Information about mental health, chemical dependency, family violence and health has additional protections.

Mental health or chemical dependency

There must be a signed release of information in order to share information about a participant’s mental health or chemical dependency condition.

· The release must identify the specific type of chemical dependency or mental health information being requested.

A welfare system agency may not require a person to consent to the release of mental health data as a condition of receiving services.

A signed release for information about a participant’s chemical dependency diagnosis or treatment must include:

· The specific name or general designation of the program or person permitted to make the disclosure.

· The name or title of the person or the name of the organization to which disclosure is to be made.

· The name of the patient.

· The purpose of the disclosure.

· How much and what kind of information is to be disclosed.

· The signature of the patient and, when required for a patient who is a minor, the signature of a person authorized to give consent; or, when required for a patient who is incompetent or deceased, the signature of a person authorized to sign in lieu of the patient.

· The date on which the consent is signed.

· A statement that the consent is subject to revocation at any time except to the extent that the program or person which is to make the disclosure has already acted in reliance on it.

· The date, event, or condition upon which the consent will expire if not revoked earlier. This date, event, or condition must insure that the consent will last no longer than reasonably necessary to serve the purpose for which it is given.

A sample form may be found at: http s://www.govinfo.gov/content/pkg/CFR-2010-title42-vol1/pdf/CFR-2010-title42-vol1-sec2-31.pdf.

Family Violence

Counties, tribes, and employment services agencies must ensure confidentiality to participants experiencing family violence. To ensure that confidentiality employment services agencies must:

· Obtain a release of information from the participant prior to talking to a family violence advocate about the participant’s issues relating to family violence. See 4.6 (Data Privacy).

· Consult with the participant to determine where to send mail or what numbers to use to make phone calls.

· This is especially critical when the victim of family violence lives with the abuser.

· Do not assume that mail can be sent or phone calls can be made to the participant’s home, because the abuser may be in the home or have access to the home.

· See what to do if the participant is enrolled with Safe At Home, see 8.36 (Resources for Addressing Family Violence).

· Consult with the local county or tribal attorney regarding the county’s or tribe’s data practices policy if you are uncertain how to apply this policy.

Medical and Health Information

Case notes about medical information should contain only the minimum necessary information.

· Rarely include an actual diagnosis.

· Use general language when writing case notes in Workforce One or comments in the Employability Measure.

Examples include: “medical condition present. See case file” or “medical condition restricts activities. See case file.” Or “mental health condition restricts activities. See case file.”

When a participant discloses a medical, mental or chemical health condition but they do not have documentation to support the claim:
Write more specific information on the Employability Measure or in a case note. For example: “participant stated she is feeling depressed, assisted participant in making an appointment for an assessment.”

Protected health Information is:
Individually identifiable health information that meets both of the following conditions:

· Is created by or received from a health care provider, a health plan, a public health authority, an employer, life insurer, school or university or a health care clearinghouse.

· Concerns a health condition, health care services or payment for health care services related to that individual.

Protected Health Information includes the following types of information:

· Oral.

· Written.

· Electronic.

Counties should establish measures to ensure that health information is not accessible to anyone other than authorized personnel.
Workforce One security provisions are sufficient to meet criteria for guarding accessibility for electronic case records.

Related forms
Request for Medical Opinion (DHS-2114) (PDF).