Healthcare professional and non-disclosure agreements I'm just curious if it's legal for a healthcare professional to sign non-disclosure agreements (NDAs) in order to hide certain things from their patient? And also, if the patient asks the healthcare professional whether or not they signed an NDA, is the healthcare professional obligated in any way to disclose that s/he signed an NDA (just not disclosing what's stipulated in the NDA)? (hopefully this makes sense.)
It would be legal for a healthcare professional to sign an NDA prohibiting them from revealing certain information to a patient. Some examples: the password to the computer system; the home phone number and address of the chief of staff. It would not be legal to use an NDA as a basis for denying a patient the right to access their medical records when the HIPAA privacy rule mandates disclosure to the patient (with exceptions).
Your confusion might be caused by the fact that even with a contract, only the data necessary for that contract is covered under the GDPR. So yes, while there might be an &quot;execution of contract&quot; under the T&amp;C, this would only cover necessary data. That means you can't ask arbitrary signup data under the guise of a contract. If you need to deliver a physical product, you can store a physical address. If it's an online service, you can store an email address or similar handle. But you can't mix the two. A physical address is unnecessary for the execution of a contract that's not physical in nature. Now, you mention &quot;consent&quot;. Under GDPR, this is a distinct justification besides &quot;execution of contract&quot;. You might have consent to store a physical address in addition to an online address, e.g. if you offer a customer to physically mail a password request form. This consent is additional to the contract. Also note that the bit above only covers the lawful reasons for the processing of personal data (article 6). You also have to obey the other GDPR rules, e.g. fully inform the user, make sure that consent is freely given, etc.
An agreement to agree is void There is a multitude of case law on this point. If the NDA was not available to you when you signed the employment contract and the term was couched as you describe; then the term would be unenforcable. That is, your employment contract would be binding except for that term i.e. you could not be compelled to sign the NDA. Now, there may be a requirement on you to negotiate in good faith in an attempt to find an NDA you can agree to but if you can't find one you can't find one. You cannot (legally) be fired for this reason. Now, if the NDA was available, and you were told where to find it, and irrespective of if you did or didn't find it, you would be bound to the NDA.
You have to look at the contract, which is that thing they made you sign before the treatment. The primary rule is that the written contract rules (look for a clause saying that &quot;this is the whole agreement&quot; – there is a legal principle, the 4 corners rule, that precludes verbal statements from determining what the agreement is), and the contract probably has a specific statement about your financial responsibility. They may be contractually limited to certain amounts if you are an &quot;in network&quot; patient (because of their contract with the insurance company), but there is always language saying that if the insurance company doesn't pay (not in-network, or some deductible or other coverage-related issue), their friendly cost estimates are not price commitments. You can refuse to pay and they can take you to court; you can make your argument that they promised to do the work for $120. They will counter-argue that they gave you an estimate of the actual cost based on information that they had available, but you agreed to pay the full amount, insurance-based estimates notwithstanding. You can argue that at no time did they ever tell you what the worst-case scenario price would be, and they can argue that a reasonable person would know that $120 is not the full price for a crown and filling. They can argue on grounds of unjust enrichment that you owe them more money. It is not uncommon for people to misinterpret dental estimates as concrete prices.
If that person becomes incapacitated or is deemed unfit to make their own decisions, will I be required to be physically present (for example, to sign something) to make those decisions if called upon? While it is customary for someone making decisions as weighty as removal of life support, to come to the hospital or care facility in person and discuss the issues with treating physicians, it isn't required. When you are physically there it is easier for you to personally assess the patient's condition rather than just taking someone else's word for it, and you have more informal access to everything that is going on in terms of people coming in and out of the patient's room, providers you wouldn't have known to speak to initiating conversations with you (e.g. there is typically an ER nurse for each shift, several residents doing rounds checking on a patient, and often also an outside specialist doctor involved in the treatment team). It is also usually easy when you are physically in a hospital to locate someone knowledgable and familiar with the kinds of issues you are facing at the moment to provide spiritual and religious guidance if you feel this would help you make your decision, while your neighborhood clergy person may not have a good understanding of these issues since they don't come up as often for someone is doesn't frequently spend time around people being treated in hospitals or hospices. And, this kind of pastoral counseling requires not just religious knowledge but an understanding of the options that are being presented through the lens of what is religiously and morally important about the differences between the different options. When I was an attorney for a hospital handling these issues for the hospital, we would have been willing to work with an out of state medical power of attorney agent without their physical presence. But, the fact that this was deep in the Rocky Mountains far from other urban areas (i.e. Grand Junction, Colorado) may have influenced a willingness to be flexible since it would often take a lot of time and money for someone to arrive in person. Also, while the medical power of attorney gives a specific person authority to act, an advanced medical directive is simply a document that goes into a patient's medical record that advises treating providers of the patient's intent and doesn't actually need next of kin approval or a medical power of attorney agent's say so to implement, although better practice is to seek that consent first in case there are any reasons why that advanced medical directive might have been procured improperly from someone lacking capacity or subsequently revoked. There usually will be forms for a medical power of attorney agent to sign, not authorizing a particular medical procedure, but authorizing treatment in general and providing personal and financial information about the patient in connection with admitting that person. But, these days, hospitals are relatively comfortable with handling that paperwork via fax or scanned copies sent via email, and some of the more flexible hospitals will even accept photos of signed documents sent via text message.
