23VA163
Patient and Employee Infectious Disease Records (Formally known as 22VA136)-VA
System location:
Paper records are maintained at VA health care facilities and
Federal record centers. Information is stored also in automated
storage media records that are maintained at: The health care
facilities (in most cases, back-up computer tape information is
stored also at off-site locations); Department of Veterans Affairs
Headquarters, 810 Vermont Ave, NW., Washington, DC; the VA Allocation
Resource Center, Braintree, Massachusetts; the VA Office of
Information Field Offices (OIFOs); the Veterans Benefits
Administration (VBA) Regional Directors and Division Offices; and the
Austin Automation Center (AAC) located in Austin, Texas. Address
locations for VA facilities are listed in VA Appendix 1 of the
biennial Privacy Act Issuances publication.
Categories of individuals covered by the system:
- Veterans who have applied for health care services under title
38, United States Code, Chapter 17.
- Beneficiaries of other Federal agencies.
- Pensioned members of allied forces who are provided health
care services under Title 38, United States Code, Chapter 1.
- Non-VA health care providers who provide fee basis services to
veterans.
Categories of records in the system:
The records include information concerning patients who are
authorized to obtain medical care and services from non-VA health
care institutions and providers and the institutions and/or providers
(e.g., individuals, pharmacies, clinics or group practices,
hospitals, nursing homes, physicians, psychologists, podiatrists,
optometrists, nurses, and others) who furnish the authorized medical
treatment, services, medications, or supplies. The patient
information may include name, address, social security and VA claim
numbers, medical conditions authorized for treatment, eligibility
information related to such treatment, the date authorization for the
services was issued and the period of validity, the amounts paid for
travel benefits, the amounts reimbursed for services paid for by the
patient, and information that pertains to the medical care.
Information that is maintained concerning the health care
institutions and providers may include name, address, social security
or employer's taxpayer identification numbers, services rendered,
fees charged and amounts paid for services rendered, and earnings for
performing such services.
Authority for maintenance of the system:
Title 38, United States Code, chapter 1, section 111 and chapter
17, sections 1703, 1710, 1712, 1720 and 1728.
Purpose(s):
The records or information are used for the purposes of reporting
health care provider earnings to the Internal Revenue Service;
producing various management and patient follow-up reports;
responding to patient and other inquiries; statistical analysis; for
resource allocation and planning; providing clinical and
administrative support to patient medical care and payments for
medical care; determining entitlement and eligibility for VA
benefits; processing and adjudicating benefit claims by VBA Regional
Office (RO) staff; audits, reviews and investigations conducted by
staff of the health care facility, the VBA Regional Directors and
Division Offices, VA Headquarters, and the VA Office of Inspector
General (OIG); law enforcement investigations; and quality assurance
audits, reviews and investigations.
Routine uses of records maintained in the System Including
categories of users and the purposes of such uses:
To the extent that records contained in the system include
information protected by 38 U.S.C. 7332 (formerly section 4132),
i.e., medical treatment information related to drug abuse, alcoholism
or alcohol abuse, sickle cell anemia or infection with the human
immunodeficiency virus, that information cannot be disclosed under a
Routine Use unless there is also specific statutory authority
permitting disclosure.
- Any information in this system, except the name and address of
a veteran, which is relevant to a suspected violation or reasonably
imminent violation of law, whether civil, criminal or regulatory in
nature and whether arising by general or program statute or by
regulation, rule or order issued pursuant thereto, may be disclosed
to a Federal, State, local or foreign agency charged with the
responsibility of investigating or prosecuting such violation, or
charged with enforcing or implementing the statute, regulation, rule
or order issued pursuant thereto. The names and addresses of veteran
may only be disclosed:
- To a Federal agency charged with the responsibility of
investigating or prosecuting such violation, or charged with
enforcing or implementing the statute, regulation, rule or order
issued pursuant thereto, in response to its official request.
