Non-Substantive Change 2900-0260

Veterans Health Administration White Paper

ICR 2900-0260 Non-Substantive Change

July 2014

Background

Section 7332, Title 38, United States Code, requires VA to obtain prior written consent from a patient before information concerning treatment for alcoholism or alcohol abuse, drug abuse, sickle cell anemia, or infection with the human immunodeficiency virus (HIV) can be disclosed from a patient medical record. This special consent must indicate the name of the facility permitted to make the disclosure, the name of the individual or organization to whom the information is being released, specify the particular records or information to be released, be under the signature of the Veteran and dated.

VA Form 10-0485 is used solely for the exchange of PHI between VA approved Nationwide Health Information Network participants. Written patient authorization is also required by the Privacy Act of 1974, VA confidentiality statute 38 U.S.C. 5701, and the Standards for Privacy of Individually Identifiable Health Information, hence HIPAA Privacy Rule, 45 Code of Federal Regulations Parts 160 and 164. VA Form 10-0485 is used solely for the electronic exchange of PHI between VA approved Nationwide Health Information Network (NwHIN) participants

and VA.

Modification

VHA has updated form 10-0485 to encompass coverage of health information exchanges to which VA has a current standing agreement. This modification has been made to the requestor name portion of the form.