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CHAPTER 2 -- CASE RECORDS
CHAPTER 2 CASE RECORDS
CASE RECORDS ............................................................................................................. 2
A. PURPOSE .................................................................................................................. 2
B. POLICY ..................................................................................................................... 2
PUBLIC DISCLOSURE PROCESS ............................................................................... 3
A. WHAT IS A PUBLIC DISCLOSURE REQUEST? ............................................................. 3
B. WHEN YOU FIRST RECEIVE A PUBLIC DISCLOSURE REQUEST ................................. 3
C. RESPONDING TO A REQUEST ................................................................................... 3
D. DETERMINING WHETHER THE INFORMATION IS RELEASABLE.................................. 4
E. TRACKING YOUR PUBLIC DISCLOSURE TIME ........................................................... 4
F. NOTIFYING THIRD PARTIES...................................................................................... 5
G. PREPARING THE RESPONSE ...................................................................................... 5
H. CHARGING FOR COPIES ............................................................................................ 6
I. NOTIFYING REQUESTORS OF APPEALS ..................................................................... 7
OBTAINING CONSENT TO SHARE CONFIDENTIAL INFORMATION (DSHS
14-012) ................................................................................................................................ 8
CASE FILE STANDARDS .............................................................................................. 9
A. RETENTION .............................................................................................................. 9
B. ORIGINAL SIGNATURES AND FAXES ......................................................................... 9
C. ORGANIZATION OF FILES ......................................................................................... 9
CASE TRANSFER GUIDELINES ............................................................................... 11
A. TRANSFERRING A CASE.......................................................................................... 11
B. RETURNING A CASE ............................................................................................... 12
C. TRACKING RETURNED CASES ................................................................................ 12
APPENDIX A: PUBLIC DISCLOSURE CONTACTS ............................................. 14
A. HCS PUBLIC DISCLOSURE COORDINATORS ........................................................... 14
B. DDD COORDINATORS ............................................................................................ 15
APPENDIX B: SITUATIONS WHEN RELEASE IS REQUIRED ......................... 16
APPENDIX C: LETTER SAMPLES........................................................................... 19
A. FIVE-DAY LETTER SAMPLES ......................................................................... 19
B. DENIAL EXAMPLE ............................................................................................ 21
Attachment
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Chapter 02\TQ Ch 02 - Case Records and Disclosure 10-04.doc
Revised 9/04 1
CHAPTER 2 -- CASE RECORDS
CASE RECORDS
A. Purpose
The purpose of this chapter is to ensure:
Confidentiality of record contents;
Compliance with public records disclosure laws;
Statewide consistency in the information transferred between Aging and
Disability Services Administration (ADSA), Home and Community Services
(HCS) Division, and the Area Agencies on Aging (AAA) case management
agencies;
File content remains intact during transfers in order to comply with federal
regulations pertaining to Medicaid clients;
The continuity of information to perform case management duties; and
Promote understanding and use of proper forms for Client Consent and
Authorization.
B. Policy
RCW 42.17.3101
Certain Personal and Other Records Exempt
Medical Records-Health Care Information Access and
RCW Chapter 70.02
Disclosure
Disclosure of Antibody Test or Testing or Treatment
RCW 70.24.105 of Sexually Transmitted Diseases-Exchange of
Medical Information.
RCW 74. 04.060 Records, Confidential-Exceptions-Penalty
RCW Chapter 74.34 Abuse of Vulnerable Adults
WAC Chapter 388-01 DSHS Organization/Disclosure of Public Records
Administrative Policy 6.09 HIV/Acquired Immune Deficiency Syndrome
Administrative Policy 5.02 Public Disclosure of Department Records
Administrative Policy 5.01 Safeguarding Personally Identifiable Information
1 In 1972, Initiative 276 was passed giving us the “Open Public Records Act” which was
later codified as Chapter 42.17 RCW. This chapter now gives us the key guidelines for
answering most public disclosure questions.
Revised 9/04 2
CHAPTER 2 -- CASE RECORDS
PUBLIC DISCLOSURE PROCESS
A. What is a Public Disclosure Request?
A request for a public (DSHS) record may include documents, audio and video
recordings, pictures, e-mail, computer disks and electronic data.
NOTE: Chapter 6 provides information on APS public disclosure issues such as
procedures related to disclosure and release of APS investigative information and
APS-related information contained in the HCS/AAA Case file.
