Fla. Admin. Code R. 33-401.701
(2) Definitions.
(h) Personal Representative – as used in this rule, means, with respect to a deceased inmate, a person appointed by a court to act as the personal representative, executor, administrator, curator, or temporary administrator of the deceased inmate’s estate, or if a court has not made such a judicial appointment, a person designated by the inmate to act as his or her personal representative in a last will that is self-proved under section 732.503, F.S. In addition, if a court has not made a judicial appointment as described herein and the inmate has not designated a person in a self-proved last will, a personal representative also means one of the following individuals:
1. A surviving spouse.
2. If there is no surviving spouse, a surviving adult child of the inmate.
3. If there is not surviving spouse or adult child, a parent of the inmate.
With respect to a living inmate, a personal representative means a health care surrogate, proxy, guardian, or other person with authority under Florida law to make decisions related to the inmate’s health care.
(3) Inmate and offender access to their own protected health information in a designated records set.
(c) 1. Inmates shall have no access to psychotherapy notes or substance abuse progress notes maintained in the department’s records.
2. Inmates shall have no access to protected health information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.
3. Inmates shall have no access to protected health information maintained by the Department that is subject to the Clinical Laboratory Improvements Amendments of 1988, 42 U.S.C. 263a, to the extent that the provision of access to the inmate is prohibited by law, or is exempt from the Clinical Laboratory Improvement Amendments of 1988, pursuant to 42 C.F.R. 493.3(a)(2).
(d) An inmate’s request for access shall be denied in whole or in part due to any of the following reasons:
1. The request is for records or information identified in paragraph (c), above.
2. The request is for protected health information that was obtained from someone other than a health care provider under a promise of confidentiality and the access requested would with reasonable likelihood reveal the source of the information.
3. The request is for information not maintained or no longer maintained by the department in its files.
4. There has been a determination by a licensed or certified health care professional that:
a. The requested access is reasonably likely to endanger the life or physical safety of the inmate or another person;
b. The requested access is to protected health information that makes reference to another person (other than a health care provider) and such access is reasonably likely to cause substantial harm to such other person; or
c. The access is requested by a personal representative of the inmate and such access is likely to cause substantial harm to the inmate.
(f) Denials must provide:
1. The basis for the denial;
2. Information on where the requested information is maintained if subparagraph (d)3. applies, and the department knows where the information is maintained;
3. Notification that the inmate may request a review of a denial based on subparagraph (d)4., by submitting a written request to the health services administrator or his or her designee in the case of medical files, or the substance abuse program manager or his or her designee in the case of substance abuse clinical files; and,
4. That the inmate may grieve the denial through the inmate grievance process pursuant to chapter 33-103, F.A.C.
5. Upon written request of the inmate to the staff member designated above, denials based on subparagraph (d)4., shall be reviewed by a licensed or certified health care professional who is designated by the health services administrator or his or her designee or substance abuse program manager or his or her designee, and who did not participate in the original decision to deny the request. Review of the denial must be completed within a reasonable time after receipt of the request for review. Immediately upon determination on review, the inmate shall be notified in writing of the decision.
(h) Providing Access:
1. Before any inmate reviews his or her medical file or substance abuse clinical file the Department will verify the inmate’s identity using the inmate’s ID card.
2. Medical and hospital files and substance abuse clinical files must be reviewed in a secure area in the presence of health record staff or the health service administrator.
3. No information shall be copied or removed from the file by the inmate at the time of the review. Form DC6-236, Inmate Request, shall be submitted by the inmate to obtain any copies.
(4) Requesting Restrictions on the Use and Disclosure of Protected Health Information in a designated records set.
(e) The Department shall terminate its agreement to a restriction, if:
1. The inmate agrees to or requests the termination in writing;
2. The inmate orally agrees to the termination and the oral agreement is documented; or
3. The Department informs the inmate that it is terminating its agreement to a restriction. The termination is only effective for protected health information created or received after the Department informed the inmate of the termination.
(5) Requesting Confidential Communications.
(6) Request to amend protected health information in a designated record set.
(d) Pursuant to 45 C.F.R. §164.526, the Department shall deny an inmate’s request for an amendment to protected health information if it determines that the protected information:
1. Was not created by the Department, unless the inmate provides a reasonable basis to believe that the originator of protected information is no longer available to act on the requested amendment;
2. Is not part of the designated record set;
3. Is information that is not available for inspection by the inmate as provided in subsection (3), above; or
4. Is accurate and complete.
(e) If the Department denies the requested amendment, in whole or in part, the Department shall send the inmate a written denial notice, in plain language that contains:
1. The basis for the denial;
2. The inmate’s right to submit a written statement disagreeing with the denial and how the inmate may submit such a statement on Form DC6-236, Inmate Request;
3. A statement that if the inmate does not submit a statement of disagreement, the inmate may request that the Department provide the inmate’s request for amendment and the denial with any future disclosures of the protected information that is the subject of the amendment; and,
4. A description of how the inmate may complain through the inmate grievance process.
(i) If the Department accepts the requested amendment, in whole or in part, the Department shall comply with the following requirements:
1. The Department shall make the amendment to the designated records set by identifying the portions in the record that are affected by the amendment and appending or otherwise providing a link to the location of the amendment.
