Is a state issued ID required to see a doctor with insurance? Suppose there is someone who has insurance but they do not have a state issued ID card, let's say they only have a school ID. If this person goes to a doctor's office and shows their school ID and insurance card and provides all details such as their DOB an SS number, can the doctor still refuse to see them because they did not show a "proper" ID (a state issued one)? A related question is does this ID check come from the insurance companies or is it a legal requirement in some or all states?
There is no state that requires you to show ID to obtain medical care. To the extent that this is done it is done at the behest of whoever is paying for the care to determine that you are someone who is authorized to benefit from this payment, and not an imposter, or as a matter of policy of the doctor. (An exception to this general rule applies when one wants to pick up a prescription for a controlled substance or a Sudafed product, where you must indeed show ID to show that your name matches a prescription or to insure that the right name is entered into the Sudafed database.) It might be more convenient for the doctor in terms of collection of bad debt, insurance policy claims (where an insurance card would normally be required, at least), protection against fraud claims from an insurer, and medical record keeping to have a name, so a doctor might make it a policy to require ID, but it is not required by law (except where a government benefit provider like Medicaid or Medicare is involved and has a regulation requiring it). For example, in the Las Vegas shooting, where there wasn't time to process paperwork, hospital triage officials simply assigned an alias to every incoming patient and wrote it in marker on their body to keep the medical records straight, and to allow that alias to track medical costs to be billed when the time came to get the proper intake paperwork filled out and the file sent to the accounting department. There are also other circumstances that do not involve emergency treatment (e.g. STD testing, methadone treatment at free clinics, and clinical trials) where an alias rather than a true name is sometimes used to keep track of patients.
Yes. There is both a duty to disclose and permit inspection of certain records (e.g. those that adversely affect either party's case or support another party's case) and a right for the court to demand access to other specific records. In england-and-wales the applicable rules are found in Part 31 of the Civil Procedure Rules. For example: Standard disclosure 31.6 Standard disclosure requires a party to disclose only– (a) the documents on which he relies; and (b) the documents which – (i) adversely affect his own case; (ii) adversely affect another party’s case; or (iii) support another party’s case; and (c) the documents which he is required to disclose by a relevant practice direction. Specific disclosure (1) The court may make an order for specific disclosure or specific inspection. (2) An order for specific disclosure is an order that a party must do one or more of the following things – (a) disclose documents or classes of documents specified in the order; (b) carry out a search to the extent stated in the order; (c) disclose any documents located as a result of that search. Party's control 31.8 (1) A party’s duty to disclose documents is limited to documents which are or have been in his control. (2) For this purpose a party has or has had a document in his control if – (a) it is or was in his physical possession; (b) he has or has had a right to possession of it; or (c) he has or has had a right to inspect or take copies of it. Right of inspection 31.3 (1) A party to whom a document has been disclosed has a right to inspect that document except where – (a) the document is no longer in the control of the party who disclosed it; (b) the party disclosing the document has a right or a duty to withhold inspection of it, or (c) paragraph (2) applies. (2) Where a party considers that it would be disproportionate to the issues in the case to permit inspection of documents within a category or class of document disclosed under rule 31.6(b) – (a) he is not required to permit inspection of documents within that category or class; but (b) he must state in his disclosure statement that inspection of those documents will not be permitted on the grounds that to do so would be disproportionate. Inspection and copying 31.15 Where a party has a right to inspect a document– (a) that party must give the party who disclosed the document written notice of his wish to inspect it; (b) the party who disclosed the document must permit inspection not more than 7 days after the date on which he received the notice; and (c) that party may request a copy of the document and, if he also undertakes to pay reasonable copying costs, the party who disclosed the document must supply him with a copy not more than 7 days after the date on which he received the request. And, in case there's any doubt that this applies to electronic records: Meaning of document 31.4 In this Part – ‘document’ means anything in which information of any description is recorded;
The Highway Code said: Vehicles. Any vehicle driven by a learner MUST display red L plates. In Wales, either red D plates, red L plates, or both, can be used. Plates MUST conform to legal specifications and MUST be clearly visible to others from in front of the vehicle and from behind. Plates should be removed or covered when not being driven by a learner (except on driving school vehicles). [Law MV(DL)R reg 16 &amp; sched 4] The good old Highway Code "Must" vs "Should". "Must" means that it is a legal issue, anything that is "Should" is only advisory
