Which laws require NC local health departments (LHDs) to keep patient information confidential?
There are several laws that require local health departments to keep patient information
confidential. The major laws protecting health care information are:
• HIPAA Privacy Rule (45 CFR1 Parts 160 and 164): This is a federal law that governs when
covered entities—a term that includes most health care providers, including LHDs—may
use and disclose protected health information.
• Public health patient confidentiality law (GS2 130A-12): This is a state law that applies
only to North Carolina LHDs and the NC Department of Health and Human Services
(DHHS). Under this law, records in the possession of LHDs or DHHS are confidential and
not subject to NC’s public records law if they contain any of the following types of
information:
o Information that is privileged under state law,
o Information that is protected under HIPAA, or
o Information that is collected under the authority of the child lead screening and
investigation program.
This law also addresses some instances in which patient information may be disclosed.
• Privilege laws (primarily GS 8-53 [physician-patient privilege] and GS 8-53.13 [nursepatient
privilege]): These are state laws. Under GS 8-53, communications between
patients and their physicians (and others working under the physician’s direction) are
privileged. Under GS 8-53.13, communications between patients and nurses are
privileged. The historic purpose of these kinds of privileges is to prevent information
from being introduced into court proceedings against the patient’s will. In North
Carolina, privileged patient information usually may be introduced into courtproceedings in only two circumstances: (1) when the patient gives permission for
disclosure of the information, or (2) when the judge orders disclosure of information
after finding that disclosure is necessary to a proper administration of justice.
Two laws of particular importance to LHDs protect specific clients or categories of information:
• Title X family planning client confidentiality (42 CFR 59.11): This is a federal law that
requires providers to keep information about Title X clients confidential and disclose it
only with the client’s documented consent, unless the disclosure is necessary to provide
services to the client or is required by law.
• Communicable disease confidentiality (GS 130A-143): This is a state law that applies to
information or records that identify a person who has or may have a reportable
communicable disease or condition. Such information may be disclosed only when the
disclosure fits into one of eleven circumstances specified in the statute.
Some LHDs may be subject to other confidentiality laws as well, depending upon the types of
health care providers and/or the types of services they offer. For example:
• School nurses who work with education records must protect them in accordance with
the federal Family Educational Rights and Privacy Act (FERPA).
• Some components or employees of some LHDs may be subject to state mental health
confidentiality laws or federal substance abuse confidentiality regulations.
This list is not exhaustive. HIPAA requires each covered entity to have a privacy official. The
person who acts as the privacy official for the LHD should be familiar with the confidentiality
laws that apply to the different activities of the LHD.
This list is not exhaustive. HIPAA requires each covered entity to have a privacy official. The
person who acts as the privacy official for the LHD should be familiar with the confidentiality
laws that apply to the different activities of the LHD.
1 CFR stands for Code of Federal Regulations. The HIPAA regulations (including the privacy rule) are available at http://www.hhs.gov/ocr/privacy/hipaa/administrative/combined/index.html.
2 GS stands for General Statutes, North Carolina’s state laws. The proper legal citation form is N.C. Gen. Stat., which makes clear we are referring to NC laws and not the laws of any other state, but it is customary to use the abbreviation “GS” in documents that are intended specifically for North Carolina audiences. The NC General Statutes are available at http://www.ncleg.net/gascripts/statutes/Statutes.asp