2. The Department shall inform the inmate that the amendment is accepted and obtain the inmate’s identification of, and agreement to have the Department notify relevant persons with which the amendment needs to be shared as described below within 60 days.
3. The Department shall make reasonable efforts to inform and provide the amendment within a reasonable time to:
a. Persons identified by the inmate as having received protected information about the inmate and needing the amendment; and,
b. Persons, including business associates, that the Department knows have the protected information that is the subject of the amendment and that may have relied, or could foreseeably rely, on such information to the detriment of the inmate.
(7) Request for Accounting of Disclosures.
(d) The Department shall provide the inmate with a written account that includes the following information:
1. The date of the disclosure;
2. The name and address of the entity or person who received the protected health information;
3. A brief description of the protected health information disclosed; and,
4. A brief statement of the purpose of the disclosure or a copy of a written request from the entity or person that received the protected information.
(e) The accounting of disclosures is not required to contain the following disclosures of protected health information:
1. Disclosures for the purpose of treatment, payment and health care operations;
2. Disclosures to law enforcement or correctional officers for the health and safety of the inmate, other inmates, officers, employees of the correctional institution or others at the correctional institution;
3. Disclosures to law enforcement on the premises of the correctional institutions;
4. Disclosures for the administration and maintenance of the safety, security, and good order of the correctional institution;
5. Disclosures for national security or intelligence purposes;
6. Disclosures made to inmates of their own protected information;
7. Disclosures made as part of a limited data set;
8. Disclosures made to third parties pursuant to the inmate’s request written authorization; and,
9. Disclosures made prior to April 14, 2003.
(f) If the Department made multiple disclosures of protected information to the same entity for a single purpose, the accounting for a given period of time shall provide:
1. The required information listed above for the first disclosure; and,
2. The frequency, periodicity, or number of disclosures made; and the date of the last disclosure.
(i) The Department shall document the following information regarding accounting of disclosures:
1. The date of disclosure;
2. The information listed in the accounting;
3. Written accounting that is provided to the inmate; and,
4. The titles and names of the people who were responsible for receiving and processing the request.
(k) The Department shall track disclosures other than for treatment, payment and health care operations. This includes the following disclosures even if the disclosure was to a business associate. The Department shall track disclosures:
1. To other government agencies providing benefits or services to the inmate;
2. To government agencies that oversee health care providers;
3. For research; and,
4. Which are required by law.
(l) The following specific information about each disclosure shall be included and documented in the medical file on Form DC4-534, Health Care Information Request Record. Form DC4-534 is hereby incorporated by reference. Copies of the form are available from the Forms Control Administrator, 501 South Calhoun Street, Tallahassee, Florida 32399-2500, HYPERLINK "https://www.flrules.org/Gateway/reference.asp?No=Ref-02949" http://www.flrules.org/Gateway/reference.asp?No=Ref-02949. The effective date of this form is 4-15-10.
1. The date of the disclosure;
2. The name and address of the entity or person who received the protected information;
3. A brief description of the protected health information disclosed;
4. A brief statement of the purpose of the disclosure; and,
5. Written account that was provided to the inmate.
(10) Use and disclosure of protected health information.
(g) A disclosure of protected health information may not be made on the basis of an authorization which:
1. Has expired;
2. On its face substantially fails to conform to any of the requirements of the Health Insurance Portability and Accountability Act Privacy Rule of 1996;
3. Is known to have been revoked; or
4. Is known, or through a reasonable effort could be known, by the person holding the records to be materially false.
(h) In accordance with 45 C.F.R. §164.502 and Florida law, a personal representative of a deceased inmate shall have access to or may authorize the disclosure of the deceased inmate’s protected health information that is relevant to the personal representative’s legal authority to act on behalf of the deceased inmate or the deceased inmate’s estate.
1. The Department shall verify and document the authority of the personal representative to serve in that capacity. All requests for access to a deceased inmate’s protected health information shall be in writing and accompanied with documentation demonstrating the authority of the personal representative to serve in such capacity as specified in paragraph (2)(h), herein.
2. If the request is made by a person appointed by a court to act as the personal representative, an executor, an administrator, a curator, or a temporary administrator of the deceased inmate’s estate, accompanying documentation shall include a copy of the letter of administration and a copy of the court order appointing such person as the representative of the inmate’s estate.
3. If the request is made by a person designated by the inmate to act as his or her personal representative in a last will that is self-proved, accompanying documentation shall include a copy of the self-proved last will designating the person as the inmate’s representative.
4. If the request is made by a surviving spouse, a surviving adult child of the inmate, or a parent of the inmate, accompanying documentation shall include a letter from the person’s attorney verifying the person’s relationship to the inmate and the absence of a court-appointed representative and self-proved last will.
5. To authorize the disclosure of the deceased inmate’s protected health information, Form DC4-711B, Consent and Authorization for Use and Disclosure Inspection and Release of Confidential Information must be signed by a personal representative.
Rulemaking Authority 944.09, 945.10 FS. Law Implemented 119.07, 395.3025, 944.09, 945.10, 945.25, 945.6034 FS. History–New 4-15-10, Amended 8-6-13, 5-25-16, 7-15-18.