Health and Medical Information
0600-500.20 | Revision Date: 2/25/2016

Overview

This policy guide provides information on Protected Health Information (PHI) and medical information. It outlines who is allowed to have access, who can disclose, how to request access to, and what to do when authorization for access to PHI has been withdrawn.

Table of Contents

Version Summary

This policy guide was updated from the 0701/14 version to include Welfare and Institutions Code (WIC) 5328.03. Clarifying changes were made to the Policy and Procedure Sections. Also, the title has been changed.

POLICY

Protected Health Information (PHI) and Medical Information

The disclosure of medical and mental health information, including Protected Health Information (PHI) is regulated by federal and state laws. Under federal law, the Health Insurance Portability and Accountability Act (HIPAA) of 1996, protects the privacy of patient health information. HIPPA limits disclosure of what is calls "protected health information " (PHI). Under state law, California Code 56, et seq, protects medical and mental health information. Pursuant to federal and state laws, laws DCFS staff may not disclose medical or mental health information unless a specific legal exception applies. Unauthorized disclosure of confidential medical or mental health information carries both civil and criminal penalties.

A provider may release medical information to “a public health authority or other appropriate government authority authorized by law to receive reports of child abuse or neglect. DCFS is authorized to receive reports of child abuse and neglect, a provider may release the requested records. A provider may release medical information for “treatment, payment and healthcare operations.

Code of Regulations 45 §164.501, defines “treatment” as, the provision, coordination, or management of healthcare and related services...including the coordination or management of health care by a health care provider with a third party…” Based on the “treatment” definition, a provider may share medical information with a social worker, in order to coordinate and manage minors’ and parents’ (and, as appropriate, other adults’) health care and related services.

Once DCFS obtains either PHI or mental health information, this policy addresses the re-disclosure of PHI or mental health information when disclosed to any of the following:

  • Caregiver(s)
  • The Court

When may DCFS access health information when authorized by either state or federal law to obtain PHI or mental health information?

The DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information (PHI), was developed to facilitate the sharing of PHI and medical information from health care providers. If neither state nor federal law referenced above are applicable, this form must be used to obtain PHI for children with an open DCFS case.

The court or a parent/legal guardian may restrict who can receive PHI. CSWs must comply with those restrictions. For more information, refer to Sharing and Disclosure of Protected Health Information (PHI) for DCFS Involved Children.

CSWs, or any other person who is legally authorized to have custody or care of a dependent child/NMD placed in a licensed and approved setting, is considered a “third party” and may receive medical information or PHI. The authority of a CSW or custodial caregiver may not be expanded beyond the authority provided under existing law to a parent or a patient representative regarding access to medical information.

When may DCFS disclose medical and mental health information?

Legally obtained medical and mental health information, and PHI may be re-disclosed only in certain circumstances. CSWs should obtain the authorization for the disclosure of PHI and for the consent for treatment and services at the same time for either a new case or when a new medical health, mental health, or developmental need is identified in an open case. CSW's must obtain consent for treatment and authorization for the disclosure of PHI on all newly detained children in out-of-home care and for children with a positive Mental Health Screening Tool (MHST) result.

Information received by a CSW may only be shared with agencies authorized to receive juvenile records when those agencies are providing or coordinating healthcare services and medical treatment of the child.

Authorization to Disclose PHI

Non-Dependent Children

In order to disclose PHI and/or medical information of non-dependent children who are not under court jurisdiction, DCFS must first obtain written authorization from the parent, child (if the child is legally permitted to authorize disclosure), or person who has been legally permitted to provide authorization is always required.

Children Under Dependency Court Jurisdiction

For children under dependency court jurisdiction (pre and post-disposition),written authorization is legally required for the disclosure of PHI except in certain specified circumstances. A medical provider may disclose medical information or mental health information to DCFS without the child and/or parent/legal guardian's authorization for the purpose of coordinating healthcare services and medical treatment per California Civil Code 56.103. These exceptions are not applicable to Nonminor Dependents (NMDs).