B. When You First Receive a Public Disclosure Request
If you are NOT a public disclosure coordinator, you should:
1. IMMEDIATELY refer all requests for information to the public disclosure
coordinator for review (Please refer to Appendix A: HCS Public Disclosure
Coordinators).
2. Make this referral either the same day as the request comes in or the next
possible day. DO NOT DELAY!
3. Keep accurate notes including the date, the name of the person requesting the
information, the address or a way to contact him/her (phone, email, etc.), and
a specific list of information that he/she is requesting.
4. Remember that people can request information over the phone, via email, in
writing, etc. Requests do not have to be in writing, as described in WAC 388-
01-060.
C. Responding To A Request
When the Public Disclosure Coordinator receives the request, he/she will:
1. Keep accurate notes including the date, the name of the person requesting the
information, their address and a phone number you can reach them at, and the
specific information that he/she is requesting.
2. Compose and send a letter within 5 days. To count five days remember the
following:
o The day the request comes into the agency is “Day Zero.”
o The 5-day letter is due (postmarked) by the close of business on “Day
Five.”
o Don’t count weekends or holidays. Count business days only.
3. The “five-day letter” must do one of three things:
o Fill the request;
o Deny the request and explain why, citing the statute or legal basis; or
o Request additional time to gather information to fill the request.
“Additional time,” is generally a maximum of thirty business days to
ensure that there is enough time to process the request. Use the maximum
Revised 9/04 3
CHAPTER 2 -- CASE RECORDS
thirty days2 especially if you have a request that is agency-wide or is high
profile.
4. The “five-day letter” must include the following:
o The date of the request;
o Any changes to the request;
o Copy and cost information (if you know it);
o Your contact name and phone number/email address;
o If you are denying or redacting, give the reason, a citation and appeal
information; or
o If you need more time, tell how long it will take, give the reason, and cite
RCW 42.17.320. You can take more time to fill a request based on a need
to:
a. Clarify the intent of the request;
b. Locate and assemble the information requested;
c. Notify third person or agencies affected by the request; or
d. Determine whether any of the information requested is exempt.
D. Determining Whether the Information is Releasable
The Public Disclosure Coordinator will then:
1. Determine if the information is releasable by looking at WAC and RCW.
Check if the information requested requires an authorization (release) or other
administrative procedure such as a court order to obtain. (See Appendix B,
Authorizations.)
2. Contact the requestor if you need to further clarify the request.
3. Contact your HCS headquarters coordinator anytime you have:
o A question regarding a request;
o A request that appears to affect other administrations;
o Reason to suspect that this request may be high profile and/or a potential
media request.
E. Tracking Your Public Disclosure Time
Public Disclosure Coordinators must track all time (and related information) spent on
public disclosure using the Public Disclosure Log. As indicated on the instructions,
send this log to the HQ Public Disclosure Coordinator quarterly.
2
If you think you will need more than thirty days, contact the HCS headquarters coordinator.
Revised 9/04 4
CHAPTER 2 -- CASE RECORDS
Headquarters PDC staff are also logging time into a spreadsheet designed and used
across ADSA. This information helps DSHS to understand how much time is spent
on public disclosure.
RCW 42.17.330
WAC 388-01-140
F. Notifying Third Parties
The Public Disclosure Coordinator will:
1. Determine if within the request there are names of third party people such as
witnesses, employees, or other organizations, contact them and give them time
to block the release of their information.
2. Include information in the notice that states:
o The record(s) being requested;
o The date you intend to release the record; and
o How the individual or organization can prevent release of the record (see
RCW 42.17.330) and the deadline to take that action.
3. Send a written notice to the requestor informing him/her that:
o The individual or organization whose personal information is contained in
the requested public record has been notified;
o You expect a response from the individual or organization regarding
disclosure of their personal information by a specified date; and
o Disclosure may be denied.
4. Release the record if no one objects or the party does not respond by the
specified date. If the third party does object to the information being released,
they can prevent release of the record by petitioning the court for protection of
the record. If you need to allow more time for someone to get a court order or
for some other reason, inform the requestor of the revised date.
The superior court for the county in which the
person named in the record resides, or in which the NOTE:
record is maintained, may grant protection of the When an individual or
record if the court agrees that such examination organization, other than
would clearly: the subject of a record,
o Not be in the public interest and would files a lawsuit to block the
substantially and irreparably damage any disclosure of records, you
person; or must notify the Office of
the Attorney General.
o Would substantially and irreparably damage
vital government functions.
