXXR##XXXRX=#RXXXXRXRX#R#R#RXXR##XXXRX#RXXXX @ RXRX#R\#Rx}QA=x h p @XE! &c$""0  H t"USUS.,  _ @  H t"USUS.,  _ @ http://answers.hhs.gov/cgi-bin/hhs.cfg/php/enduser/std_alp.phphttp://answers.hhs.gov/cgi-bin/hhs.cfg/php/enduser/std_alp.php?p_sid=f47XY6Gg&p_lva=&p_li=&p_page=1&p_cat_lvl1=7&p_cat_lvl2=%7Eany%7E&p_search_text=&p_new_search=1 !USUS.,  _ N  8XXdd8PERSONALREPRESENTATIVES   [45CFR164.502(g)]     Background      TheHIPAAPrivacyRuleestablishesafoundationofFederallyprotectedrightswhich Z  permitindividualstocontrolcertainusesanddisclosuresoftheirprotectedhealthinformation. F  Alongwiththeserights,thePrivacyRuleprovidesindividualswiththeabilitytoaccessand 2t amendthisinformation,andtherighttoanaccountingofcertaindisclosures.TheDepartment ` recognizesthattheremaybetimeswhenindividualsarelegallyorotherwiseincapableof  L  exercisingtheirrights,orsimplychoosetodesignateanothertoactontheirbehalfwithrespectto 8  theserights.UndertheRule,apersonauthorized(underStateorotherapplicablelaw,e.g.,tribal $  ormilitarylaw)toactonbehalfoftheindividualinmakinghealthcarerelateddecisionsisthe   individuals personalrepresentative.Section164.502(g)provideswhen,andtowhatextent,   thepersonalrepresentativemustbetreatedastheindividualforpurposesoftheRule.Inaddition   totheseformaldesignationsofapersonalrepresentative,theRuleat45CFR164.510(b)   addressessituationsinwhichpersonsareinvolvedintheindividualshealthcarebutarenot ~ expresslyauthorizedtoactontheindividualsbehalf. j  HowtheRuleWorks  B   GeneralProvisions.Exceptasotherwiseprovidedin45CFR164.502(g),thePrivacy \ Rulerequirescoveredentitiestotreatanindividualspersonalrepresentativeastheindividual H withrespecttousesanddisclosuresoftheindividualsprotectedhealthinformation,aswellas 4 theindividualsrightsundertheRule.     Thepersonalrepresentativestandsintheshoesoftheindividualandhastheabilitytoact  fortheindividualandexercisetheindividualsrights.Forinstance,coveredentitiesmust   providetheindividualspersonalrepresentativewithanaccountingofdisclosuresinaccordance ! with45CFR164.528,aswellasprovidethepersonalrepresentativeaccesstotheindividuals z" protectedhealthinformationinaccordancewith45CFR164.524totheextentsuchinformation f# isrelevanttosuchrepresentation .Inadditiontoexercisingtheindividualsrightsunderthe R$ Rule,apersonalrepresentativemayalsoauthorizedisclosuresoftheindividualsprotectedhealth >%  information. *&l!   Ingeneral,thescopeofthepersonalrepresentativesauthoritytoactfortheindividual (D # underthePrivacyRulederivesfromhisorherauthorityunderapplicablelawtomakehealthcare (0!$ decisionsfortheindividual.Wherethepersonhasbroadauthoritytoactonthebehalfofaliving )"% individualinmakingdecisionsrelatedtohealthcare,suchasaparentwithrespecttoaminor *#& childoralegalguardianofamentallyincompetentadult,thecoveredentitymusttreatthe +#' personalrepresentativeastheindividualforallpurposesundertheRule,unlessanexception  applies.