Healthcare providers are permitted but not required to disclose health or mental health information to DCFS. Healthcare providers asked to disclose medical or mental health information have the right to require authorization from the child, the child’s parent/legal guardian, or a court order for the disclosure of medical or mental health information. If a mental healthcare provider is reluctant to disclose confidential information, refer to the “Limits” section of Parent/Guardian’s Right to Authorize a Release of Child’s Mental Health Records/Information.

Court Appointed Special Attorney

A child’s attorney may assert the doctor-patient or therapist-patient privilege to ensure that confidential communications between a child and his/her doctor/therapist are not inappropriately used as evidence in court. If a provider expresses concerns about disclosing privileged communications, CSWs must contact the County Counsel immediately for assistance.

Nonminor Dependents (NMDs) in Extended Foster Care (EFC)

In most circumstances, DCFS may not disclose PHI of an NMD without valid written authorization from the NMD. However, for Nonminor Dependents (NMDs) participating in Extended Foster Care (EFC) and placed in licensed and approved settings, a valid, written authorization is not legally required for the disclosure of PHI within the Health and Education Passport (HEP) only . In the case of NMDs placed in licensed and approved settings, DCFS may provide the information contained in the HEP to the caregiver. The HEP is provided to the caregivers of NMDs in a non-Supervised Independent Living Placement (SILP). Personal rights of NMDs require that caregivers keep all their medical information confidential. Caregivers cannot release information to a party without written consent from the NMD,

Before the HEP can be attached to court reports, per WIC 16010(b), a valid, written authorization is legally required and must be obtained prior to disclosure of PHI.

NMDs in Supervised Independent Living Placements (SILPs)

For NMDs participating in EFC in a Supervised Independent Living Placement (SILP), a written authorization is always required to obtain and/or disclose PHI.

  • HIV/AIDS information cannot be included in the NMD’s HEP.
  • The NMD’s HIV/AIDS status cannot be provided to the court unless the NMD gives his/her written consent authorization. For more information on the disclosure of HIV/AIDS information, refer to HIV/AIDS Testing and Disclosure of HIV/AIDs Information.

The DCFS 6009, Nonminor Dependent Informed Consent, must be used to discuss consent with the NMD authorization. The NMD’s signature acknowledging receipt the DCFS 6009 must be obtained at the time the NMD signs the SOC 161, Six-Month Certification of Extended Foster Care Participation.

The DCFS 6010, Nonminor Dependent 2-Way Authorization for Sharing Information, must be used to obtain authorization from the NMD to exchange confidential information with providers.

Youth Authorized Disclosure of PHI

The youth may authorize disclosure of his/her medical or mental health PHI in the following circumstances:

  • When a youth age twelve (12) or older has the statutory authority to consent to their own treatment, the youth may also authorize disclosure of the medical records pertaining to such healthcare.
    • The youth may also authorize the disclosure of mental health PHI if the youth, in the opinion of the attending professional person, is mature enough to participate intelligently in the mental health outpatient or residential services per Health and Safety Code 124260(c).
  • A youth who has been declared emancipated from his/her parent/legal guardian by the court and has been issued a California DMV ID card.
  • A youth that are considered self-sufficient because he or she is over fifteen (15) years old, not living at home, manages their own financial affairs, and whose parent(s) are not liable for their healthcare.
  • A youth who is currently serving in the US Armed Forces.
  • A youth who is, or have been, married.
  • A youth who is a Nonminor Dependent (NMD) under Juvenile Court jurisdiction and DCFS supervision (eighteen (18) to twenty-one (21) years old).

Re-Disclosure

If PHI is to be used to coordinate healthcare services and medical treatment for a child/NMD placed in a licensed and approved setting, healthcare providers can disclose medical and mental information to a CSW or other person who is legally authorized to have custody or care of a dependent child/NMD. However, providers are not required to disclose this information.

As mandated reporters, healthcare providers or healthcare service plan providers who report suspected child abuse or neglect, are permitted to disclose medical and mental information pertaining to a mandated report to the agency investigating the claim. This allows psychotherapists, as mandated reporters, to disclose information pertaining to reported child abuse or neglect.

Medical Information disclosed to a CSW or to any person legally authorized to have custody or care of a dependent child/NMD placed in a licensed and approved setting cannot be re-disclosed by the recipient (including the CSW), except when the re-disclosure is for the sole purpose of coordinating healthcare services and medical treatment.