G. Preparing the Response
1. Gather releasable information and make 2 copies.
Revised 9/04 5
CHAPTER 2 -- CASE RECORDS
2. Make sure all original files stay in their original office.
3. Redact one copy of the records (See redaction section).
4. Make a copy of the redacted records.
5. Make sure that you cannot see redacted information through the copy and
send a bill for copies (see copies section below) and postage to the requestor.
Call the requestor and ask them if they would like to avoid the postage charge
by picking up the package at your office.
6. When you receive the check in the appropriate amount from the requestor,
send them the package.
7. Keep one clean copy and one redacted copy for your files. Currently the
retention period for public disclosure files is one year from the response or
final action.
8. Cc any collateral contacts and inform them that the information has been sent
out. You do not need to send them the entire packet of information. Send
only a copy of the cover letter. Collateral contacts may include your co-
worker(s) that were involved in the request, third parties that did not attempt
to block the release of their information, your supervisor, etc.
RCW 42.17.300
WAC 388-01-080
H. Charging for Copies
According to RCW 42.17.300 and WAC 388-01-080(2), DSHS may charge fifteen
cents per page for normal photocopies plus postage. Typically, cost of processing
and accounting for a check is $10.00. Collect any copy charge above $10.00. If
requestors come in to view the record, they may avoid charges. Only charge
requestors for actual copies made. If the requestor prefers to view the record, it still
must be processed per normal public disclosure procedure (e.g. you must still make
copies and redact exempt information).
When mailing a record, charge the requestor postage. Call the requestor in advance
and ask them if they would like to avoid paying the charge for postage by picking up
the package.
Checks for public disclosure should be made payable to DSHS (with a note: “For
public disclosure costs”) and sent to:
DSHS/ADSA
Attn: Deb Cherry
PO Box 45600
Olympia, WA 98504-5600
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CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
The requestor may send the check directly or they can submit it to the public
disclosure coordinator and the coordinator can forward it to the address above. Be
sure to include the note on or with the check informing Deb Cherry that the check is
for PUBLIC DISCLOSURE.
I. Notifying Requestors of Appeals
If you deny any part of the record requested or redact any information, you need to
inform the requestor of the right to appeal the denial. Under WAC 388-01-130(1),
requestors may request an internal review within DSHS.
If you receive an appeal (a petition for review), forward it immediately to your
headquarters public disclosure coordinator for processing. The response time for
appeals is only two business days.
Requestors may also seek review from the Office of the Attorney General or may
appeal a denial in court. Contact your coordinator if you have additional questions
related to the appeals process.
Revised 9/04 7
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
OBTAINING CONSENT TO SHARE CONFIDENTIAL
INFORMATION (DSHS 14-012)
You are required to obtain consent prior to sharing confidential information about a
client. Use form DSHS 14-012 to document this consent.
The client or representative (e.g. DPOA or guardian)3 may sign this form. The
instructions on the consent form (DSHS 14-012) under the signatures portion of the
instructions explain who can sign the consent form. In those cases where the client
understands, but can only make a mark in the signature box, a mark is sufficient. In these
cases, a witness should sign and then make a note about the client's inability to properly
sign and the reason.
You must use this form in order to obtain, use, or share confidential information about a
client for the purpose of providing services to the client. If you need to list multiple
providers on the consent form and cannot fit all the information in the blanks provided,
you may mark the box, “See attached list,” and attach a list to the consent form to
accommodate all information.
Potential Providers-
When looking for the appropriate provider for a client, only list the provider’s name and
address if known. If you do not know the names and addresses of the providers you will
be seeking out, in the blank space provided state, “Searching for appropriate provider”.
This will allow you to research multiple providers for a client in order to locate the one
that best fits the client’s needs.
3
DPOA document should be specific as to consent for health care. A DPOA (as a type of
Power of Attorney) is the only one that can be used when a person becomes
incapacitated. A general power of attorney is not sufficient. Keep copies of
DPOA/Guardianship verification in the file.
Revised 9/04 8
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
CASE FILE STANDARDS
This section outlines standards for retaining files, obtaining original
documents/signatures, and organizing files.
