Privacy Officer's Roundtable

1.  Disclosure to School Nurse

Posted 10-10-2017 02:54 PM
Hi all.  Would you say a school nurse is someone who could lessen a threat to the health of others?

Scenario:  child sees provider for contagious illness.  Mom takes child back to school.  School nurse calls and wants to know if child is cleared to be at school because if not, the child could expose other students to their illness.

Is a disclosure to the school nurse if child is cleared or not permissible?


David Garrison CHC,CHPC
Compliance/Privacy Officer

2.  RE: Disclosure to School Nurse

Posted 10-11-2017 07:58 AM
​I would say yes​ it would be permissible. I believe this would be covered under 164.512(j) in addition to an state laws pertaining to education and safety that may speak to this. In the scenario, it sounds like the school nurse already knows the child has/had something contagious so I don't know what else would be disclosed other than if they are still contagious. Of course shouldn't this be the parent's responsibility?

Nancy O'Neill, RN, MBA, CHC, CHPC
Manager, Corporate Responsibility
BayCare Health System
Clearwater, Florida
The opinions I express are mine and not that of BayCare Health System

3.  RE: Disclosure to School Nurse

Posted 10-11-2017 10:54 AM

First it depends...



Thank you,


Lela "Annie" Goldwyn, MS, CHC, CPC, CPMA

Senior Compliance Analyst, CUMG

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CUMG Mailstop:  CSB-100

4500 Sand Point Way, NE, Suite 100

Seattle, WA  98105



Compliance Hotline  866-964-7744



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4.  RE: Disclosure to School Nurse

Posted 10-11-2017 12:41 PM
Interesting Lela. Based on that I would say the provider cannot talk to the school nurse about the patient, but should direct the nurse to the parent. Of course the school nurse, should she have the authority granted by the school, could refuse to allow the child back to school unless the parent produces a signed document from the provider stating the patient is no longer contagious.

Carl Russell
Compliance Analyst
Delta Dental of Idaho

Anything I say is my sole opinion and not of my company.

5.  RE: Disclosure to School Nurse

Posted 10-12-2017 08:03 AM

Just curious... why would it matter if the school is a CE? HIPAA allows us to share information with those who are not CEs for certain purposes. So, even if the student health record the school has is covered under FERPA, the information the provider would share is still covered under HIPAA. Would that be a fair statement? If not, where am I going wrong?

Nancy O'Neill, RN, MBA, CHC, CHPC
Manager, Corporate Responsibility
BayCare Health System
Clearwater, Florida
The opinions I express are mine and not that of BayCare Health System

6.  RE: Disclosure to School Nurse

Posted 10-16-2017 10:07 AM
​While HIPAA allows the sharing of information to non-covered entities under "certain circumstances" the interpretation of both state and federal regulations is what will determine those "certain circumstances".  Case in point.  Pediatric office routinely had court appointed child ombudsman from Health and Human Services review medical records of reported abuse cases.  Prior to HIPAA (in the state of Florida), this was the norm, after HIPAA, it was determined that without a court subpoena, those same Ombudsman had no right what-so-ever to review the medical record.  Why could a court appointed ombudsman for a reported case of child abuse no longer review the medical record?  Because the cases they reviewed were  "reported" abuse, not definitive. It was decided in Lee County, Florida, that medical information could not be shared with those ombudsman without parental approval, unless accompanied by a subpoena.

Lela Goldwyn CHC
Senior Compliance Analyst
CUMG Seattle

7.  RE: Disclosure to School Nurse

Posted 10-12-2017 01:25 PM
Ok, you have all provided interesting view points on this subject.  Here is another view point.

The rule was changed to allow the CE to provide the school with immunization records without an authorization, but only an agreement from mom and dad.

As to disclosing PHI to the school nurse regarding the contagious diseases (some can argue a cold is contagious), let me share this real world event for comparison.

A doctors office finds out that little Johnny has positive TB.  As a result, the doctors office contacts the child care center and notifies them that Johnny has positive TB and to have little Johnny immediately removed from the other children until mom could pick him up.

This permitted disclosure was made to prevent a serious and imminent threat to the other children AND the director of the child care center was resaonably able to prevent the threat by moving Johnny to another room by himself.

Both these factors msut be in place in order to disclose to the school, the treat is imminent and the party notified can prevent the threat.

We would have to know more about what is wrong with this child in order to disclose under this provision of the rule.



Hernan Serrano
Compliance Manager
St Louis,Mo