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captrncap
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Posts: 181

« on: April 26, 2006, 04:43:14 PM »

Can Medical Officers “officially” request squadron members to provide medical information that may be important for the Medical Officer to know such as epilepsy, asthma, diabetes, etc? Will this apply to both seniors and cadets? Is this optional, if requested?
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capchiro
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« Reply #1 on: April 26, 2006, 05:40:19 PM »

According to CAPR 160-1, it would appear that the following duties would enable and require the medical officer to be so involved.  That being said, everything in CAP is "optional".  This is a volunteer program and you don't have a right to belong, it's a privilege.  So if you are so requested, you can either comply or not, however, if not, you might want to consider leaving the program or you might have your "privilege" revoked.  been known to happen. 

SECTION C – DUTIES OF HEALTH SERVICE PERSONNEL 7. CAP health service personnel are responsible for advising CAP commanders and unit personnel on the health, fitness, disease and injury prevention, and environmental protection of CAP members relevant to CAP activities, with special emphasis on those members involved in flying, emergency services and disaster relief activities, field exercises, encampments, and special activities. a. Such advice will be in writing; however, in the case of verbal advice given in an emergency, it will be documented as soon as possible. b. CAP health service personnel should provide advice and guidance in their area of medical expertise only; otherwise they should seek appropriate consultation. CAP medical officers will not give required FAA or other examinations as part of their CAP duties. c. All health service personnel will be trained in CPR, first aid and blood-borne pathogens/disease prevention, and hold current certifications and/or training documentation in these areas. d. Provide for training in first aid, CPR, and other life-saving measures. e. Provide for blood-borne pathogen/disease prevention training. f. Report illness, injury, and blood-borne pathogen exposures and urge members so injured, ill and/or exposed to obtain appropriate follow-up medical care from non-CAP sources. (See CAPR 62-2 for reporting procedures.) g. Advise members to obtain necessary examinations from non-CAP health care sources and to complete emergency care consent forms where required by regulation in order to participate in various CAP activities. CAP health service personnel will not perform such examinations as part of their CAP duties. h. Assist in providing necessary health service training materials, supplies, and equipment for unit missions or special activities, including first aid and blood-borne pathogen/disease prevention kits. i. All health service personnel should espouse the Air Force’s health promotion/wellness/fitness philosophy.
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Lt. Col. Harry E. Siegrist III, CAP
Commander
Sweetwater Comp. Sqdn.
GA154
smj58501
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« Reply #2 on: April 26, 2006, 05:53:28 PM »

Can Medical Officers “officially” request squadron members to provide medical information that may be important for the Medical Officer to know such as epilepsy, asthma, diabetes, etc? Will this apply to both seniors and cadets? Is this optional, if requested?

We would need a JAG read on how the Health Insurance Portability and Accountability Act (HIPAA) of 1996 applies here, before we establish a process to ask members about their health. Since I am not a JAG I won't even speculate. I do know that, even in the "real" military, health information on and health information requests regarding Soldiers is a very by the book process due to HIPAA, with less people having access to the info than one may think. I am sure there is a way to do it in CAP which serves organizational needs while protecting the privacy of the individual, but we would need a JAG recommendation coupled with a national policy I imagine.
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Sean M. Johnson
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mmouw
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« Reply #3 on: April 26, 2006, 06:03:00 PM »

Don't forget when requesting medical records or information, HIPPA comes into play. They don't mess around and as a Medical Officer myself, I am not sure that I would want that responsibility. Leave that to the member and their physician.
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Mike Mouw
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« Reply #4 on: April 26, 2006, 08:05:18 PM »

Believe me, HIPAA is not fun.  Immediately coming to mind are things like: What types of precautions will you take to protect any health information collected from your members? Who gets access to health information? Are there written HIPAA releases that detail what information each CAP member is permitting CAP to know, who should have access to it, for how long, and for what purposes?  Are these written releases filed and on-hand?  Does each CAP member have the opportunity to review their health information collected by you and revoke their HIPAA release at any time?   Is the Medical Officer also acting as the Privacy Officer and are those conflicts-of-interest? 