A. Retention
1. The active file contains material two years old or less. The most current
Acknowledgement of Services Form (14-225) and all legal documents must
remain in the active file even if it is over two years old. All client files must be
maintained for three years.
2. Inactive files contain material over two years old.
o Retain the file on local office’s shelves until the old volume is one inch or
more in width (Support staff: See Manual E for splitting records). Send
the volume to a retention center per record retention procedures.4
o If material in an older, multi-volumed file is needed, request this material
from the retention center according to retention center procedures.
B. Original Signatures and Faxes
Certain forms require that the original signatures and the original document be filed
in the case record. Examples of this are the (DSHS 14-225) Acknowledgement of
Services and the (DSHS 16-172), Rights and Responsibilities form. Typically, you
can obtain these signatures during the face-to-face contact with the client.
On occasion, a document must be faxed. Fax transmissions are acceptable as long as
the original document is accounted for properly. Although more widely used, faxing
is not a substitute for properly forwarding and filing the original document. Some
source documents (containing original signatures) may be maintained by different
entities or organizations. If this is the case, include a note in the file of where the
original is maintained.
C. Organization of Files
Use four loose sections bound by brads in the organizational structure outlined below.
Individual AAAs may choose to organize their files differently as long as written
policy outlines the organization of files and it is consistent with HCS organization
when transferred.
1. Service Episode Records (optional); NOTE:
2. SSPS Documents: This section contains all SSPS Do not remove any
documents: 14-154(X), Social Service documents from the
Authorization and the 14-159, Change of Service record prior to
Authorization. File authorization documents in transfer or at any
chronological order, with the most current on top. other time.
3. CARE Service Summaries: with most current on
4
Maintain files on site for a minimum of 2 (two) years after termination of Medicaid services
before transferring to State Archives.
Revised 9/04 9
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
top.
4. Supporting documentation and correspondence section: This section
contains all supporting documentation and correspondence relevant to the
decision of authorizing or terminating services. Place current information on
top of each section, with the exception of the narrative section.
Adult Protective Services (APS) documents: APS documents are treated differently.
Please refer to Chapter 6 of this manual for specific instructions on how to file APS
documents.
Revised 9/04 10
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
CASE TRANSFER GUIDELINES
Use these protocols when transferring a physical and electronic record from one office to
another. At any point during a case transfer, the social worker/case manager may request
a case transfer consultation or case staffing. The case staffing may be done via telephone
or in-person.
A. Transferring a Case
1. The transferring Social Worker/Case Manager is responsible for file completeness
and accuracy. The Assessment and Care Plan section must meet minimum
standards outlined in Chapter 3. (The receiving agency will assign the case to an
individual social worker/case manager within 30 days.) Prior to transferring a
case where Fast Track Services are authorized, the transferring Social
Worker/Case Manager will verify that at least pages 1 and 2 of the Medicaid
application has been received by financial services.
2. Prior to transferring the case, the transferring Social Worker/Case Manager must
call the client and/or the authorized service providers to verify that all services
have been authorized and have started. Use the phone call to notify the client of
the imminent transfer and give the client contact information should they have
questions/concerns prior to the receiving worker contacting them.
3. Environmental modifications will be arranged and contracted for prior to transfer.
Completion of the modification and payment of the services may be completed
after the transfer of the case.
4. The transferring Social Worker/Case Manager must complete the Case Transfer
form (DSHS form #10-284) and attach it to the front of the client’s file.
Transferring of the physical file will be entered into the barcode system as
required by policy. The transferring agency will change the worker ID on the
154/159 to 00TC00. (The receiving agency will change the worker ID on the
154/159 upon assignment of the case to an individual Social Worker/Case
Manager.)
5. The transferring Social Worker/Case Manager will complete a Financial/Social
Services Communications Form (14-443) to notify the Financial Worker of the
case transfer.
6. When the case involves an Individual Provider authorization, the transfer
materials will include a provider file with the following information:
a. Copy of the WATCH background check results;
b. Copy of the IP’s signed Central Background Unit check form;
c. Documentation that fingerprint card was sent to Central Background Unit,
if applicable;
d. Signed IP contract with provider’s Social Security Number;
e. I-9 form with supporting documentation (copies of required identification
or documentation that documents were seen);
Revised 9/04 11
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
f. Documentation in the Service Episode Record that the provider has
received the IP Handbook and that training and time slip requirements
have been discussed with the provider;
g. Documentation in the Service Episode Record that the client’s service plan
and description of the personal service definitions were reviewed with the
IP; and
h. Documentation that the IP has completed mandatory IP orientation. This
is required only if the IP is working for his/her first DSHS client. When
applicable, the SSPS provider file needs to be updated prior to the file
transfer to indicate completion of orientation.
