Appendix C

Clarification on Confidentiality for “Need to Know” and School Staff

 

This section is to provide general information and is not to be used as legal guidance.  Specific questions should be referred to the district’s legal counsel.

 

Background:

 

All student information in schools that receive funds under an applicable program of the U.S. Department of Education is regulated by the Family Educational and Privacy Rights Act hereafter referred to as FERPA. FERPA requires every school district to have a written policy explaining the standards for keeping education records confidential.  This includes student health information.  In Washington State, the Revised Code of Washington (RCW) 70.02 Medical Records – Health Care Information Access and Disclosure provides additional requirements for health care providers in any practice setting that are more restrictive than FERPA.

 

FERPA privacy rules specifically allow parents the right to inspect and review their student’s records and identifies what information may be shared without parental consent.  It uses the concept of legitimate educational interest to identify who within the school should have access and to what information.  Legitimate educational interest has been further described as a person’s legitimate need to know such information to fulfill their professional responsibilities. 

 

Health Care Providers, individuals licensed by Washington Department of Health such as registered nurses, occupational therapists, physical therapists, speech and language therapists, and clinical social workers also are subject to RCW 70.02.  This law:

●      defines health care information

●      describes what and when information can be shared without consent

●      describes what should be included in a written consent to share health information form

●      describes penalties for breaching these rules

 

It is important for the school nurse to get the written consent of the parent (or the student if age 18 and older) before sharing information about a student’s health.  Some health problems have specific rules for consent and are described on pages 11-13 in the publication, Guidelines for Handling Health Care Information in School Records (OSPI, 2001). 

 

All school staff members who need access to the health care information should be listed on the consent for release of information.  These names should be discussed with the parent and documented before the consent is signed. It is not always possible to know the name of each person who needs access to the information so titles or positions may be used. The parent should also be informed that they may rescind or restrict their consent in writing at any time.

 

●      Emergent Situations in which School Staff “Need to Know What to Do”

 

In the case of emergency health care plans, many different people “Need to Know What to Do” because the child may be at risk for a life-threatening problem in any area of the school campus and at off-site school activities (athletic events, field trips, etc.). The school nurse (registered nurse) should only share the health information school staff need to know to perform their responsibilities. 

 

When parental consent cannot be obtained or if the parent refuses to give consent, the school nurse and the school administration need to discuss a plan to keep the student safe while at school.  The law allows the school nurse to release specific information to other school staff if the student is at risk for an emergency at school.  This step can be taken after documented attempts to reach the parent to try to get consent have occurred.

 

Forms used by some school districts:

▪        Health Registration Form (district-specific) provides or updates each student’s health status. It is recommended that this form be completed before each school year begins. The form should indicate that information on the form may be shared with school staff to ensure the student’s health and safety.  The parent / guardian signature at the bottom of the form gives implied consent for sharing information.  This may not stand the test of a court case but is an indication from the parent of the need to share information.

 

▪        Parental Consent to Share Health Information with School District Staff (sample form on the last page of this appendix) is a way to document consent of parents / guardians for students with specific health conditions such as those identified on the Health Registration Form.  The nurse, after assessing the condition and developing an individualized emergency care plan, would decide which staff members need to know about the condition and be trained how to carry out the steps outlined in the plan.  With this form, the nurse is requesting written permission from the parent to share information.  It may be impossible to identify every staff by name, so job titles are often used.  The parent also has the right to identify specific staff that they do not want to be involved. 

 

It is advisable that these types of forms be regularly reviewed by district administration and/or district legal counsel to verify they continue to meet current regulations and standards.

 

The Bottom Line:

It is imperative that the school nurse share specific health information with school staff regarding a student who has a potentially life-threatening health condition to create a safe learning environment for all students. The school nurse should, with consent of parent or guardian, share other health information with staff that have a legitimate educational interest.   It is always best practice to work directly with the student and the family; complete a thorough assessment, obtain consent from the parent/legal guardian, and create a plan in partnership with all staff involved so students with health conditions can be healthy, safe, and fully participate in school.

 

 

 

 

 

Specific references:

Chapter 70.02 RCW, Medical Records — Health Care Information Access and Disclosure:

"Health care provider" means a person who is licensed, certified, registered, or otherwise authorized by the law of this state to provide health care in the ordinary course of business or practice of a profession. Revised Code of Washington (RCW) 70.02.010 (18)

 

WAC 246-840-700, Standards of nursing conduct or practice.

The registered nurse […] shall respect the client’s right to privacy by protecting confidential information and shall not use confidential health information for other than legitimate patient care purposes or as otherwise provided in the Health Care Information Act, chapter 70.02 RCW. Washington Administrative Code (WAC) 246-840-700 (4) (e)

 

Guidelines for Handling Health Care Information in School Records (2001). Retrieved from http://www.k12.wa.us/HealthServices/pubdocs/Guidelines.pdf

 

Parental Consent to Share Health Information with School District Staff

 

You have notified the school nurse that your child:

_____________________________________________ DOB: ____________

 

 

has the following health condition(s):

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

In order to safeguard your child’s health and safety during school time, it will be necessary to develop a plan of action if your child needs assistance for any health problems that may occur.  Other school staff will need to be involved in some situations, especially when the nurse is unavailable.

 

School staff (and substitutes) will work in partnership with you and the school nurse to do what is necessary to assist your child.  The following school staff that may “need to know what to do” include, but are not limited to:

•       Classroom Teacher

•       Office Staff

•       Principal

•       Playground Monitor

•       Bus Driver

•       Cafeteria Staff

•       Other (specify) ________________________________________

 

If you agree that the above school staff may have as much information as they need in order to respond quickly and appropriately to care for your child's health needs, please sign below:

•       I agree that the school nurse may decide who needs to know specific information to assist my child.

 

____________________________________________________________   

Parent Signature                                                                         Date

 

 

If there is specific school staff you do NOT want to know about your child’s health problem, please specify by name and sign below:

•       I do not want _______________________________ to know health information about my child.

 

_____________________________________________________   __________

Parent Signature                                                                                           Date