Transmitting PHI or Medical Information

The transmittal of highly sensitive materials must be done in person. Do not email or fax PHI or medical information to Regional Offices or other locations from an alternative work location (i.e. one outside of DCFS). For more information on DCFS protocol for handling confidential information, refer to General Records Retention and Protection of Records Containing Personal and Confidential Information and BIS Computer Support/Computer Security on LA Kids. Any electronic transmission of PHI must be encrypted.

Some healthcare providers may be reluctant to deliver PHI or medical information via fax, even from DCFS offices. In these cases, other arrangements must be made for standard mail delivery, or in-person pick up, etc.

Disclosure of Mental Health Records/Information

A mental healthcare provider may determine that the disclosure of information concerning the diagnosis and/or treatment of a mental health condition of a dependent child/NMD placed in a licensed and approved setting is reasonably necessary for coordinating his/her treatment/care. In such a case, that information can be disclosed to a CSW or other person who is legally authorized to have custody or care of the child/NMD. This information cannot be further disclosed by the recipient, including the CSW, unless the disclosure is to assist in coordinating mental health services and/or treatment for the child and the disclosure is authorized by law.

CSWs should notify mental health providers of a child’s status regarding detention and jurisdiction orders to ensure that case issues are addressed in the proper forum, if applicable.

Parent/Guardian’s Right to Authorize a Release of Child’s Mental Health Records/Information

A psychotherapist, who knows a child has been detained, is prohibited from releasing records and/or information based on an authorization signed by the parent/legal guardian absent a court order authorizing the parent/guardian to sign the authorization, per Welfare and Institutions Code (WIC) 5328.03.

A psychotherapist, who knows a child has been detained, is prohibited from allowing a parent/legal guardian to inspect or obtain a child’s records absent a court order authorizing the parent/guardian to inspect or obtain the records, per Health and Safety Code (HSC) Section 123116(a).

Using Medical/Mental Health Information PHI as Evidence

Medical or mental health information PHI disclosed to a CSW, or to any person legally authorized to have custody or care of a dependent child/NMD who has been placed in a licensed and approved setting (including a Supervised Independent Living Placement (SILP)), cannot be admitted into evidence against that child/NMD in any criminal or delinquency proceeding. However, identical or similar evidence may be admitted in a criminal proceeding if that evidence is derived solely from lawful means and when not disclosed under the circumstances described above.

Disclosure and Exchange of Information Among a Multidisciplinary Team

Members of a multidisciplinary team engaged in the prevention, identification, and treatment of child abuse may disclose and exchange information relating to child abuse among each other. This information may also be a part of a child’s court record or designated as confidential under state law if the team member possessing that information or writing the record believes it is relevant to the prevention, identification, or treatment of child abuse.

PROCEDURE

Accessing PHI/Medical Information During Child Abuse Investigations

CSW/ER CSW/ISW Responsibilities

  1. Complete an ABCDM 228, Applicant’s Authorization for Release of Information, for each medical or mental healthcare provider.
    1. Obtain the signature of the parent(s) or of the child, if applicable.
  2. If the parent(s)/child or medical/mental healthcare provider denies access to the protected medical or mental health information, contact County Counsel.

Accessing PHI/Medical Information for DCFS Youth/NMD Parents with a Non-Dependent Child

CSW/ISW Responsibilities

  1. Ask the DCFS-supervised parent to complete and sign the Parenting Youth’s Authorization to Document and Share Her/His Non-Dependent Child’s Health Information form.
    1. Inform the youth/NMD parent that they have the right to refuse consent.
      1. Indicate the youth's decision on the release form and obtain necessary signatures.
  2. Provide a signed copy of the form to the DCFS-supervised parent and keep a copy of the signed form in the case file.
  3. Enter the non-dependent child’s health information into the DCFS-supervised parent’s case file and in CWS/CMS, as needed, if consent is granted.

Accessing PHI/Medical Information in Newly Detained DCFS/Court Supervised Family Reunification (FR) Cases

“Newly detained,” in this case, is defined as a child who is:

  • Removed from the custody of his/her parent(s)/legal guardian(s) under a WIC 300 petition,
  • Placed in out-of-home care, and
  • Not named on a currently open case.

