Receiving and Disclosing School Health Informatiom

History
Student health information can be oral, written or transmitted electronically. Special rules for student information come from North Carolina state statutes and the federal Family Educational Rights and Privacy Act (FERPA). The United States Department of Education has ruled that medical records sent to schools are subject to FERPA. These statutes guide school nurses and all other school employees in protecting the confidentiality of student information.

Description of Issue 
Protecting the confidentiality of student health information is a complex and evolving issue due to the increased use of technology. Students and families have the right to expect that confidential health information will be safeguarded.

Rationale
A variety of health information is collected and maintained by a local education agency. It is the responsibility of the LEA (Local Education Agencies) to limit the sharing and releasing of student health information within the school system to the minimum necessary to provide for the health and safety of students during school hours. The school system may not release health information beyond the school system without written parental or eligible student consent.

Conclusion
It is the position of the School Nurse Association of North Carolina (SNANC) that school nurses ensure LEA policy and procedures exist to guide the management of student health information.

I. Receiving health information from outside sources

To obtain information from an outside source, written consent is required.

• The consent form should contain the elements listed below:
  • Name of the agency releasing the information
  • Identification of the person or agency to whom the disclosure will be made
  • Name and date-of-birth of the student
  • A description of the student health information to be disclosed
  • Purpose for the disclosure
  • Statement that consent may be revoked (until acted upon)
  • Date or condition when the consent expires
  • Statement that the signer has a right to a copy of the release
  • Signature of the parent/legal guardian or eligible student
  • Date the consent is signed
  • Statement to parent or eligible student that the record, once released, may no longer be protected by HIPAA
• The school district should send an individual cover letter explaining why specific information is needed
• Confidential health information should be sent to appropriate school health professionals
• Health information that was not requested should be returned to the sender or shredded
• Once accepted by the LEA, medical records obtained from an outside provider are subject to FERPA.

II. Disclosure

Disclosure includes the release, transfer, or communication of information by any means
including oral, written, or electronic.

A. Internally: Within the school system

In accordance with FERPA, written parental consent is not required to release information
within the school system.

• The nurse may initiate the disclosure when:
  • It is relevant to the health, safety and/or education of the student.
  • It may impact the child's academic achievement
  • There is a legitimate need to know
  • The individual staff member needs the information to carry out health related care
• Limit information to the minimum necessary to achieve the purpose of the disclosure
• Lists/logs with multiple student names or diagnosis should not be used when sharing information

B. Externally: Releasing health information to another school system

FERPA does not require written parental consent to release information to another school
system.

• Determine with school administrators how health records will be transferred to another school system.
• Send only information that is pertinent to the student's educational plan or affects their health or safety. A summary may be sufficient.
• Must transfer information/summary of information that could affect the health or safety of other students and staff.

C. Externally: Releasing health information outside the school system

FERPA does require written parental consent to release information outside the school system.

• The medical release of information form should contain the same information as outlinedpreviously (See I: Receiving health information from outside sources).
• If transmitting by fax, always use a cover page addressing the fax to a specific individual and labeling it confidential. Call ahead to ensure the recipient is there to receive the fax.
• Avoid using emails to transfer health information. If necessary, take measures such as encryption to maintain confidentiality. Work with technology experts.

III. Exceptions

FERPA does allow some exceptions to the requirement for written consent to release
information.

These include but are not limited to:

• Reporting suspected child abuse/neglect as required by state law
• Reporting to appropriate authorities when there is reason to believe that the student may be dangerous to him/her self or to others
• Reporting communicable diseases as required by state law
• Providing information to law enforcement agencies/juvenile courts as required by state law
• Complying with subpoenas and court orders. (The LEA must make a reasonable effort to notify the parent of receipt of the subpoena.)
• Responding to state and federal officials responsible for supervising and auditing school funds
• Providing information to contractors providing education or support services for a student (contractors are bound by FERPA)
• Providing information to certain educational researchers
• Responding to a health or safety emergency
• Directory information

References

Information about FERPA from the United States Department of Education is available at
http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html

All North Carolina statutes are available at http://www.ncleg.net/gascripts/Statutes/statutestoc.pl

Protecting and Disclosing Student Health Information: How to Develop School District Policies
and Procedures, American School Health Association, (2005). Kent, Ohio.

Legal Issues in School Health Services: A Resource for School Attorneys, School
Administrators, School Nurses. Schwab, N. and Gelfman, M., 2001. Sunrise River Press,
North Branch, MN.

NC School Health Program Manual. NC Department of Health and Human Services & Public
Schools of North Carolina, 2005. Raleigh, NC.

Records Retention and Disposition Schedule: Local Education Agencies. NC Dept. of Cultural
Resources, Records Services Branch, Feb. 1999.

Created by the Professional Practice & Standards Committee, March 2007
Adopted by: School Nurse Association of North Carolina, May 18, 2007