- To any foreign, State or local government agency or
instrumentality charged under applicable law with the protection of
the public health or safety if a qualified representative of such
organization, agency or instrumentality has made a written request
that such name and address be provided for a purpose authorized by
law.
- A record from this system of records may be disclosed as a
``routine use'' to a Federal, State, or local government agency, or
to a non-governmental organization maintaining civil, criminal or
other relevant information, such as current licenses, registration or
certification, if necessary to obtain information relevant to an
agency decision concerning the hiring or retention of an employee,
the use of an individual as a consultant, attending or to provide fee
basis health care, the issuance of a security clearance, the letting
of a contract, or the issuance of a license, grant or other health,
educational or welfare benefits. Any information in this system also
may be disclosed to any of the above-listed governmental
organizations as part of a series of ongoing computer matches to
determine if VA health care practitioners and private practitioners
used by the VA hold current, unrestricted licenses, or are currently
registered in a State, and are board certified in their specialty, if
any. These computer matches are performed pursuant to the VA OIG's
authority under Pub. L. 95-452, section 4(a), to detect and prevent
fraud and abuse.
- A record from this system of records may be disclosed to a
Federal agency, in response to its request, in connection with the
hiring or retention of an employee, the issuance of a security
clearance, the reporting of an investigation of an employee, the
letting of a contract, or the issuance of a license, grant, or other
benefit by the requesting agency, to the extent that the information
is relevant and necessary to the requesting agency's decision on the
matter.
- To the Treasury Department to facilitate payments to
physicians, clinics, and pharmacies for reimbursement of services
rendered.
- To the Treasury Department to facilitate payments to veterans
for reimbursements of travel expenses.
- Disclosure may be made to a congressional office from the
record of an individual in response to an inquiry from the
congressional office made at the request of that individual.
- Disclosure may be made to National Archives and Records
Administration (NARA), General Services Administration (GSA) in
records management inspections conducted under authority of 44 United
States Code.
- Records from this system of records may be disclosed to a
Federal agency or to a State or local government licensing board and/
or to the Federation of State Medical Boards or a similar non-
government entity which maintains records concerning individuals'
employment histories or concerning the issuance, retention or
revocation of licenses, certifications, or registration necessary to
practice an occupation, profession or specialty, in order for the
agency to obtain information relevant to an agency decision
concerning the hiring, retention or termination of an employee or to
inform a Federal agency or licensing boards or the appropriate non-
government entities about the health care practices of a terminated,
resigned or retired health care employee whose professional health
care activity so significantly failed to conform to generally
accepted standards of professional medical practice as to raise
reasonable concern for the health and safety of patients in the
private sector or from another Federal agency. These records may also
be disclosed as part of an ongoing computer matching program to
accomplish these purposes.
- Identifying information in this system, including name,
address, social security number and other information as is
reasonably necessary to identify such individual, may be disclosed to
the National Practitioner Data Bank at the time of hiring and/or
clinical privileging/reprivileging of health care practitioners, and
other times as deemed necessary by VA, in order for VA to obtain
information relevant to a Department decision concerning the hiring,
privileging/reprivileging, retention or termination of the applicant
or employee.
- Relevant information from this system of records may be
disclosed to the National Practitioner Data Bank and/or State
Licensing Board in the State(s) in which a practitioner is licensed,
in which the VA facility is located, and/or in which an act or
omission occurred upon which a medical malpractice claim was based
when VA reports information concerning: (a) Any payment for the
benefit of a physician, dentist, or other licensed health care
practitioner which was made as the result of a settlement or judgment
of a claim of medical malpractice if an appropriate determination is
made in accordance with agency policy that payment was related to
substandard care, professional incompetence or professional
misconduct on the part of the individual; (b) a final decision which
relates to possible incompetence or improper professional conduct
that adversely affects the clinical privileges of a physician or
dentist for a period longer than 30 days; or (c) the acceptance of
the surrender of clinical privileges or any restriction of such
privileges by a physician or dentist either while under investigation
by the health care entity relating to possible incompetence or
improper professional conduct, or in return for not conducting such
an investigation or proceeding. These records may also be disclosed
as part of a computer matching program to accomplish these purposes.