This does not include children removed from one parent and placed with another parent under court Family Maintenance (FM) or failed Voluntary Family Maintenance (VFM).

ER and ERCP CSW Responsibilities

  1. Explain to the parent/legal guardian that their authorization is needed to facilitate the sharing of protected health information (PHI).
    1. Explain to the parent/legal guardian that by signing the DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information, they authorize the following individuals and entities that have provided treatment or services, including mental health treatment, to his/her child, to release relevant health and mental health information upon request to authorized employees of DCFS: physicians, healthcare professionals, the hospital a clinic, laboratories, medical facilities, and other healthcare providers.
      • If the parent/legal guardian does not agree to sign the DCFS 179-PHI, or is not permitted to authorize the release of mental health records/information, it will not be held against them. However authorization for disclosure of PHI will be sought through the court.
    2. Inform the parent/legal guardian that parents/guardians from whom the child has been removed are not permitted to authorize release of mental health records/information unless the court grants authorization.
  2. Once signed, place the original DCFS 179-PHI in the Psychological/Mental/Dental/School folder (purple) and provide a copy to the following individuals:
    • Parent/legal guardian
    • Any caregiver responsible for obtaining medical health, mental health, and/or developmental services (Regional Center) for the child
    • Any service provider responsible providing medical or mental health services and/or any Regional Center providing developmental services to the child
    • The Coordinated Services Action Team (CSAT) Screening Clerk. Additionally provide him/her with the DCFS 179-MH, Parental Consent for Child's Assessment & Participation in Mental Health and/or Regional Center Developmental Services, and the Mental Health Screening Tool (MHST).
  3. If the parent/legal guardian signed the DCFS 179-PHI, the DCFS 179, and the DCFS 179-MH prior to the detention hearing, document the following under REASONABLE EFFORTS AND/OR PRIOR INTERVENTIONS/SERVICES OFFERED in the Detention Report:
    • “Parent/Legal Guardian [enter parent’s name] signed the DCFS 179, Parental Consent and Authorization for Medical Care and Release of Health and Education Records, the DCFS 179-MH, Parental Consent for Child’s Assessment and Participation in Mental Health and/or Regional Center Developmental Services, and the DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information.”
  4. If the parent/legal guardian declined to sign the DCFS 179-PHI, the DCFS 179 and the DCFS 179-MH, was unavailable to sign these forms,, or is not permitted to authorize the release of mental health records and/or information before the detention hearing:
    1. Describe the efforts made to obtain the parent/legal guardian’s signature on the forms and the reason why it was not possible to obtain signature(s) in the REASONABLE EFFORTS AND/OR PRIOR INTERVENTIONS/ SERVICES OFFERED section of the report.
    2. Use the language in Recommendation for Court Order for Mental Health and/or Developmental Assessment, Services, and Release of Information to write the RECOMMENDATION for court authorization for a health/mental health assessment and services and for the disclosure of PHI.
  5. When the court minute order is received authorizing a medical health, mental health, and/or developmental (Regional Center) assessment and services, and when disclosure of PHI is relevant to the care and treatment of the child, provide a copy of the redacted minute order to the health provider, the mental health provider to initiate mental health treatment, and/or to the Regional Center to complete the developmental assessment and to provide services.

CSW/ISW Responsibilities

  1. Upon placement, provide the caregiver with the child/youth’s Health and Education Passport (HEP), HEP Binder, and DCFS 561(a)(b)(c) (Medical, Dental, Psychological/Other Examination) series forms.
  2. Instruct the caregiver on how to use the forms for documentation of the child/youth’s health and mental health information during the child’s regular visits to the doctor, dentist, mental healthcare provider, or psychiatrist.
  3. When available, ensure that a DCFS 179-PHI, the DCFS 179, and the DCFS-MH (when appropriate) signed by the parent(s)/legal guardian(s) is in the child’s case file.
  4. Request PHI from health, mental health, and developmental (Regional Center) service providers by using the DCFS 179-PHI and a redacted minute order if required.

