Medical Records and the Law

QIO Record Keeping 203ria, and standards used for initial screening of cases and other reviewactivities; routine reports submitted by the QIO to CMS to the extentthey do not contain confidential information; and quality review studiesfrom which the identification of patients, practitioners, and institutionshas been deleted. 467 A QIO also must disclose to state or federalhealth planning agencies all aggregate statistical information that doesnot implicitly or explicitly identify individual patients, practitioners, orreviewers. 468 In addition to these mandatory disclosures, a QIO maydisclose any of the above nonconfidential information to any person,agency, or organization on its own initiative. 469The regulations generally require a QIO that intends to disclosenonconfidential information to give 30-day advance notice to any institutionidentified in the material and to provide a copy to the institution.The institution may submit written comments to the QIO thatmust be included with the information disclosed or forwarded separately.470 Where the QIO plans to disclose “confidential information,”it also must give advance notice. If the request for information comesfrom a patient or patient representative, the QIO must provide the noticeto the practitioner who treated the patient. 471 On the other hand, ifthe request comes from an investigative or licensing agency, the QIOmust: (1) notify the practitioner or institution, (2) provide the practitioneror institution with a copy of the requested information, and(3) include comments submitted by the practitioner or institution inthe disclosure to the agency. 472There are three exceptions to the general requirement that a QIOgive advance notice to a practitioner or institution before confidentialinformation is disclosed:• If a QIO determines that the requested information is necessary toprotect against an imminent danger to individuals or the publichealth, notice of the disclosure may be sent to the practitioner or institutionat the same time the disclosure is made, rather than 30 daysin advance 47346742 C.F.R. § 480.120(a).46842 C.F.R. § 480.120(b).46942 C.F.R. § 480.121.47042 C.F.R. § 480.105(a).47142 C.F.R. § 480.105(b)(1).47242 C.F.R. § 480.106(b)(2).47342 C.F.R. § 480.106(a).