- Relevant identifying and medical treatment information
(excluding medical treatment information related to drug or alcohol
abuse, infection with the human immunodeficiency virus or sickle cell
anemia) may be disclosed to a Federal agency or non-VA health care
provider or institution when VA refers a patient for treatment or
medical services or authorizes a patient to obtain non-VA medical
services and the information is needed by the Federal agency or non-
VA institution or provider to perform the services or for VA to
obtain sufficient information in order to make payment for the
services, to evaluate the services rendered, or to determine the need
for additional services.
- Information maintained in this system concerning non-VA
health care institutions and providers, including name, address,
social security or employer's taxpayer identification numbers, may be
disclosed to the Treasury Department, Internal Revenue Service, to
report calendar year earnings of $600 or more for income tax
reporting purposes.
- In order to prevent or identify duplicate payments by
Medicare intermediaries, relevant information (excluding medical
treatment information related to drug or alcohol abuse, infection
with the human immunodeficiency virus or sickle cell anemia) may be
disclosed to the Department of Health and Human Services (HHS) for
the purpose of identifying individuals who are authorized by VA to
obtain non-VA health care services at VA's expense and those for whom
payments have been made. The information to be disclosed to HHS
includes identifying information (patient and provider names,
addresses, social security and taxpayer identification numbers, and
date of birth of patient), treatment information (dates and
diagnostic, surgical, and services provided codes) and payment
information (payee, amounts and dates).
- Disclosure of relevant information may be made to
individuals, organizations, private or public agencies, etc., with
whom VA has a contract or agreement to perform such services as VA
may deem practicable for the purposes of laws administered by VA, in
order for the contractor or subcontractor to perform the services of
the contract or agreement.
Policies and practices for storing, retrieving, accessing,
Retaining, and Disposing of records in the system:
Storage:
Records are maintained on paper documents at the health care
facilities. Paper payment vouchers are maintained at the health care
facility or AAC at Austin, Texas. Information on automated storage
media (e.g., microfilm, microfiche, magnetic tape and magnetic disks
and laser optical media) is stored at the health care facilities
(includes record information stored in the Integrated Hospital System
(IHS) at selected medical facilities and at other facilities in the
Veterans Integrated Systems and Technology Architecture (VistA)
system, and, in most cases, copies of back-up computer files
maintained at off-site locations), VA Headquarters, the VA Allocation
Resource Center (ARC), the Regional Directors and Division Offices,
the OIFOs and the AAC. Reports generated from these records are
maintained on paper and microfiche at the health care facilities, VA
Headquarters, the Regional Directors and Division Offices, and the
AAC.
Retrievability:
Information is retrieved by the patient's name and/or social
security number and/or the name or social security or taxpayer
identification numbers of the non-VA health care institution or
provider.
Safeguards:
- Access to working spaces and record storage areas in VA health
care facilities is restricted to VA employees on a ``need-to-know''
basis. Generally, file areas are locked after normal duty hours and
the health care facilities are protected from outside access by the
Federal Protective Service or other security personnel. Access to the
records is restricted to VA employees who have a need for the
information in the performance of their official duties. Employee
records or records of public figures or otherwise sensitive records
are generally stored in separate locked files. Strict control
measures are enforced to ensure that access to and disclosures from
these records are limited to a ``need-to-know'' basis.
- Access to the VistA and IHS computer rooms at health care
facilities is generally limited by appropriate locking devices and
restricted to authorized VA employees and vendor personnel.
Peripheral devices are generally placed in secure areas (areas that
are locked or have limited access) or are otherwise protected.
Information in the VistA and IHS systems may be accessed by
authorized VA employees. Access to file information is controlled at
two levels: the system recognizes authorized employees by a series of
individually unique passwords/codes as a part of each data message,
and the employees are limited to only that information in the file
which is needed in the performance of their official duties.