SCSW/SISW Responsibilities

  1. Support and assist the CSW in obtaining required medical health and/or mental healthcare information for the child/youth, as appropriate.

Accessing PHI/Medical Information for Youth with a Positive MHST, an Observation of Behavioral Indicator, or a Potential Developmental Delay

Case-Carrying CSW/ISW Responsibilities

For youth with a new court ordered Family Maintenance (FM) case:

  1. Upon placement, provide the caregiver with the youth’s Health and Education Passport (HEP), HEP Binder, and DCFS 561(a)(b)(c) (Medical, Dental, Psychological/Other Examination) series forms.
  2. Instruct the caregiver on how to use the forms for documentation of the youth’s health and mental health information during the youth’s regular visits to the doctor, dentist, mental healthcare provider, or psychiatrist.
  3. When available, ensure that a DCFS 179-PHI, the DCFS 179, and the DCFS-MH (when appropriate) signed by the parent(s)/legal guardian(s) is in the child’s case file.

Case-Carrying CSW/DI/ISW Responsibilities

For children in open DCFS court supervised cases:

  1. Explain to the parent/legal guardian that their authorization is needed for the sharing of PHI.
    1. Explain to the parent/legal guardian that by signing the DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information, they authorize the following individuals and entities that have provided treatment or services, including mental health treatment, to their child, to release relevant health and mental health information upon request to authorized employees of DCFS: physicians, healthcare professionals, the hospital a clinic, laboratories, medical facilities, and other healthcare providers.
    2. Inform the parent/legal guardian that the parents/guardians from whom the child has been removed are not permitted to authorize release of mental health records/information unless the court grants authorization.
  2. Once signed, place the original DCFS 179-PHI in the Psychological/Mental/Dental/School folder (purple) and provide a copy of it to the following:
    • Parent/legal guardian
    • Any caregiver responsible for obtaining medical health, mental health, and/or developmental services (Regional Center) for the youth
    • Any service provider responsible providing medical or mental health services and/or any Regional Center providing developmental services to the youth
    • The Coordinated Services Action Team (CSAT) Screening Clerk. Additionally provide him/her with the DCFS 179-MH, Parental Consent for Child's Assessment & Participation in Mental Health and/or Regional Center Developmental Services and the Mental Health Screening Tool (MHST).
  3. If the parent/legal guardian declined, is unavailable to sign the DCFS 179-PHI, or is not permitted to authorize the release of mental health records and/or information, document the efforts made to obtain authorization from him/her in the CWS/CMS Contact Notebook.
    1. Attempt to obtain authorization from either the youth (if twelve (12) years of age or older) or the court.
  4. If the youth is twelve (12) years of age or older:
    1. Ask the service provider to determine if the youth can legally authorize their own release of information.
    2. If the youth can legally provide authorization for release of their own medical, mental health, and/or developmental information, notify the service provider that they must obtain the signature of the youth on the applicable form(s) used by that provider.
    3. Request copies of the documents and file them in the Psychological/Medical/Dental/School folder (purple).
  5. To obtain court consent:
    1. Document efforts made to obtain consent from the parent/legal guardian in the CWS/CMS Contact Notebook.
    2. Submit whichever of the following forms will expedite the matter:
      • A request at the next court hearing
      • A walk-on an ex parte request
    3. Within three (3) business days of determining that the parent/legal guardian will not sign the DCFS 179-PHI or is not permitted to authorize the release of mental health records/information, walk on an Ex parte report, requesting an appearance hearing for the court to consent for the youth’s mental health, developmental assessment and services (Regional Center), and/or for the release of mental health records/information.
    4. Include the following information in the Status Review or ex parte report:
      1. Explain that the parent/legal guardian is not available, declines to provide authorization for disclosure of the youth’s PHI, or is not permitted to authorize the release of mental health records/information.
      2. Description of the efforts made to obtain authorization from the parent/legal guardian.
      3. Explain that court authorization for disclosure of the youth’s PHI is necessary to meet the youth’s mental health and/or developmental needs.
      4. Use the language found in Recommendation for Court Order for Mental Health and/or Developmental Assessment, Services, and Release of Information to write the RECOMMENDATION for a court authorization for a medical health and/or mental health assessment and services, and for the disclosure of PHI.
    5. When the court minute order is received authorizing a medical health, mental health, and/or developmental (Regional Center) assessment and services, and the disclosure of PHI relevant to the care and treatment of the youth, provide a copy of the redacted minute order to the following individuals and entities, as appropriate:
      • Health and/or mental health provider to obtain records and/or information or to initiate mental health treatment for the youth.
      • Regional Center to obtain records and/or information or to complete the developmental assessment and provide services.
  6. Upon placement, provide the parent/legal guardian with the youth’s Health and Education Passport (HEP), HEP Binder, and DCFS 561(a)(b)(c) (Medical, Dental, Psychological/Other Examination) series forms.
  7. Instruct the parent/legal guardian on how to use the forms for documentation of the youth’s health and mental health information during the youth’s regular visits to the doctor, dentist, mental healthcare provider, or psychiatrist.
  8. When available, ensure that a DCFS 179-PHI, the DCFS 179, and the DCFS-MH (when appropriate) signed by the parent(s) is in the child’s case file.
  9. Request PHI from health, mental health, and developmental (Regional Center) service providers by using the DCFS 179-PHI and, if required, a redacted minute order.