7. The transferring Social Worker/Case Manager will verify record completeness
using the checklist on the Case Transfer Form. If a supervisor reviews the file
prior to transfer, the supervisor will sign and date the Case Transfer Form. See
LTC Manual Chapter 23 for supervisory file review requirements.
B. Returning a Case
If the transferred case does not meet the minimum standards or has
payment/authorization errors:
1. The receiving agency will notify the transferring agency within 10 working
days of receipt of the file.
2. The transferring agency is expected to make necessary corrections to the file
documents. Whenever possible, this will be done electronically. In rare
instances, it may be necessary to return the physical file to the transferring
agency for correction. Necessary changes will be made by the transferring
agency within 10 working days from the date notification was received.
Unless the transferring agency is notified within the timeframe, the transfer
will be deemed complete.
3. Track returned cases, using the form in the following section.
4. The transferring and receiving supervisors are responsible for resolving issues
related to case transfers. If any disagreement occurs, it will be addressed
through the chain of command established by both the transferring and
receiving agencies. Unresolved differences between the HCS regions and
AAAs should be referred to the Chief of the State Unit on Aging and Assistant
Director of Home and Community Services Division or their designees for
resolution.
NOTE: Additional information regarding the case transfer of in-home, Nurse
Delegation clients can be found in Chapter 13 of this manual.
C. Tracking Returned Cases
Use the format listed below to identify trends and patterns in files that are identified
as needing correction. It is the responsibility of the receiving agency to document the
reasons transferred files do not meet the transfer protocols. Use the forms in
discussions between AAA and HCS at local coordination meetings. The identified
Revised 9/04 12
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
trends and patterns will be used to determine training needs and to address personnel
related issues.
DATE CLIENT AGENCY CASE WORKER CASE REASON
NAME/ TRANSFERRED TRANSFERRED RETURNED COMMENTS
FROM FROM CODE
Reason Return Codes
A. Assessment does not meet minimum standards.
B. Plan does not meet minimum standards.
C. Obvious inconsistency and/or discrepancy in the
assessment or plan.
D. Errors in payment authorization and/or authorized
services.
Revised 9/04 13
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
APPENDIX A: PUBLIC DISCLOSURE CONTACTS
A. HCS Public Disclosure Coordinators
Below is a list of Public Disclosure Coordinators (PDCs) by HCS region. In section
B, PDCs for DDD are listed. If you are not a PDC, if this request involves another
region, or the request involves the media or is potentially high profile, use the contact
numbers below. It is important to adhere to the strict public disclosure timelines, so if
you receive a request and are not accustomed to processing public disclosure, contact
the PDC in your region immediately after receiving the request.5
Region Contact Phone Email
Dan Dowler (360) 725-2446 Dowledm@dshs.wa.gov
HCS Headquarters Kristi Knudsen (360) 725-2537
Christine Faber (509) 323-9424 Faberca@dshs.wa.gov
* Lisa Malpass (APS (509) 323-5250 MalpalA@dshs.wa.gov
HCS Region 1 information)
Carolyn Giovanini (509) 225-4426 Giovacs@dshs.wa.gov
HCS Region 2
Val Bauermeister (509) 545-2692 Bauerv@dshs.wa.gov
HCS Region 2 (APS information)
Jerry Gould (360) 416-7415 Gouldjg@dshs.wa.gov
HCS Region 3
Kathleen Burge (APS (206) 341-7665 Burgekt@dshs.wa.gov
HCS Region 4 information)
Sonja Sanders (206) 341-7616 Sandesr@dshs.wa.gov
HCS Region 4 *Kwame Amoateng (206) 341-7878 Amoatk@dshs.wa.gov
HCS Region 5 *Andre King (253) 476-7215 Kingaw@dshs.wa.gov
Rebecca Garcia (APS
HCS Region 5 information) (253) 476-7283 GarciRL@dshswa.gov
Suzanne Thompson (360) 664-7610 Thompse@dshs.wa.gov
HCS Region 6 (APS Information)
Indicates back-up for primary Public Disclosure Coordinator.