It means that the agreement lasts for 6 months under which confidential information (CI) provided must be kept secret for 3 years. So lets say you signed this agreement on January 1, 2018. Any CI materials provided between Jan-1 2018 to Jun-30 2018 must be kept confidential up until January 1, 2021 (3 years from the effective date). However if you received a CI material on July 1, 2018 the NDA would have expired and you would not be obligated to keep it confidential at all. These types of short-term NDA's require careful oversight because it is easy to forget that the NDA has expired and start providing CI to third parties not obligated to keep them confidential because the NDA expired. So, in short, it means that anything provided as CI during the 6-month term of the NDA must be kept confidential for 3 years. After 6 months the NDA is no longer in effect and care must be taken in exchange of CI to third parties.
The health insurance contract should set forth what is and is not covered in detail (in addition, there would be a short summary version). They probably don't have to provide procedure codes that are covered or not covered because no such one to one correspondence exists because the language of the insurance contract is controlling and does not exactly correspond to procedure codes. For example, one of the basic eligibility questions is whether a procedure is medically necessary. A procedure may be medically necessary for one person, but not for another, and usually a denial based upon medical necessity is subject to appeal to other medical professionals engaged by the insurance company. Unless the insurance contract provides that an EOB must contain procedure codes, it probably doesn't have an affirmative obligation to do so, because there is no general principle of law that would require them to disclose their internal classification of services provided outside of a litigation context. And, in a litigation context, you probably could obtain procedure codes in discovery from the insurance company, as the code assigned to a procedure on an EOB would almost surely not be privileged or a legally protected secret. It may very well be that the company has an in house set of procedures for certain common diagnosis codes that are routinely allowed or are flagged for review by an insurance company bureaucrat. But, that would ordinarily be considered something of a trade secret of the company and is not a statement of what is or is not allowed under the actual health insurance contract. However, the privilege against disclosing the information in that context would flow from trade secret law and not from the fact that they are PHI. I don't agree that PHI is the correct reason for failing to disclose that information (unless some case law of which I am not aware has interpreted it differently). The federal law definition of PHI is at 45 CFR 160.103: Protected health information means individually identifiable health information: (1) Except as provided in paragraph (2) of this definition, that is: (i) Transmitted by electronic media; (ii) Maintained in electronic media; or (iii) Transmitted or maintained in any other form or medium. (2) Protected health information excludes individually identifiable health information: (i) In education records covered by the Family Educational Rights and Privacy Act, as amended, 20 U.S.C. 1232g; (ii) In records described at 20 U.S.C. 1232g(a)(4)(B)(iv); (iii) In employment records held by a covered entity in its role as employer; and (iv) Regarding a person who has been deceased for more than 50 years. The cross reference to 20 U.S.c. 1232g(a)(4)(B)(iv) reads as follows: (iv) records on a student who is eighteen years of age or older, or is attending an institution of postsecondary education, which are made or maintained by a physician, psychiatrist, psychologist, or other recognized professional or paraprofessional acting in his professional or paraprofessional capacity, or assisting in that capacity, and which are made, maintained, or used only in connection with the provision of treatment to the student, and are not available to anyone other than persons providing such treatment, except that such records can be personally reviewed by a physician or other appropriate professional of the student’s choice. In short, it is B.S. that you are being given an illegitimate reason for not complying with your request, but it is probably still within the company's rights for other legitimate reasons to deny your request.
No Voluntary disclosure, even accidental, by the client ends privilege. The information may still be confidential (inadmissible) if it happened in the appropriate circumstances, for example, as part of a mediation. Edit A recent decision of the High Court of Australia has determined that a litigant can use material that comes into its possession that would have attracted privilege irrespective of how this happens. In that case, the law firm was hacked by an unknown party, the information was given to a journalist and published and the litigant wanted to use it in their case - they were allowed to do so. The court decided that privilege is not a legal right that could found a course of action. Basically, it only prevents the compulsory production of such information - it doesn't protect the information itself.