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Confidentiality
Inappropriate disclosure of health information may violate
patient/provider confidentiality, including the federal Healthcare
Insurance Portability Act (HIPAA). As important, the inappropriate
disclosure of suspected IPV/DV can threaten patient safety.
Perpetrators who discover that a victim has sought care may
retaliate with further violence. Employers, insurers, law
enforcement agencies, and community members who discover abuse
may discriminate against a victim or alert the perpetrator.
It is imperative that policy, protocol, and practice surrounding
the use and disclosure of health information regarding victims
of IPV/DV should respect patient confidentiality and autonomy
and serve to improve the safety and health status of victims
of IPV/DV.
Reporting Laws in Florida
Florida mandates that reports are made for
the treatment of gunshot wounds. Florida statute requires
that physicians, nurses and employees or hospitals, clinics,
nursing homes and sanitariums must report treating any person
sustaining a gunshot wound, or life-threatening injury indicating
an act of violence, or receiving a request for such treatment.
Reports are to be made to the sheriff's department or the
police department. Failing to report is a 1st degree misdemeanor
and is punishable by up to a $1,000 fine and up to one year
in prison.
Florida law also mandates the reporting of
child abuse or neglect and elder abuse or abuse of the disabled.
Documentation
Documentation is critical, both for the protection
of the patient and of the healthcare provider. Document relevant
history, including:
- Chief complaint or history of present illness.
- Record details of the abuse and its relationship
to the presenting problem.
- Document any concurrent medical problems that may
be related to the abuse.
- For current IPVDV victims, document a summary of
past and current abuse including:
- Social history, including relationship to abuser
and abusers name if possible;
- Patient's statement about what happened, not
what lead up to the abuse (e.g." boyfriend John
Smith hit me in the face" not "patient arguing
over money");
- Include the date, time, and location of incidents
where possible;
- Patients appearance and demeanor (e.g. "tearful,
shirt ripped" not "distraught");
- Any objects or weapons used in an assault (e.g.
knife, iron, closed or open fist);
- Patients accounts of any threats made or other
psychological abuse;
- Names or descriptions of any witnesses to the
abuse.
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Document results of physical examination:
- Findings related to IPV/DV, neurological, gynecological,
mental status exam if indicated; " If there are injuries,
(present or past) describe type, color, texture, size,
and location;
- Use a body map and/or photographs to supplement
written description;
- Obtain a consent form prior to photographing patient.
Include a label and date.
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Document laboratory and other diagnostic
procedures:
- Record the results of any lab tests, x-rays, or
other diagnostic procedures and their relationship
to the current or past abuse Document results of assessment,
intervention and referral:
- Record information pertaining to the patient's
health and safety assessment including your assessment
of potential for serious harm, suicide and health
impact of IPV/DV; " Document referrals made and options
discussed;
- Document follow-up arrangements.
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If patient does not disclose IPV/DV victimization:
- Document that assessment was conducted and that
the patient did not disclose abuse;
- If you suspect abuse, document your reasons for
concerns: i.e. "physical findings are not congruent
with history or description," "patient presents with
indications of abuse".
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Follow-up
At least one follow-up appointment (or referral) with a healthcare
provider, social worker or IPV/DV advocate should be offered
after disclosure of current or past abuse:
- "If you like, we can set up a follow-up appointment
(or referral) to discuss this further";
- "Is there a number or address that is safe to use
to contact you?";
- "Are there days/hours when we can reach you alone?";
- "Is it safe for us to make an appointment reminder
call?".
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At every follow up visit with patients currently in abusive
relationships:
- Review the medical record and ask about current
and past episodes of IPV/DV;
- Communicate concern and assess both safety and coping
or survival strategies:
- "I am still concerned for your health and safety"
- "Have you sought counseling, a support group
or other assistance?"
- "Has there been any escalation in the severity
or frequency of the abuse?"
- "Have you developed or used a safety plan?"
- "Told any family or friends about the abuse?"
- "Have you talked with your children about the
abuse and what to do to stay safe?"
- Reiterate options to the patient (individual safety
planning, talking with friends or family, advocacy
services and support groups, transitional/temporary
housing, etc.).
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The Guidelines provide additional information about identifying
and intervening in IPV/DV, such as:
- Setting Specific Clinical Responses: A Quick Reference
Guide
- Dilemmas Faced by Child Health Providers
- Dilemmas When Assessing All Patients for Victimization
- Suggested Assessment Questions and Strategies
- Validated Abuse Assessment Tools
- Abuse Assessment Screen
- Body Map
- Danger Assessment Tool
- Expanded Assessment
- Indicators of Abuse
- Safety Plan and Discharge Instructions * (A copy
appears in the Appendix)
- Interventions with Current or Past Victims of Domestic
Violence
- State Codes on Intimate Partner Violence
- Victimization Reporting
- Photo Documentation and Forensic Evidence Collection
- Confidentiality Procedures
- Preparing Your Practice
- Resources and Referrals See the complete Guidelines
at http://endabuse.org/programs/display.php3?DocID=206.
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