SCSW/SISW Responsibilities

  1. Support and assist the CSW in obtaining required medical health or mental healthcare information for the youth, as appropriate.

Case-Carrying CSW Responsibilities

For children in open DCFS non-court supervised cases:

  1. Explain to the parent/legal guardian that their authorization is needed to facilitate the sharing of PHI.
    1. Explain to the parent/legal guardian that by signing the DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information, they authorize the following individuals and entities that have provided treatment or services, including mental health treatment, to his/her child, to release relevant health and mental health information upon request to authorized employees of DCFS: physicians, healthcare professionals, the hospital a clinic, laboratories, medical facilities, and other healthcare providers.
    2. If the parent/legal guardian does not agree to sign the DCFS 179-PHI or if they are not permitted to authorize the release of mental health records/information, it will not be held against them. However authorization for the disclosure of PHI will be sought through the court.
  2. Inform the parent/legal guardian that the parents/guardians from whom the child has been removed are not permitted to authorize release of mental health records/information unless the court grants authorization.
  3. Once signed, place the original DCFS 179-PHI in the Psychological/ Mental/ Dental/School folder (purple) and provide a copy of it to the following:
    • Parent/legal guardian
    • Any caregiver responsible for obtaining medical health, mental health, and/or developmental services (Regional Center) for the child
    • Any service provider responsible providing medical or mental health services and/or any Regional Center providing developmental services to the child
    • The Coordinated Services Action Team (CSAT) Screening Clerk. Additionally provide him/her with the DCFS 179-MH, Parental Consent for Child's Assessment & Participation in Mental Health and/or Regional Center Developmental Services, and the Mental Health Screening Tool (MHST).

Responding to a Parent/Legal Guardian of a DCFS-Supervised Child who Withdraws Authorization for Disclosure of PHI/Medical Information

CSW/DI/ISW Responsibilities

Upon receipt of the complete and signed Revocation of Authorization for Disclosure of Child’s Protected Health Information (PHI) form (i.e. the reverse side of the DCFS 179-PHI):

  1. Inform the health and/or mental health provider that the parent/guardian withdrew his/her authorization for the disclosure of the child’s PHI.
  2. Inform the provider of what health information is needed.
    1. Determine if the health and/or mental healthcare provider is willing to disclose the information without authorization as allowed by law.
  3. If the medical and/ or mental healthcare provider requires authorization, determine if the youth may authorize the disclosure or if the authorization must be requested from the court.

Guidelines for Youth Authorization for Disclosure of PHI:

Authorization For:

Steps to Take:

PHI/Medical Information Disclosure

  1. Determine if the youth meets the requirements to authorize the disclosure of their medical information.
  2. Obtain the youth’s authorization via the ABCDM 228, Applicant’s Authorization for Release of Information, or DCFS 6010, Nonminor Dependent 2-Way Authorization for Sharing Information (for NMDs).
  3. Request the needed medical information from the healthcare provider

Mental Health Information Disclosure

  1. If the youth is twelve (12) years or older, ask the mental health provider to determine if the youth can authorize the disclosure of their own PHI. If so, have the mental health provider obtain written consent from the youth.
  2. Ask the mental health provider to include DCFS as an authorized PHI recipient on the document authorizing disclosure of PHI.
  3. Request a copy of the mental health provider’s document, authorizing the disclosure of PHI signed that is by the youth. File it in the Psychological/Medical/Dental/School folder (purple).