HIPAA does not legally protect physicians from disclosing PHI to another party, although there are a few exceptions: HHS provides an excellent resource on these, but the regulation most relevant to your question is Permitted Uses and Disclosures (5) Public Interest and Benefit Activities, which includes "Required by Law. Covered entities may use and disclose protected health information without individual authorization as required by law (including by statute, regulation, or court orders)." These statues, regulations, and court orders vary from state, but almost all of them refer to STDs and not genetic conditions (in some states, physicians are required to disclose positive STD test results to known sexual partners, but I can't find similar legislation for genetic tests). Here's an example of a voluntary patient information disclosure form – you'll notice that an individual has to specify the parties to whom they're willing to have PHI disclosed. The example you provided is still a violation of the Privacy Rule in the U.S., but this is a very curious grey area in bioethics and law. Disclosure of Genetic Information Within Families: How nurses can facilitate family communication. Gallo et al. Am J Nurs. 2009 Apr; 109(4): 65–69. (Emphasis mine.) HIPAA and Genetic Disclosure Does the law affect families? The privacy rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) went into effect on April 14, 2003. The rule created new requirements for health care providers, third-party payers, and health care clearinghouses to protect the privacy and security of health information, including genetic information, that could identify a person. A person's decision not to disclose her or his risk of developing a genetic condition to a family member may pose a dilemma for the health care professional, who has to choose between ethical obligations to inform the at-risk party and legal requirements to respect and protect the patient's privacy. The potential for harm to family members often plays a large role in the decision. For example, in rare cases, the use of a certain surgical anesthesia can cause death in people with the mutation that disposes them to malignant hyperthermia. Likewise, strenuous exercise can bring on sudden death in people with hypertrophic cardiomyopathy. In such cases, clinicians should carefully explain the reasons for sharing information with family members, strongly encourage patients to notify at-risk relatives, and offer to help develop a plan for notifying them. When patients choose not to notify family members, clinicians typically respect the decision. There are situations, however, in which the clinician may consider overriding the patient's preferences because the family member is judged to be in danger of serious or immediate harm or there is a high likelihood that a dangerous condition will occur that can be either prevented or adequately treated with early recognition. Clinicians who believe it is necessary to override a patient's wish regarding the notification of family members, should consider consulting an ethics committee or legal council. In most situations, though, the risk of serious harm associated with nondisclosure is not clearly immediate. For instance, if a woman has tested positive for the BRCA1 or BRCA2 mutation but doesn't want to upset her two sisters by sharing that information with them, the need for disclosure isn't clearly urgent. Each sister has a one in two chance of carrying the same mutation. It would be understandable for the patient to try to learn more about what the mutation means for her and her children and to give careful thought to whether and how she'll share her test results with her sisters. Clinicians can best help family members by clearly informing patients who test positive for genetic conditions or the mutations that cause them about the risks faced by their family members, discussing the value of disclosure and offering assistance with it. The "Duty to Warn" a Patient's Family Members About Hereditary Disease Risks. Offit et al. JAMA. 2004;292(12): 1469–1473. (I can send you the full-text of this if you want it; it contains an excellent overview of cases and their outcomes relating to disclosing genetic information in the U.S. under HIPAA.) In general, the special nature of genetic tests has been viewed as a barrier to physicians' breaching the confidentiality of personal genetic information. However, the failure to warn family members about hereditary disease risks has already resulted in 3 lawsuits against physicians in the United States. While the findings of case law and the state and federal statutes that bear on the issue of "duty to warn" of inherited health risk are still being defined, we believe that health care professionals have a responsibility to encourage but not to coerce the sharing of genetic information in families, while respecting the boundaries imposed by the law and by the ethical practice of medicine. ...in considering whether to breach patient confidentiality to warn of risks of a genetic disease, clinicians need to balance the actual risk of that disease, the efficacy of potential preventive interventions, as well as emerging legal considerations and potential liabilities. Overriding patient confidentiality and genetic privacy might very well mean violation of HIPAA and certain state regulations, with attendant civil or criminal liability. At the same time, in one state appellate court decision that has not been overturned, the estate of a physician was held liable for his failure to warn relatives of hereditary disease risk.
