Caring for a parent

Doctors can tell family more than you think. Your parent decides.

Your dad is in the hospital. You call his doctor. Usually it goes fine. Doctors have more room to talk with family than most people expect. But your parent holds the final say. Once you see that, the order is simple: the conversation comes first, the paperwork second.

Photo: Kampus Production / Pexels

What doctors are allowed to share

The federal privacy rule (HIPAA) lets a doctor, hospital or insurance plan share information with a family member or friend who is involved in your parent's care, or in paying for it. Only what's relevant to your part. If your parent can decide, they must agree or not object.

The key word is "may", not "must". No office has to tell family anything. Your parent can object, or ask the office to limit what it shares. Once the office agrees to a limit, it must follow it.

If your parent can't decide, say in an emergency, the office may share what's directly relevant if it judges that's in your parent's best interest.

• A signed authorization. A form your parent signs naming you. It has an end date or event, and your parent can cancel it in writing at any time.
• A health care power of attorney. It names a health care agent (the law calls this person, or a court-appointed guardian, a "personal representative"). The agent is treated like the patient, records included. Some of these documents work right away. Others only start once your parent can't decide.

Requesting records step by step: How do I get my parent's medical records?

Why the conversation comes first

This part isn't law. It's what we see in practice.

A relative calls without permission. The office says no and often notes the call. Usually nothing more comes of it.

Sometimes the parent hears about it, feels bypassed, and tells the office not to share with that person. A "do not release" note can then sit in the file for a long time. The relative who was trying to help becomes the one person the office won't talk to.

To be clear: this isn't common. We see it mostly in families with a lot going on. Siblings with different views. A divorce or remarriage. A very private parent. A child far away. If that sounds familiar, talk first.

How to start the talk

Pick a quiet moment, not the hospital hallway. Lead with your parent's wishes. Ask, don't assume:

"If you ever need help with doctors or bills, I'd like to do it the way you want. Can we talk about that?"

"Who would you like your doctors to be able to talk to? Is there anyone you'd rather they didn't?"

"Is it all right if they tell me about appointments and bills? Is there anything you'd like kept private?"

"That's okay. Let's come back to it whenever you're ready."

If your parent says "not yet", accept it. Pressure makes a private parent more private. What to put in place while they can still decide: What should my parent sign now, while they still can?

Getting the permissions in place

There isn't one form that covers everyone. Each place keeps its own.

• Each doctor's office and hospital. Ask how your parent can give you permission. Usually it's their own release form.
• The pharmacy. A pharmacist may hand a filled prescription to someone your parent sends. For questions about medicines, ask whether they want something in writing.
• Medicare. Your parent says yes on the phone with you, or adds you with the "Authorization to Disclose Personal Health Information" form. Online, in their Medicare account, it works right away. On paper, it generally takes a few weeks.
• Other insurance. A Medicare Advantage, drug, Medigap or employer plan is a separate company. Call the number on the card and ask for its own form.

Keep a phone photo of every signed form, with the date and who received it. Tell your siblings who the contact person is, so the office isn't getting four calls a day. For the day-to-day side: How do I talk to their doctor when I'm not the patient?

The 60-second recap

• Doctors may talk with family involved in care. They don't have to, and your parent can say no.
• A signed authorization names you. Your parent can cancel it in writing.
• A health care power of attorney may only start once your parent can't decide. Check the document.
• Each office, Medicare and each insurance plan needs its own permission.
• Calling without permission rarely backfires, but a "do not release" note is hard to undo. Talk first.

Sources

• HHS — Family members and friends
• HHS — Under HIPAA, when can a family member access the individual's health information?
• HHS — Personal representatives
• HHS — Does having a health care power of attorney allow access to the patient's records?
• eCFR — 45 CFR 164.510: Uses and disclosures requiring an opportunity to agree or object
• eCFR — 45 CFR 164.502: Uses and disclosures (personal representatives)
• eCFR — 45 CFR 164.508: Uses and disclosures for which an authorization is required
• eCFR — 45 CFR 164.522: Rights to request privacy protection
• Medicare.gov — Talking with a friend's or family member's doctor during an appointment (fact sheet)
• Medicare.gov — Other forms (Authorization to disclose personal health information)