OWD license without a doctor's certificate?

[rsingler]

"Under HIPAA, protected health information is considered to be individually identifiable information relating to the health status of an individual, the provision of healthcare, or individually identifiable information that is created, collected, or transmitted by a HIPAA-covered entity in relation to payment for healthcare services." [Emphasis mine]

and...

"PHI only relates to information on patients or health plan members. It does not include information contained in educational and employment records." [Emphasis mine]

from www.hipaajournal.com

 

[dmaziuk]

But that's exactly the point. No scuba professional, from a divemaster up to an agency training director, is qualified to assess your medical history or current conditions. This has come up time and time again - you can't expect them to say that this guy's asthma is well controlled enough to dive, or that guy's diabetes is too brittle to allow him to dive. They can't, and if they are, they shouldn't.

All I'm saying is that from the point of view of the dive professional's liability (and the agency's liability), they HAVE to rely on a medical opinion, and if they have a doctor's note saying there is no contraindication to diving, nothing that they can do should contradict that.

So why ask? And put the "you must", "you are responsible for all omissions" wording on the form? Make the questionnaire for the user a separate page that is not submitted with the form, just like the doctor's instructions. Put a "choose one" on page 1: "I certify that I'm fit to dive", or "I am including medical release om p.2". Problem solved.

 

[dmaziuk]

"Under HIPAA, protected health information is considered to be individually identifiable information relating to the health status of an individual, the provision of healthcare, or individually identifiable information that is created, collected, or transmitted by a HIPAA-covered entity in relation to payment for healthcare services." [Emphasis mine]

and...

"PHI only relates to information on patients or health plan members. It does not include information contained in educational and employment records." [Emphasis mine]

from www.hipaajournal.com

That is my understanding from work too. That's why I mentioned the GDPR scare: they are specifically trying to protect individuals, not "entities", and aim to interpret "PII" in a "most broad sense". Not just health status of a health plan member.

 

[doctormike]

So why ask? And put the "you must", "you are responsible for all omissions" wording on the form? Make the questionnaire for the user a separate page that is not submitted with the form, just like the doctor's instructions. Put a "choose one" on page 1: "I certify that I'm fit to dive", or "I am including medical release om p.2". Problem solved.

Yup, I agree with you! No need to leak potentially sensitive data if there is no advantage of doing so.

 

[doctormike]

"Under HIPAA, protected health information is considered to be individually identifiable information relating to the health status of an individual, the provision of healthcare, or individually identifiable information that is created, collected, or transmitted by a HIPAA-covered entity in relation to payment for healthcare services." [Emphasis mine]

and...

"PHI only relates to information on patients or health plan members. It does not include information contained in educational and employment records." [Emphasis mine]

from www.hipaajournal.com

Interesting! I was actually googling around, and I can't really find anything specific about this. I doubt that scuba diving was considered when HIPAA was drafted, but I'm assuming that there is still some privacy law governing personal information that your employer gathers, right?

And if the PHI on the RSTC form is NOT subject to HIPAA (in the US) or other privacy law elsewhere, that would make me even MORE concerned about sharing information with dive professionals when (a) those dive pros aren't in a position to do anything with the information, and (b) that information is superseded by a physician's attestation so whatever would be released is moot in terms of instructor or agency liabilities...

 

[rsingler]

And if the PHI on the RSTC form is NOT subject to HIPAA (in the US) or other privacy law elsewhere, that would make me even MORE concerned about sharing information with dive professionals

Let's hope that recent EU actions provide the prod that PADI (and the RSTC) clearly need to resolve this issue.
- Divers deserve privacy protection
- Instructors and shops deserve a transparent way of confirming that their students are fit to dive
- Divers need a cleaner path through the swamp of questions that pull too much into question when considering dive training.

While the background pages that accompany the questionnaire are excellent guidance for the physician who doesn't specialize in dive medicine, the questionnaire and what prompts a doc's signoff needs some work.

 

[Jcp2]

If the diver is the “patient” who is the “doctor” and what “medical care” is being provided?

 

[Jcp2]

These sorts of health disclosures are used all the time outside of diving. Kids in school? Forms needed. Kids in Scouts? Forms needed. Kids in sports? Forms needed. I was team manager for a kids sports team and I collected the medical forms with insurance information for the organization for our team so we could have players registered, covered by association insurance, and so I would know who had life threatening allergies, what they were to, and who to call. I also had consents for medical treatment, and I carried it around whenever the team was together so that if something were to happen, we could know what to do.

 

[doctormike]

These sorts of health disclosures are used all the time outside of diving. Kids in school? Forms needed. Kids in Scouts? Forms needed. Kids in sports? Forms needed. I was team manager for a kids sports team and I collected the medical forms with insurance information for the organization for our team so we could have players registered, covered by association insurance, and so I would know who had life threatening allergies, what they were to, and who to call. I also had consents for medical treatment, and I carried it around whenever the team was together so that if something were to happen, we could know what to do.

In that case, you are being designated as taking some responsibility for specific medical conditions (i.e. the parents are designating authority to you to take the kid to an ER, give them an epi-pen, etc...

To be honest, this thread is probably one of the most confusing ones I have ever read. I'm not really sure what we are even arguing about. How about this.

1) Don't lie on your form to avoid needing a doctors exam

2) It seems that the agency is OK with a doctor's note in lieu of you disclosing to them your specific medical conditions, which seems reasonable, since dive pros aren't doctors and they just need to know that your doctor considers you fit to dive.

3) It's perfectly reasonable for people to not want their personal medical information disseminated where they have no control over it, whether or not dives shops are HIPAA covered entities.

4) All of these things are about liability and agency paperwork. If you have a SPECIFIC medical condition where your dive instructor or buddy knowing about it ahead of time would actually make a difference in your on-site management, then it would be ridiculous to keep that from them. But for many if not most medical conditions - while involving some risk to divers - it doesn't necessarily follow that it is crucial that your dive instructor or buddies know those details, since it doesn't usually change the first aid decision tree. Yes, I can think of many conditions where it might, and I'm sure that you all can too. That's not the point.

 

[Jcp2]

Honestly reconciling 1 and 4 is not possible unless you are a younger person who appears and feels relatively healthy and has not seen a doctor since childhood. There is no allowance on the form (1) for personal judgement for disclosure (4). I think that is where the debate lies. If it’s understood that the form is a liability release, then choosing 4 over 1 seems reasonable.