Clergy Access to Patient Information
Purpose
To describe the circumstances wherein Clergy representing various Religious Affiliations may have access to patient information, including certain protected health information (PHI) at the Department of Chaplaincy Services office regarding members of their specific Community of Faith, and/or patients of the same Religious Affiliation or Faith Group as that of the inquiring Clergy.
Definition
Clergy - a person who fulfills the educational, training, and other qualifying expectations of a faith tradition and has been duly designated and authorized as a recognized religious and spiritual leader of that faith tradition's individual members and the accompanying congregations or communities of faith
Community of Faith - the specific house of worship or congregation with which the patient is affiliated, and/or is a member, and with whom the patient worships, learns, serves, fellowships
Disclosure or Disclose - The release, transfer, provision of access to, or divulging in any other manner of information outside the Entity holding the information.
Entity - A person or organization having an independent legal existence, which is often indicated by having its own social security number or tax identification number (e.g., PHS, PHP, Bernalillo County Health Care Corporation, or Business Associate of PHS-E).
Faith Group- an corporate community of adherents with the following elements:
- A goverance structure that provides oversight to the individual communities of faith, and which speaks on behalf of the Faith Group
- A process and procedure for training its clergy, endorsing them to serve, and holding them accountable for their conduct
- A means by which the various faith communities are united by common practices, beliefs, and actions
Individual - The person who is the subject of PHI.
Policy
The Department of Chaplaincy Services in the Central New Mexico Delivery System has as its Vision "To valuke, educate and integrate the benefits of spirituality for health and healthcare" The Mission of the department is "To integrate spirituality and emotional support throughout PHS by providing nationally excellent chaplaincy services and education to patients, families, staff and the community.' The efforts of the department are aligned with the values of Presbyterian Healthcare Services, particularly the value of "Totality of Health: body, mind and spirit." Chaplains are integral to the interdisciplinary team, and provide chaplaincy services to patients, families and staff.
Clergy from the various faith and spiritual traditions of our community and state visit those patients and families who are members of that Clergy's congregation, (house of worship), or Religious Affiliation. Through the Clergy's visit, the patient receives comfort, encouragement, hope and support, all of which contribute to the overall well-being of the patient. The chaplains of the Department of Chaplaincy Services seek to link patients with their personal Clergy. Chaplains honor the relationship of Clergy and patient as primary in the patient's spiritual care.
Patient confidentiality and privacy are honored by both the Department of Chaplaincy Services, and the community-at-large Clergy members. This policy sets forth specific procedures related to protecting patient confidentiality and privacy, while also honoring the patient's right to have access to the Clergy from his or her community of faith.
Procedure
- Clergy wishing information regarding specific members of their Community of Faith are to identify themselves at the hospital Information Desk as a member of the Clergy who has come to visit those members. The Clergy are encouraged to present some form of identification regarding their title, name, phone number and the name of the community of faith where they serve (business card, brochure, etc.)
- After identifying themselves, the Clergy may ask for the room number of those patients the Clergy wishes to visit.
- The Clergy may also ask to see the Religious Affiliation census for the Religious Affiliation which the Clergy represents and serves. Only the names and room numbers of those patients who have designated their Religious Affiliation, and whose Religious Affiliation is identical to that of the inquiring Clergy, will be provided to the Clergy. The names of those patients who do not belong to the Religious Affiliation claimed by the Clergy will not be provided.
- If the personnel at the Information Desk have any questions regarding the identity of the person presenting himself or herself as a Clergy, the Information Desk personnel may telephone the Department of Chaplaincy Services to request assistance in confirming the visitor's identity
- Clergy who ask to see the "Religious Affiliation Census" will be directed to Department of Chaplaincy Services.. The Department Secretary will ask the clergy to sign a "Clergy Request for Patient Information" log. The log will carry a statement about patient confidentiality, with a comment that by signing the log the Clergy acknowledge they have read the statement and agree to abide by the regulations and laws pertaining to patient confidentiality, privacy and protection. The log will request the following: the Clergy's signature, printed name, Religious Affiliation, specific house of worship, address, phone number.
- The Department Secretary will provide the clergy a listing of those patients belonging the same Faith Group as the requesting clergy. That list is NOT to leave the hospital with the Clergy, who is not permitted to take the Religious Affiliation Census sheet with him or her under any circumstances. It is required that the Clergy member ask any Unit Secretary to dispose of that list.
- The patient and/or the patient's family are the appropriate persons to convey to their Clergy information regarding the patient's condition. Clergy are not permitted access to any of the patient's confidential medical information and/or records except information maintained in the facility directory that the patient has not objected to disclosure to Clergy.
- Any question or problem related to Clergy's access to patient information is to be referred to the Department of Chaplaincy Services.