5
For disclosure information relating to APS, see Chapter 6.
Revised 9/04 14
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
B. DDD Coordinators
Region Name Phone Email Address
DDD Debbie Hoines (360) 902-8436 HoineDA@dshs.wa.gov
Headquarters
Region 1 Janie McCaslin (509) 458-2061 McCasJL@dshs.wa.gov
Region 2/YVS Pat Yergen (509) 698-1269 YergePJ@dshs.wa.gov
Region 3 Linda Cummings (425) 339-3820 CummiLI@dshs.wa.gov
Region 4 Rod Duncan (206) 568-5716 DuncaRA@dshs.wa.gov
Region 5 Debbie Johnson (253) 593-2819 JohnsDA2@dshs.wa.gov
Region 5/FHMC Vicki Phillippi (360) 475-3463 PhillVL@dshs.wa.gov
Region 5/Rainier Pam Elkins (360) 829-3013 ElkinPM@dshs.wa.gov
Region 6 Dawn Baker (360) 570-3154 dlbaker@dshs.wa.gov
15
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
APPENDIX B: SITUATIONS WHEN RELEASE IS REQUIRED
This table shows when a release may or may not be required, for NON-APS situations
only. (DSHS 17-063). Refer to Chapter 6 for APS situations.6
Person Requesting Type of File Do you need authorization?
Information
The Client Client’s own file No, but the person must be able to
prove identity by showing / faxing
/ sending copy of ID or having a
signature notarized. Also, certain items
are still subject to redaction, such as
another client’s information that may
be located in the file.
The Guardian Client’s file No, but the guardian does need a copy
of the guardianship appointment
paper(s). These should be checked to
be sure they authorize access to the
information requested. This file is
also subject to redaction of certain
information (e.g. info. about another
client.) In a case where the guardian
is also the alleged perpetrator
involved in an APS allegation, see
Chapter 6.
Client’s Client’s file Yes, needs an authorization signed by
Daughter/Son/Friend/ the client if he/she is “just” the
Cousin, etc. Daughter/Son/Friend/
Cousin, etc and doesn’t have other
specific authority.
Client’s Attorney or Client’s file Yes, needs signed authorization from
any Attorney. the client. Again, look at the
authorization to ensure they are entitled
to the information they are requesting.
A Legislator or Staff Client’s file Yes, needs a signed authorization from
the client for verbal or written
disclosures. See letter from Dennis
Braddock.
Client’s Husband/Wife Client’s file Yes, unless the person requesting is the
guardian or has Power of Attorney.
Check the appointing papers for
6
If the person requesting the client’s information is also an alleged perpetrator in an APS case, or you
suspect that the release of this information could potentially put the client in danger, contact your HCS
Headquarters Coordinator (located on the list above) and refer to LTC manual Chapter 6.
16
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
Person Requesting Type of File Do you need authorization?
Information
accuracy. Also, in these situations,
check to ensure that APS is not an
issue. See LTC manual Chapter 6 for
more information on APS disclosure
procedures.
Client’s Power of Client’s file No, but check to ensure that the
Attorney appointing papers are accurate. Also,
see Chapter 6 for information related to
APS.
Client’s Estate Client’s file No, but you must obtain a copy of the
Representative proof of appointment as estate
representative and ensure that they are
entitled to the information requested. If
there is no estate representative, next of
kin may have authority to obtain
information.
See RCW 70.02.140 and RCW
7.70.065 for next of kin information.
A Nursing Home (for a Client’s file Yes, the authorization must be signed
conference or prior to the nursing facility receiving
otherwise) the client’s file. Also, the
client/representative should be
informed of all care conferences before
they take place.
Area Agency on Aging Client’s file No, ADSA contracts with the Area
Agencies on Aging (AAA)/Aging
Network to administer the programs of
the agency. No authorization is
necessary to transfer files or share
information with these agencies if they
are gathering information for the
purpose of providing services to the
client.
The Media Client’s file Yes, members of the media need a
release to access confidential client
information. If you get a request
from the media, contact your
headquarters public disclosure
coordinator listed above.
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CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
Person Requesting Type of File Do you need authorization?
Information
Court Orders: People requesting information may attempt to obtain a court order. If a court
order is granted, the person is entitled to the information spelled out in the order. Read the
orders completely to ensure that accurate information is disclosed.