The world of HIPAA is not fun at all, and can be a complicated and potentially hazardous area to tread in.   I would say do your homework and check with your Wing or Group legal officer for more advice, for sure.
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Michael F. Kieloch, Maj, CAP
Concord Composite Squadron, NH       
shorning
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« Reply #5 on: April 26, 2006, 08:37:23 PM »

Can Medical Officers “officially” request squadron members to provide medical information that may be important for the Medical Officer to know such as epilepsy, asthma, diabetes, etc? Will this apply to both seniors and cadets? Is this optional, if requested?

Personally, if you "officially" requested my medical information, I'd tell you to take a hike.  That's outside the bounds of your duties.
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Eclipse
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« Reply #6 on: April 26, 2006, 09:05:43 PM »

Can Medical Officers “officially” request squadron members to provide medical information that may be important for the Medical Officer to know such as epilepsy, asthma, diabetes, etc? Will this apply to both seniors and cadets? Is this optional, if requested?

Personally, if you "officially" requested my medical information, I'd tell you to take a hike.  That's outside the bounds of your duties.

No, its not - it is required information for participation in ES operations, encampments, and similiar events. You're free to refuse to provide it, and I am free to refuse your participation. That the information is kept resonably confidential is common sense, but I haven't seen any regs which require it.

Whether HIPA applies to CAP is, as noted, up to the JAGs.  The current posture of CAP with regards to handling of medical information would tell me we are not bound OR no one has considered it yet.  Ever wonder who reads those forms 60's you have to turn into admin when you sign into a mission?  How about the same data which is on the WMU?

This may fall into the same realm as ADA. 

ADA did not apply to CAP, but CAP wrote a letter to Congress indicating they would comply with the letter of ADA anyway.

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iowacap
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« Reply #7 on: April 27, 2006, 01:19:05 AM »

OK I know the legalities of medical information is a pain in the rear and I am going to school to do something in the health field and currently work in a hospital doing release of information for medical records. If they release this information to a health officer and sign that they have willingly done so in a matter to let others know health information that would be relevent in case of an emergency. I believe on the form that they sign there should be some sort of a small disclaimer or statement letting the person know by signing the document that they are willingly and OK the release of this information to the health officer for purposes of nothing other than treating in case of an emergency. There should be no other time that the health officer should be requesting medical records even though they are for this purpose. But a basic medical history provided by the member and signing the statement that they acknowledge that this is OK for the medical officer to have this information and keep. where HIPPA comes into play is that this information should be in a spot where other passersby can not see any information of the members or medical information but if they are left just sitting on paperwork in the open and someone See's it and goes around telling people then that could be a violation and could face biiig trouble. Hope this helps a little gimme a shout if you want to know more or have any questions.
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SarDragon
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« Reply #8 on: April 27, 2006, 05:09:19 AM »

The CAPF 31 requests medical information, and has places for release signatures for both the applicant, and parents if the applicant is a cadet. There is also a FOUO designation at the top of page 3. It is a 1996 form, but might be just a revision of an original that predates HIPPA.

The CAPF 60 also requests medical info, is dated Dec 03, and has no FOUO designation.

Both forms request the info so providers have it in case medical care is necessary at an activity. In the case of the CAPF 31, it can also assist in determining if there is a condition that would be disqualifying for an activity.

