315 Confidentiality of Health and Medical Records Confidential information in the employee’s health or medical record is considered privileged information and should not be disclosed without the employee’s written consent. Occupational health professionals have an ethical obligation to ensure public trust and to safeguard the em- ployee’s right to privacy of health and medical information, which means protecting that infor- mation from unauthorized disclosure. This obligation includes “information contained in a health/medical record that is based on examination, evaluation, intervention, observation, or conversation with the client. Health promotion data (i.e., cholesterol and blood pressure screenings and other health risk behaviors) must also be safeguarded and kept confidential” (American Association of Occupational Health Nurses [AAOHN], Advisory on Confidentiality, 2006). The guarantee of confidentiality between an employee and health care provider helps to en- sure that information important to the employee’s care and treatment will not be withheld by the employee. It also is recognized that access to and sharing of health and medical informa- tion is permitted only by and with those health care providers involved in the employee’s health care. Exceptions to confidentiality of health and medical information is made on a case- by-case basis and includes the threat of danger to self or others, reportable diseases, child or elder abuse, and injuries caused by potentially lethal means (i.e., gunshots, stabbings). The AAOHN has established a Code of Ethics, Guidelines for Confidentiality of Health Informa- tion, and a Confidentiality Advisory, all of which address handling and protecting health and medical information. AAOHN supports a three-tiered structure of confidentially and informa- tion access, with information controlled and managed by the occupational health nurse (OHN). Level Information Access and Control I. Information required by law, including work- related illness and injury, mandated special examinations, exposure data II. Information to assist human resources man- agement, including job placement and related examinations to determine the employee’s ability to work III. Personal health information, including all non- level 1 and 2 information (e.g., screening and treatment of non-work-related health problems or counseling) ● Disclosure to employee or employee’s representative with appropriate written consent ● Disclosure to management only with regard to ability to work and on a need-to-know basis ● Disclosure to employee or employee’s representative with appropriate written consent ● Disclosure to management only with regard to ability to work and on a need-to-know basis ● Disclosure to any source only on employee’s written authorization Guideline continues on next page