(Seebelowwithrespecttoabuse,neglectorendangermentsituations,andthe  applicationofStatelawinthecontextofparentsandminors).Wheretheauthoritytoactforthe   individualislimitedorspecifictoparticularhealthcaredecisions,thepersonalrepresentativeis   tobetreatedastheindividualonlywithrespecttoprotectedhealthinformationthatisrelevantto n  therepresentation.Forexample,apersonwithanindividualslimitedhealthcarepowerof Z  attorneyregardingonlyaspecifictreatment,suchasuseofartificiallifesupport,isthat F  individualspersonalrepresentativeonlywithrespecttoprotectedhealthinformationthatrelates 2t tothathealthcaredecision.Thecoveredentityshouldnottreatthatpersonastheindividualfor ` otherpurposes,suchastosignanauthorizationforthedisclosureofprotectedhealthinformation  L  formarketingpurposes.Finally,wherethepersonhasauthoritytoactonthebehalfofa 8  deceasedindividualorhisestate,whichdoesnothavetoincludetheauthoritytomakedecisions $  relatedtohealthcare,thecoveredentitymusttreatthepersonalrepresentativeastheindividual   forallpurposesundertheRule.Stateorotherlawshouldbeconsultedtodeterminetheauthority   ofthepersonalrepresentativetoreceiveoraccesstheindividualsprotectedhealthinformation.     WhoMustBeRecognizedastheIndividualsPersonalRepresentative.Thefollowing ~ chartdisplayswhomustberecognizedasthepersonalrepresentativeforacategoryof j individuals: V   IftheIndividualIs:0  0h(#(#0h(#h(#ThePersonalRepresentativeIs:.p(#(#   AnAdultor0 0 (# (#0h(#(#0h(#h(#ApersonwithlegalauthoritytomakehealthH(#(#   AnEmancipatedMinor0 h 0h(#h(#caredecisionsonbehalfoftheindividual4(#(#    `     h   Examples:0 p Healthcarepowerofattorney p(#p(#    `     h      p Courtappointedlegalguardian     `     h      p Generalpowerofattorney     AnUnemancipatedMinor0 h 0h(#h(#Aparent,guardian,orotherpersonactinginloco z" parentiswithlegalauthoritytomakehealthcare f# decisionsonbehalfoftheminorchildR$(#(#    `     h   Exceptions:0 p Seeparentsandminorsdiscussion *&l! below.'X"p(#p(#   Deceased0 0 (# (#0h(#(#0h(#h(#Apersonwithlegalauthoritytoactonbehalfofthe (0!$ decedentortheestate(notrestrictedtohealthcare )"% decisions)*#&(#(#  +#'    `     h   Examples:0 p Executoroftheestatep(#p(#    `     h      p Nextofkinorotherfamilymember     `     h      p Durablepowerofattorney     ParentsandUnemancipatedMinors.ThePrivacyRuledeferstoStateorotherapplicable n  lawsthataddresstheabilityofaparent,guardian,orotherpersonactinginlocoparentis Z  (collectively, parent)toobtainhealthinformationaboutaminorchild.Inmostcasesunderthe F  Rule,theparentisthepersonalrepresentativeoftheminorchildandcanexercisetheminors 2t rightswithrespecttoprotectedhealthinformation,becausetheparentusuallyhastheauthorityto ` makehealthcaredecisionsabouthisorherminorchild.Regardlessofwhetheraparentisthe  L  personalrepresentative,thePrivacyRulepermitsacoveredentitytodisclosetoaparent,or 8  providetheparentwithaccessto,aminorchildsprotectedhealthinformationwhenandtothe $  extentitisexpresslypermittedorrequiredbyStateorotherlaws(includingrelevantcaselaw).   Likewise,thePrivacyRuleprohibitsacoveredentityfromdisclosingaminorchildsprotected   healthinformationtoaparent,orprovidingaparentwithaccessto,suchinformationwhenand   totheextentitisexpresslyprohibitedunderStateorotherlaws(includingrelevantcaselaw).   Thus,Stateandotherapplicablelawgovernswhensuchlawexplicitlyrequires,permits,or ~ prohibitsthedisclosureof,oraccessto,thehealthinformationaboutaminorchild. j   ThePrivacyRulespecifiesthreecircumstancesinwhichtheparentisnotthe personal B representativewithrespecttocertainhealthinformationabouthisorherminorchild.These .p exceptionsgenerallytracktheabilityofcertainminorstoobtainspecifiedhealthcarewithout \ parentalconsentunderStateorotherlaws,orstandardsofprofessionalpractice.Inthese H