1. Nebraska SNIP Medical Consents (Decisions) - “101” Suggestions and Resources January 16, 2002 Subgroup Members zChristine Heeren, Faith Regional - Norfolk zLois Givens, BryanLGH - Lincoln zCharlene Dunbar, Madonna - Lincoln zJean Dowling, Saint Elizabeth - Lincoln

2. Resources zLetter to Faith Regional from Baird Holm dated November 19, 1999 zLetter to Saint Elizabeth Regional Medical Center from Cline Williams dated January 18, 2001

3. Case Scenario 1: zA nursing home patient is dropped off for an outpatient test. They do not have any paperwork with them and they are somewhat disoriented. zDilemma: Can the patient sign the consent for treatment?

4. Points to Consider for Case Scenario 1: zIf an adult patient is alert and generally oriented to person, place, time and situation the patient makes major decisions. zIf an adult patient is not generally oriented or there are questions regarding the patient’s capacity to understand the information and to make decisions, contact the nursing home facility to verify who has authority to provide consent to treat. zReference Baird Holm, “2. Incapacitated Persons” for more specifics. zDoes your hospital/ facility have a specific guideline that you can share?

5. Case Scenario 2: zA patient arrives in the Admissions department and is physically unable to sign. zDilemma: Who signs the consent?

6. Points to Consider for Case Scenario 2: zIf an adult patient is alert and generally oriented to person, place, time and situation the patient makes major decisions. yAny mark on a paper made with pen in hand or mouth and witnessed by 2 people ySignature generated with pen in the patient’s mouth yThumb print or finger print facilitated by another person and witnessed by 2 people yVerbal consent witnessed by two people

7. Case Scenario 3: zA patient is visiting from a foreign country and arrives at your emergency room and does not speak English. zDilemma: How does the registrar explain to the patient that she/he needs the patients permission prior to providing medical care?

8. Points to Consider for Case Scenario 3: zThe hospital/facility is responsible for providing an effective means of communication, thereby ensuring meaningful access to health care programs and services, in compliance with the Civil Rights Act of 1964 and the Age Discrimination Act of 1975. At Saint Elizabeth we use the following guidelines: zAll patients/families will be assessed for communication needs upon admission or at the time of scheduling admission when possible. Hospital personnel will utilize the following criteria as a guide to determine which interpreter resource is appropriate:

9. Points to Consider for Case Scenario 3: zAVAILABLE RESOURCES (Suggested by Saint Elizabeth) CHIRP Line *For brief (15 minutes or less) interactions. *When immediate access to an interpreter is required. *For simple patient/family education/instruction. *Dial 2167. The menu includes 1 for Arabic, 2 for Bosnian, 3 for Russian, 4 for Spanish, and 5 for Vietnamese. AT&T Language Line *For brief (5 minutes or less) interactions. *When immediate access to an interpreter is required. *For simple patient/family education/instruction. *Call the main Switchboard for connection to Language Line. International Communications, Inc. On-Site Interpreter *For complex patient/family education/instruction. *For patient/family interactions greater than 15 minutes. International Communications, Inc. 2-Way, 3-Way Phone Conferencing z*For scheduling healthcare appointments and Pre-admission assessment

10. Case Scenario 4: zA comatose patient arrives via an ambulance at your facility. zDilemma: Who signs the consent?

11. Points to Consider for Case Scenario 4: zReference Baird Holm, “2. Incapacitated Persons” for more specifics. zIf treatment is considered emergent, the consent should be noted “patient unable to sign” and follow-up should continue to occur with someone with legal authority. zEMTALA Considerations

12. Case Scenario 5: zA five year old child was riding their bike and was hit by a motor vehicle. The child was at their father’s for weekend visitation. zDilemma: The father states that he is not responsible for the child’s medical bills, and he will sign the consent to treat but not sign the payment agreement. What does the registrar do?

13. Points to Consider for Case Scenario 5: zReference Neb. Rev. Stat § 42-364 - Dissolution or legal separation; decree; parenting plan; children; custody determination; rights of parents; child support; termination of parental rights; court; duties. y(4) Regardless of the custody determination of the court, (a) each parent shall continue to have full and equal access to the education and medical records of his or her child unless the court orders to the contrary and (b) either parent may make emergency decisions affecting the health or safety of his or her child while the child is in the physical custody of such parent pursuant to a visitation order entered by the court. yNote: Many facilities often list the custodial parent as the guarantor, however with HIPAA your facility may require contact with the guarantor prior to billing to obtain written consent. zReference Cline Williams - Section D zReference Baird Holm - Section 3 C

14. Other Key Points zEmancipated Minors zCollege Students and Active Military under the age of 19

15. Relationship to HIPAA? zReference 45 CFR §164.506 - Consents yThe Privacy Rule establishes a federal requirement that most doctors, hospitals, or other health care providers obtains a patient’s written consent before using or disclosing the patient’s personal health information to carry out treatment, payment or health care operations. zRefer to the Office of Civil Rights “Guidance to the Standards for Privacy of Individually Identifiable Health Information” - July 2001 zAll of the points that you must consider today when obtaining consents will need to be considered with the HIPAA consent to disclose information.

16. Questions? zAsk your legal counsel!