Court Authorization

  1. Walk-on an Ex parte report, informing the court that the parent/legal guardian withdrew his/her authorization for disclosure of the child’s PHI.
  2. State that the healthcare or mental healthcare provider is unwilling to disclose PHI to DCFS for progress reports on the child’s health or mental healthcare without court authorization.
  3. Attach a copy of the “Revocation of Authorization for Disclosure of Child’s Protected Health Information (PHI)” form, signed by the parent/legal guardian, to the court report. Include the following language under “Recommendation:”
    • “It is respectfully recommended that the court make the following order: The child(ren)’s service provider shall provide DCFS with information relevant to the care and treatment of the child(ren) upon request by DCFS. Such information shall not include the details of therapeutic sessions or statements made by the child(ren) unless otherwise required by law. Further pursuant to Welfare and Institutions Code Section 5328.04 and Civil Code Section 56.103 information disclosed pursuant to this order may not be admitted into evidence in any criminal or delinquency proceeding against the child. Nothing in this order shall prohibit identical evidence derived solely from other lawful means from being admissible in a criminal proceeding.
  4. Upon receipt of the court minute order authorizing disclosure of PHI, submit a request for the medical or mental health information to the provider accompanied by a redacted copy of the minute order.

SCSW/SISW Responsibilities

  1. Review the Ex parte court report.
    1. If complete, approve the Ex parte court report.
    2. If changes are needed, instruct the CSW to make the required changes.
APPROVALS

SCSW and SISW Approval

  • Detention report
  • Ex parte report
HELPFUL LINKS

Attachments

Recommendation for Court Order for Mental Health and/or Developmental Assessment, Services, and Release of Information

Sharing and Disclosure of Protected Health Information (PHI) for DCFS Involved Children

Forms

CWS/CMS

Health an Education Passport (HEP)

LA Kids

DCFS 179, Parental Consent and Authorization for Medical Care and Release of Health and Education Records

DCFS 179-MH, Parental Consent for Child’s Assessment and Participate in Mental Health and/or Regional Center Developmental Services (also available in Spanish)

DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information (PHI) (also available in Spanish)

DCFS 179-PHI Reverse Side of Form, Revocation of Authorization for Disclosure of Child’s Protected Health Information (PHI)

DCFS 561(a), Medical Examination Form

DCFS 561(b), Dental Examination Form

DCFS 561(c), Psychological/Other Examination Form

DCFS 6009, Nonminor Dependent Informed Consent

DCFS 6010, Nonminor Dependent 2-Way Authorization for Release of Information

JV-225, Health and Education Questionnaire

SOC 161, Six-Month Certification of Extended Foster Care Participation

Parenting Youth/Nonminor Dependent’s Consent to Document and Share Her/His Non-Dependent Child’s Health Information

REFERENCED POLICY GUIDES

0070-516.10, Assessing a Child’s Development and Referring to a Regional Center

0070-516.15, Screening and Assessing Children for Mental Health Services and Referring to the Coordinated Services Action Team (CSAT)

0080-505.20, Health and Education Passport (HEP)

0300-503.94, Set-On/Walk-On Procedures

0100-535.25, Extended Foster Care (EFC) Program

0100-560.40, Supervised Independent Living Placement (SILP)

0500-501.20, Release of Confidential DCFS Case Record Information

0500-507.10, Confidentiality Protocols for Mobile Workers, Teleworkers, and Portable Devises

0600-502.20, HIV/AIDS Testing and Disclosure of HIV/AIDS Information

0600-500.05, Multidisciplinary Assessment (MAT) Assessments and Meetings

0600-501.09, Consent for Mental Health and/or Developmental Assessments and Services

STATUTES AND OTHER MANDATES

California Department of Social Services (CDSS), All County Information Notice (ACIN) I-20-08 – References and incorporates current and new legal requirements regarding health records for foster children, access to foster child’s PHI by CSWs, documentation of PHI in CWS/CMS, and restrictions on sharing PHI gathered by DCFS.