IMHO, it keeps everybody's butts covered. YMMV.
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Dave Bowles
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iowacap
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« Reply #9 on: April 27, 2006, 06:23:39 AM »

3Thank you sir for the clarification on the forms I was not sure exactly I dont memorize alot of the forms I dont' utilize enough I am glad that they have the forms and releases but is the signature from parents or person involoved in the activity specifically releasing the medical information? Thats what I am worried about I just want to make sure from that stand point but other than a simple medical history (problems, history, meds, ect) I dont think that any other information is irelevent to the care of that member and should be left up to the provider and/or paramedics. I beleive someone brought up th release of medical records earlier in the thread but at no time does a medical officer does not try to "officially" request records because HIPPA says you are only entitled to the information that is needed for the care at that time therefore the info in the form 31 or 60 is the only information you need.
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fyrfitrmedic
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« Reply #10 on: April 27, 2006, 10:16:32 AM »

 The penalties for unauthorized release of information are severe; that in theory should be sufficient means of deterrence.
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MAJ Tony Rowley CAP
Lansdowne PA USA
"The passion of rescue reveals the highest dynamic of the human soul." -- Kurt Hahn
capchiro
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« Reply #11 on: April 27, 2006, 11:47:01 AM »

IIRC HIPAA applies to medical care providers and the submission of insurance claims for care rendered.  I am not at all sure that a Medical Officer falls under the heading of treating physician or health care giver.  I am also not sure that a Medical Officer is required to do anything under HIPAA as he has no contact with any insurance carrier and as such may be exempt from HIPAA.  Further, I can see a need for an operations commander to require and/or need medical information regarding flight and/or ground crew health status.  If a pilot is on certain medications he may be more prone to vertigo, etc.  We must also remember that this is a volunteer program and a person joining such a program may knowingly and/or unknowingly waive certain rights that they would retain in non-voluntary situations.  It would appear that CAPR-160 does give Medical Officers the authority to require pertinent medical information from CAP personnel.  If this is offensive to some, they may wish to consider joining other organizations.  I also do not believe CAPR-160 gives the Medical Officer the right to abuse or overstep his authority in the performance of his duties.  JMHO   
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Lt. Col. Harry E. Siegrist III, CAP
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Eclipse
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« Reply #12 on: April 27, 2006, 01:10:16 PM »

3Thank you sir for the clarification on the forms I was not sure exactly I dont memorize alot of the forms I dont' utilize enough I am glad that they have the forms and releases but is the signature from parents or person involoved in the activity specifically releasing the medical information? Thats what I am worried about I just want to make sure from that stand point but other than a simple medical history (problems, history, meds, ect) I dont think that any other information is irelevent to the care of that member and should be left up to the provider and/or paramedics. I beleive someone brought up th release of medical records earlier in the thread but at no time does a medical officer does not try to "officially" request records because HIPPA says you are only entitled to the information that is needed for the care at that time therefore the info in the form 31 or 60 is the only information you need.

I guess it should be asked, or stated - your inquiry sounds like you may be concerned about a past or present condition which is either embarrassing, or might potentially disqualify you from an activity.  The ones you specifically mention - epilepsy, asthma, and diabetes, all qualify IMHO as "need to know".  They are serious, may mean the member has  to take medication, and may also put others at risk if the affected member should be incapacitated.

There is also the unspoken reluctance of soome members to wish to be involved in the duty-of-care  of someoone with a serious medical condition.  I have a duty to them as well, and as a volunteer org, cannot require that participation.

If its embarrassing, and is not a limitation, then I suppose its none of anyone's business and you should refuse the request and move on.

If its a potential disqualifier, you have a DUTY to your unit to be honest.  Your unit or event CC's and MO's have a duty to try and ascertain any information which might put either you or the organization at risk.  Lying about or hiding some piece of information which risks your health is a lot more serious than any nonsense about who sees your form 60.

It also struck me that your HSO might be trying to build a medical file on members - that's unnecessary.  He / they need what they need for a given event or your unit participation, that's it.

Now, as with a lot of CAP stuff, the "order" is "legal" until someone with standing challenges it and the challenge is upheld by a higher HQ or a court.  CAPtalk may be a nice sounding board, but we sure aren't making policy.
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DrDave
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« Reply #13 on: April 28, 2006, 02:34:25 PM »

HIPAA doesn't apply to CAP as we're not a health services provider.  Period.