.
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CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
APPENDIX C: LETTER SAMPLES
A. FIVE-DAY LETTER SAMPLES
Example 1:
October XX, 2004
Bob Anyone
Any Street NE
Anywhere, WA 98666
Dear Mr. Anyone:
This letter confirms the receipt of your request, dated October XX, for public records
concerning [enter specific request info. here]. Home and Community Services received
your request on October XX, 2004.
We estimate that it will take approximately thirty business days to search for and copy
the records you requested (or until approximately 11-XX-01). Under WAC 388-01-
080(2), DSHS may charge fifteen cents per page plus postage for regular photocopies.
We will send you another letter informing you of the charge for copies and postage once
we have gathered any releasable information pertaining to this request.
If you have any questions, please do not hesitate to contact me by phone, ___________
or email, at______________.
Sincerely,
Your Name Here
Your Title Here
cc: Anyone you need to cc here.
19
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
Example 2:
5-Day Forwarded Request
{Your return address}
December 12, 2011
[name and address of requester]
Subject: Request for Public Disclosure
Dear [Requester’s name]:
This letter confirms receipt of your enclosed public records request under RCW
42.17.320 and WAC 388-01-090. The Department of Social and Health Services
received your request on [insert date].
You have requested copies of the agency’s records concerning [brief summary]. These
records would be held by the [xxyy] Administration. Your request is being forwarded to
that program for response. The public disclosure coordinator is: [Name, address, phone
and e-mail of admin PDC – see contact list]
We estimate that it will take approximately thirty business days to search and copy the
records you requested. The program having the records will respond directly to you
when the records are located and notify you of any charge for copies. Under WAC 388-
01-080(2), DSHS may charge fifteen cents per page plus postage for regular photocopies.
We will send you the records upon receipt of a check payable to DSHS for the total, or
arrange for you to pick them up if you prefer.
If you have any questions or need more information, please feel free to contact the public
disclosure coordinator listed above or myself. Thank you.
Sincerely,
{Your name, title, phone, and e-mail}
Enclosure
cc: [Name and admin] Public Disclosure Coordinator
20
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
B. DENIAL EXAMPLE
You are directed to the following http://tools.dshs.wa.gov/radar/pd_sample.htm for
examples of various denial letters as applicable. Whenever you deny a request for
public disclosure (in full or in part), you are required to enclose the following as an
appeal option to the requestor.
21
CHAPTER 2 -- CASE RECORDS—CONFIDENTIALITY, DISCLOSURE, AND TRANSFER
REFERENCE NUMBER
#XXXXXXX
DENIAL OF REQUEST FOR DISCLOSURE OF
DSHS RECORDS
TO: Anybody Smith
PERSON REQUESTING RECORDS
69076 Any Rd.
MAILING ADDRESS
Any city WA 98607
CITY STATE ZIP CODE
I am denying your request for disclosure of Department of Social and Health Services records
because:
Under RCW 42.17.310(1)(a): certain information is exempt from public inspection and copying:
(THE ABOVE IS AN EXAMPLE OF WHY YOU WOULD DENY A REQUEST. CITE YOUR
REASON ABOVE)
PUBLIC DISCLOSURE COORDINATOR DATE TELEPHONE NUMBER (INCLUDE AREA CODE)
Your name here XX-XX-XX (XXX)XXX-XXXX
OFFICE FAX AND EMAIL ADDRESS
HCS Region X (XXX) XXX-XXXX [email here]
MAILING ADDRESS CITY STATE
PO Box whatever Anywhere WA
You may petition to have my decision reviewed by completing and mailing the form below.
PETITION FOR REVIEW
TO:
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
PUBLIC DISCLOSURE COORDINATOR: DAN DOWLER
PO Box 45600
MAILING ADDRESS
Olympia WA 98504-5600
CITY STATE ZIP CODE
Please review the above request for denial of disclosure of DSHS records. I consider the denial wrong because:
(FOR REQUESTOR TO FILL OUT)
NAME DATE TELEPHONE NUMBER (INCLUDE AREA CODE)
Anybody Smith XX-XX-XX (XXX) XXX-XXXX
ORGANIZATION FAX AND EMAIL ADDRESS
Any Organization (206) 695-XXXX
Smithar@xxxxxx.com
MAILING ADDRESS CITY STATE
69076 Any rd. Any City WA
22
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