situations,theparentdoesnotcontroltheminorshealthcaredecisions,andthusundertheRule, 4 doesnotcontroltheprotectedhealthinformationrelatedtothatcare.Thethreeexceptional   circumstanceswhenaparentisnottheminorspersonalrepresentativeare:   {c    {c("0 `   WhenStateorotherlawdoesnotrequiretheconsentofaparentorother   personbeforeaminorcanobtainaparticularhealthcareservice,andthe ! minorconsentstothehealthcareservice;{c((݌~"` (#` (# Ќ     `  Example:0  AStatelawprovidesanadolescenttherighttoobtainmental V$ healthtreatmentwithouttheconsentofhisorherparent,andthe B%  adolescentconsentstosuchtreatmentwithouttheparentsconsent..&p!(#(# {c  0  {c]+"0` (#(#  Whenacourtdeterminesorotherlawauthorizessomeoneotherthanthe (H # parenttomaketreatmentdecisionsforaminor ;{c]++݌(8!$` (#` (# Ќ  0   ` Example:0(#(#Acourtmaygrantauthoritytomakehealthcaredecisionsforthe *#& minortoanadultotherthantheparent,totheminor,orthecourt +$' maymakethedecision(s)itself.(#(# {c    {c-"0 `   Whenaparentagreestoaconfidentialrelationshipbetweentheminorand   thephysician .{c--݌ ` (#` (# Ќ     `    ` Example:0  Aphysicianaskstheparentofa16yearoldifthephysiciancan   talkwiththechildconfidentiallyaboutamedicalconditionandthe   parentagrees.n|(#(#   Evenintheseexceptionalcircumstances,wheretheparentisnotthe personal FT  representativeoftheminor,thePrivacyRuledeferstoStateorotherlawsthatrequire,permit, 2@  orprohibitthecoveredentitytodisclosetoaparent,orprovidetheparentaccessto,aminor ,  childsprotectedhealthinformation.Further,inthesesituations,ifStateorotherlawissilentor    unclearconcerningparentalaccesstotheminorsprotectedhealthinformation,acoveredentity   hasdiscretiontoprovideordenyaparentwithaccesstotheminorshealthinformation,ifdoing   soisconsistentwithStateorotherapplicablelaw,andprovidedthedecisionismadebya   licensedhealthcareprofessionalintheexerciseofprofessionaljudgment.d  d  Abuse,Neglect,andEndangermentSituations.Whenaphysicianorothercoveredentity  reasonablybelievesthatanindividual,includinganunemancipatedminor,hasbeenormaybe ~ subjectedtodomesticviolence,abuseorneglectbythepersonalrepresentative,orthattreatinga jx personasanindividualspersonalrepresentativecouldendangertheindividual,thecovered Vd entitymaychoosenottotreatthatpersonastheindividualspersonalrepresentative,ifinthe BP exerciseofprofessionaljudgment,doingsowouldnotbeinthebestinterestsoftheindividual. .< Forexample,ifaphysicianreasonablybelievesthatdisclosinginformationaboutanincompetent ( elderlyindividualtotheindividualspersonalrepresentativewouldendangerthatindividual,the  PrivacyRulepermitsthephysiciantodeclinetomakesuchdisclosure.   RXXXXFrequentlyAskedQuestions7 !  RXRX#R7#R#RXXR8#7  ToseePrivacyRuleFAQs,clickthedesiredlinkbelow:6Y z# _#XXXRX\8#RXXXX   ` _ X#XXXRXR9# 4QsPO  5  PO  8PO9   _69P_  7#:RXXXX4n PO  5  FAQsonPersonalReps/ParentsandMinors6T;POh;  7 ;#XXXRX2;#RXXXX p  R%`   X#XXXRXJ<#dRXXXXd#XXXRX<# X9%4 4 <DLX94r PO  5  PO  dRXXXXFAQsonALLPrivacyRuleTopics dPOk=   #XXXRX=#RXXXX6W=PO  7 =dRXRXԀ *'8" #RXXR>##XXXRX}>#myNFz8RRXXdXXd8<( ` hp x 44X<RXXXXRXRX(Y#RXXR`@##XXXRXA@#RXXXXoucanalsogotod#XXXRX@#4~ 2 PO  5  PO  RXXXXhttp://_answers.hhs.gov_/cgi_Ԅbin/hhs.cfg/php/enduser/std_alp.phpP5A_  _#XXXRX锛A#RXXXX6!AP_  7 !cAdRXRX,#RXXR-C##XXXRX锤B#RXXXXthen ( $ select"PrivacyofHealthInformation/HIPAA"fromtheCategorydropdownlistand )!% clicktheSearchbutton.d#XXXRX锔C#RXXXX)RXRX#RsD#R    #RD##XXD#