Category: Privacy

Date: March 2003

Reviewed/Revised: April 2013

Policy

It is the policy of EVMS Medical Group and affiliates to have sufficient safeguards in place to protect confidential healthcare information.

Procedure

The following are to be used to protect confidential healthcare information.

Paper Charts

  1. Medical records must be stored in areas which are attended or secure.
  2. As necessary to facilitate patient care, medical records of patients may be stored in the nurses’ station or in the intake area, provided these areas are always attended or secure. The following employees are permitted access to these medical records to the extent required to perform their duties:

    Physicians, nurses, ancillary personnel, and specified individuals with permission to access limited portions of a patient’s medical record are to be provided access to the specific information by a nursing or medical records employee

  3. Individuals without permission to access a patient’s medical record are not provided access to the record.
  4. Records not in use in the clinical area are stored in the Medical Records Department. Clinical, administrative and billing employees may have access to medical records to the extent required to perform their duties.

EHR

Electronic/computerized records of any current or previous patient can only be accessed by those with permission to do so. Permission is granted via the log-in procedure and utilizing the designated password.

Any non-medical record documents containing identifiable patient healthcare information are to be shredded prior to disposal. Examples of these documents include notes taken by nurses, notes made during the course of providing patient care, and notes made from communication among and between other healthcare providers regarding patient care.

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