Unless the notary personally knows the signer, the notary should, and normally will, ask for identification, and the name that the notary puts in the notarization certificate should be copied exact6ly from whatever ID is presented. For Alan Jones to sign as J7, he would need some sort of official proof, acceptable to the notary, that he is "J7". What would that be? I doubt that any notary would certify such a doccument. (If the document is signed as "Alan Jones" but the ID says "Alan J Jones" I am not sure if the notary must follow the ID or may follow the document, assuming that the notary is convinced that the two are the same person. Many notaries in practice will follow the ID.) I agree that the normal way would be for the document to say "Alan Jones, also known as 'J7'", and possibly include wording such as "I Alan Jones, am the person who posts on site XYZ.com as "J7", and specifically who posted a message starting {quote} at {timestamp}." (Or it could give the secure hash of the message, or of several messages.) This would clearly est6ablish a link between the document and the online conversations/acts that it is meant to refer to. The questions says: a need has developed for Alan Jones to sign a document using the name J7 I doubt that doing such a thing is either required or helpful. Rather I suspect he will need to sign a document in which he acknowledges being the particular "J7" involved in the matter.
This is currently untested but the U.S. Supreme Court did leave the door open to allow someone to plead the 5th amendment in order to hide their identity. In Hiibel v. Nevada the U.S. Supreme Court held that the petitioner did not have a 5th amendment right to withhold his name from a questioning police officer. The Supreme Court held that Mr. Hiibel could be arrested for failing to identify himself because Nevada's statute requiring identification was narrowly tailored and was not vague. The police officer who stopped Mr. Hiibel had reasonable suspicion that a crime had occurred and Mr. Hiibel could have satisfied Nevada's statute by simply stating his name; there was no requirement to turn over any papers or other documentation. The final paragraph of the opinion speaks of the importance of the narrow scope of the disclosure requirement and then goes on and states: ...Answering a request to disclose a name is likely to be so insignificant in the scheme of things as to be incriminating only in unusual circumstances...Even witnesses who plan to invoke the Fifth Amendment privilege answer when their names are called to take the stand. Still, a case may arise where there is a substantial allegation that furnishing identity at the time of a stop would have given the police a link in the chain of evidence needed to convict the individual of a separate offense. In that case, the court can then consider whether the privilege applies, and, if the Fifth Amendment has been violated, what remedy must follow. We do not resolve those questions here. While the court is leaving unanswered the question of whether there are circumstances where one may refuse to identify themselves, they are making it quite clear that such a situation would be very different than the case decided in Hiibel. There is a strong hint that they would uphold Fifth Amendment privilege in the situation you posit.
No. HIPAA places no limits on who you may share your medical records with - only on those with who your doctors (et al) can share. The HIV laws you refer to, place a positive obligation on you to share the information.
This practice is known as "rescission". It is legal under 45 CFR §147.128 in some circumstances. The regulation says (a) A group health plan, or a health insurance issuer offering group or individual health insurance coverage, must not rescind coverage under the plan, or under the policy, certificate, or contract of insurance, with respect to an individual (including a group to which the individual belongs or family coverage in which the individual is included) once the individual is covered under the plan or coverage, unless the individual (or a person seeking coverage on behalf of the individual) performs an act, practice, or omission that constitutes fraud, or makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage. The law also prohibits surprises: A group health plan, or a health insurance issuer offering group or individual health insurance coverage, must provide at least 30 days advance written notice to each participant (in the individual market, primary subscriber) who would be affected before coverage may be rescinded under this paragraph (a)(1), regardless of, in the case of group coverage, whether the coverage is insured or self-insured, or whether the rescission applies to an entire group or only to an individual within the group. (The rules of this paragraph (a)(1) apply regardless of any contestability period that may otherwise apply.) Note that the regulation pertains to insurance plans, and not employers. The employer may in good faith believe that you are stuck with the medical bills, but their opinion does not matter as far as this regulation goes. However, the employer also does not have the right to "declare" on behalf of the insurance company that your wife was covered. If you assume that she had coverage because the employer (mistakenly) said you did, but there was actually no coverage, then that is between you and the employer, or possibly you and the doctor. A prior question is whether she was actually covered in that past period. The contract between the insurance company and the employer might hypothetically state that only employees are covered, and may have accidentally submitted enrollment information with mistaken information ("X is an employee"). Since there was no intentional misrepresentation (we assume), coverage cannot be rescinded. Also note that rescission is retroactive cancelling, not prospective cancelling ("henceforth, you are not covered").