I know.  I'm a physician who deals with HIPAA every day.

However, "ethically" we're bound by the traditions of medicine that have been around for thousands of years -- i.e. the confidentiality of personal health information.

As a physician, I would say that the health of every one of our members is "mission critical" information and needs to be known in order for the safety of activities and missions.  I would also say that CAPR 160-1 is very clear on this and that this information must be known to a commander for proper training and planning. 

Capt. (Dr.) David A. Miller, MD
Assistant Medical Officer, Missouri Wing
Group II Medical Officer, Missouri Wing
Spirit of St. Louis Comp. Squadron
xfiler@pol.net

Past President, St. Louis Academy of Family Physicians
Past President, Family Health Foundation of Missouri
Board of Directors, Missouri Academy of Family Physicians


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Lt. Col. (Dr.) David A. Miller
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iowacap
Recruit

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« Reply #14 on: April 28, 2006, 06:32:00 PM »

Thank you Dr. Dave I wasn't all sure on the specifics and that. That is what I was curious if it really applied to CAP and since you are a physician you know a little more about it than me.

That is what I was trying to get at, information that would be critical for the treatment of that officer or cadet that gets injured or sick.

Thanks for the clarification!
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fyrfitrmedic
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« Reply #15 on: April 28, 2006, 07:28:01 PM »

 Geeze Dave, you have huge sigfiles everywhere!  ;D
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MAJ Tony Rowley CAP
Lansdowne PA USA
"The passion of rescue reveals the highest dynamic of the human soul." -- Kurt Hahn
DrDave
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« Reply #16 on: April 28, 2006, 11:06:08 PM »

Hey Tony, great to hear from you!  Been seeing your posts here.

Yeah, wanted to make sure all knew where I was coming from.

(Really gotta learn how to say "no" more effectively!)

Dr. Dave
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Lt. Col. (Dr.) David A. Miller
Director of Public Affairs
Missouri Wing
NCR-MO-098

"You'll feel a slight pressure ..."
fyrfitrmedic
Salty & Seasoned Contributor

Posts: 555

« Reply #17 on: April 30, 2006, 03:45:33 PM »

Hey Tony, great to hear from you!  Been seeing your posts here.

Yeah, wanted to make sure all knew where I was coming from.

(Really gotta learn how to say "no" more effectively!)

Dr. Dave

 I picked up a button somewhere that reads: Stop me before i volunteer again!

 I know the feeling...
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MAJ Tony Rowley CAP
Lansdowne PA USA
"The passion of rescue reveals the highest dynamic of the human soul." -- Kurt Hahn
SARMedTech
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« Reply #18 on: May 30, 2007, 02:02:25 AM »

Its seems that one thing is missing: your not going to get in trouble for violating a patients rights if the patient/member provides medical information voluntarily. You ask, they say yes, youre good to go. Especially in a field situation where you might have someone experiencing chest pains, SOB, etc. You would get this information in taking a SAMPLE medical history which you would then pass on to EMS who responds to assist. This is done every day by those of us in EMS and as long as I dont share that information with someone not involved in the patients care, we're all good. For those of you not familiar with SAMPLE history:

S-Signs and Symptoms
A-Allergies to medications and others
M-Medications currently taken
P-Pertinent past history
L-Last oral intake of food, liquid or meds
E- Events leading to the injury or illness

When I go out, I carry a little EMS notebook in my BDU pocket that allows me to record information that I ask and also that I gain through getting a set of vital signs. Dont get so caught up in privacy laws that you are afraid to ask someone who is in dire straits a question. If you think that the answer might be embarrasing or something that they just dont want anyone else to hear, have any uncessaries clear out of the area before taking your member/found persons history.
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RiverAux
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« Reply #19 on: May 30, 2007, 02:06:32 AM »

I didn't see anything in the regulation cited that authorized medical officers to either request or demand medical information of CAP members. 
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CAP Talk  |  Operations  |  Safety  |  Topic: Medical Information
 


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