CDSS All County Letter (ACL) 11-77, 11/18/11 – Addresses Medical Confidentiality regulations related to NMDs placed in licensed and approved settings.

CDSS ACL 11-61, Extension of Foster Care – Provides counties with instructions regarding the policies and procedures for the EFC program created by AB12.

Civil Code (CIV) Section 56.05(g) – Defines “medical information.”

CIV Section 56.10(c)(14) – States that a healthcare provider or a healthcare service plan may disclose medical information when the disclosure is otherwise specifically authorized by law, including, but not limited to the disclosures made pursuant to Penal Code Section 11167(b) by a person making a report pursuant to Penal Code Sections 1165.9 and 1166, provided that those disclosures concern a report made by that person.

CIV Section 56.10(c)(20) – Allows a provider of healthcare or a healthcare service plan to disclose Medical Information as described in Civil Code Section 56.103.

CIV Section 56.103 – Allows healthcare providers to disclose foster child Medical Information related to service coordination, service delivery, and treatment to CSWs, caregivers, and the court. This Section also defines healthcare services and medical treatment and states that it prohibits re-disclosure unless related to service coordination, service delivery, or treatment. It also defines CSWs as HIPAA “third parties” and permits them to receive PHI/Medical Information. It also prohibits the use of disclosed medical or mental health information to be used as evidence against the foster youth in a criminal proceeding. Finally, it clarifies that the authority of the CSW does not expand beyond the authority of a custodial parent or patient representative regarding access to medical information (unless that authority has been limited by the court).

CIV Section 56.104(e)(3) – Allows a psychotherapist to disclose information pursuant to Civil Code Section 56.10(c)(14) and requested by an agency investigating the abuse reported pursuant to that paragraph.

CIV Section 56.106(a) – Prohibits a psychotherapist who knows a child has been detained from releasing records/information based on an authorization signed by the parent/guardian absent a court order authorizing the parent/guardian to sign the authorization.

Code of Federal Regulations, Title 45, Section 164.01 – Defines Psychotherapy Notes.

Family Code (FAM) Section 6922 – Prohibits a psychotherapist, who knows a child has been detained, from releasing records/information based on an authorization signed by the parent/guardian absent a court order authorizing the parent/guardian to sign the authorization.

FAM Section 6924 – Lists the requirements that must be met before a minor may consent to her/his mental health treatment or counseling on an outpatient basis, or to residential shelter services.

Health & Safety Code (HSC) Section 121025(a) – Prohibits the release of disclosure of NMDs HIV/AIDS records without their written authorization.

HSC Section 123116(a) – Prohibits a psychotherapist, who knows a child has been detained, from allowing a parent/guardian to inspect or obtain the child’s records, absent a court order authorizing the parent/guardian to inspect or obtain the records.

HSC Section 124260 – States, in part that a minor who is twelve (12) or older may consent to mental health treatment or counseling services, if, in the opinion of the attending professional person, the minor is mature enough to participate intelligently in the mental health treatment or counseling services.

Welfare and Institutions Code (WIC) Section 830 – States the circumstances under which members of a multidisciplinary personnel team engaged in the prevention, identification, and treatment of child abuse may disclose and exchange information and writings to and with one another.

Welfare and Institutions Code (WIC) 5328.03 states that a psychotherapist, who knows a child has been detained, is prohibited from releasing mental health records or allowing the parent/guardian to inspect mental health records of the minor based on an authorization signed by the parent/legal guardian absent a court order authorizing the parent/guardian to inspect or obtain copies of the mental health records of the minor patient.

WIC Section 16010(b) – States in part that a court report or assessment required pursuant to Section 361.5(g), Section 366.1, Section 366.21(d), or Section 366.22 (c) must include a copy of the current health and education summary. With respect to NMDs, as described in Section 11400(v), a copy of the current health and education summary must be included in the court report only if and when the NMD consents in writing to its inclusion.