Information that is downloaded from the AAC and VistA and IHS files
and maintained on personal computers is afforded similar storage and
access protections as the data that is maintained in the original
files. Remote access to file information by staff of the OIFOs, VBA
Regional Offices, and access by OIG staff conducting an audit or
investigation at the health care facility or an OIG office location
remote from the health care facility is controlled in the same
manner.
- Access to the AAC is generally restricted to Center employees,
custodial personnel, Federal Protective Service and other security
personnel. Access to computer rooms is restricted to authorized
operational personnel through electronic locking devices. All other
persons gaining access to computer rooms are escorted. Information
stored in the computer may be accessed by authorized VA employees at
remote locations including VA health care facilities, OIFOs, VA
Headquarters, Regional Directors and Division Offices, and OIG
headquarters and field staff. Access is controlled by individually
unique passwords/codes which must be changed periodically by the
employee.
- Access to records maintained at VA Headquarters, the VA ARC,
the OIFOs and the Regional Directors and Division Offices is
restricted to VA employees who have a need for the information in the
performance of their official duties. Access to information stored on
automated storage media is controlled by individually unique
passwords/codes. Information stored on computers at the OIFOs may be
accessed by authorized VA employees at remote locations including VA
health care facilities and Regional Directors and Division Offices.
Access is controlled by individually unique passwords/codes. Records
are maintained in manned rooms during nonworking hours. The
facilities are protected from outside access during working hours by
the Federal Protective Service or other security personnel.
- Information downloaded from VistA and IHS and VA AAC files and
maintained by the OIG Headquarters and field offices on automated
storage media is secured in storage areas or facilities to which only
OIG staff have access. Paper documents are similarly secured. Access
to paper documents and information on automated storage media is
limited to OIG employees who have a need for the information in the
performance of their official duties. Access to information stored on
automated storage media is controlled by individually unique
passwords/codes.
Retention and disposal:
Paper documents at the health care facility related to
authorizing the fee basis care and the services authorized, billed
and paid for are maintained in the Patient Medical Records-VA
(24VA136). These records are retained at health care facilities for a
minimum of three years after the last episode of care. After the
third year of inactivity the paper records are transferred to a
records facility for seventy-two (72) more years of storage.
Automated storage media and other paper documents that are included
in this system of records and not maintained in the Patient Medical
Records-VA (24VA136) are retained and disposed of in accordance with
disposition authorization approved by the Archivist of the United
States.
System manager(s) and address:
Director, Health Administration Service (163), VA Headquarters,
810 Vermont Ave., NW., Washington, DC 20420.
Notification procedure:
An individual who wishes to determine whether a record is being
maintained in this system under the individual's name or other
personal identifier, or wants to determine the contents of such
record, should submit a written request or apply in person to the
last VA health care facility where care was authorized or rendered.
Addresses of VA health care facilities may be found in VA Appendix 1
of the biennial publication. All inquiries must reasonably identify
the portion of the fee basis record involved and the place and
approximate date that medical care was provided. Inquiries should
include the patient's full name, social security number and return
address.
Record access procedures:
Individuals seeking information regarding access to and
contesting of VA fee basis records may write, call or visit the last
VA facility where medical care was authorized or provided.
Contesting record procedures:
(See Record Access Procedures above.)
Record source categories:
The patient, family members or accredited representative, and
friends, employers or other third parties when otherwise unobtainable
from the patient or family; military service departments; private
medical facilities and health care professionals; Patient Medical
Records-VA (24VA136); other Federal agencies; VA regional offices; VA
automated record systems including Individuals Submitting Invoices/
Vouchers for Payment-VA (13VA047), Veterans and Beneficiaries
Identification and Records Location Subsystem-VA (38VA23) and the
Compensation, Pension, Education and Rehabilitation Records-VA
(58VA21/22); and various automated systems providing clinical and
managerial support at VA health care facilities.
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