LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 310.01 HIV/AIDS Legal Responsibilities
 
  PROCEDURES
  1. Clinicians shall inform clients prior to service delivery that Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) information relevant to their treatment shall be documented in the clinical record. 
    1. Tools to facilitate client understanding of privacy related to HIV/AIDS include:
      1. DMH Consent for Service (MH 500E)
      2. Consumer Information Sheets on HIV 
    2. HIV/AIDS Medications/Prescriptions and Laboratory Results:
      1. Authorized personnel shall document HIV/AIDS information, including medications/prescriptions, in the same manner and place as other medical information.
      2. Laboratory results shall be filed with all other laboratory results. 
  2. Ordering HIV Tests
    1. When ordering an HIV test, authorized personnel shall:
      1. Share with the client that the test will be ordered;
      2. Obtain verbal consent (clients have the right to decline the test);
      3. Document consent or declination in the client’s file (written consent by the client is not necessary); and
      4. Order the test in accordance with DMH Policy 306.10
        1. Primex HIV test in OrderConnect  
    2. Authorized personnel shall disclose an HIV test result to clients in the same manner as other medical information.
      1. Standards for releasing information shall be in accordance with DMH Policy 401.01.
      2. For clients who test positive for HIV, authorized personnel shall provide available treatment options and resources.
      3. Authorized personnel in need of additional support with either disclosing positive results or linking clients to HIV medical care can contact the Department of Public Health (DPH) Division of HIV and STD Programs’ Partner Services Unit at (213) 639-4277 during regular business hours.
  3. Authorized personnel shall report confirmed HIV test results to the DPH without the requirement of client consent.
    1. All lab reporting shall be in accordance with DMH Policies 306.09 and 306.10.
    2. For acute infections, authorized personnel shall report a client’s confirmed HIV test:
      1. Within one (1) business day.
      2. To the local health officer of the jurisdiction in which the client resides.
      3. By telephone to (213) 351-8516.
      4. For confirmed HIV tests at any stage, including diagnosis of HIV infection and progression to stage three (3) disease (AIDS), authorized personnel shall:
        1. Report within seven (7) calendar days of receipt from a laboratory.
        2. Complete the appropriate report:
          1. County of Los Angeles Confidential Provider HIV/AIDS Adult Case Report Form.
          2. Pediatric HIV Confidential Case Report form.
        3. Send the completed report to the local health officer for the jurisdiction where the authorized personnel’s facility is located via:
          1. Traceable mail (e.g., courier service, U.S. Postal Service Express or Registered mail).
          2. Secure and confidential electronic reporting system.
          3. Person-to-person transfer with the local health officer or designee.
  4. Other Disclosures of HIV/AIDS Not Requiring Authorization
    1. Partner Notification
      1. For assistance in notifying spouses, sex partners or needle-sharing partners of persons with HIV/AIDS, authorized personnel shall contact DPH at (213) 639-4277.
    2. Situations in which the release of HIV/AIDS information/test results are allowed:
      1. To other health care providers working to provide care or treatment to the client.
      2. In emergencies to other health plans, medical examiners, researchers, public health authorities involved in reporting and control of illness and injury to emergency personnel who, in the course of their work, may be exposed to HIV/AIDS.
      3. To emergency personnel who, in the course of their work, may be exposed to HIV/AIDS.
  5. Disclosures of HIV/AIDS Information Requiring Authorization for Use or Disclosure of PHI
    1. The release of HIV test information is regulated and requires specific consent when transmitted outside of the DMH System of Care.
      1. If only a general authorization for disclosure of medical information is received:
        1. That does not specifically authorize the disclosure of HIV test results; HIV test results must be redacted from the information disclosed.
      2. A valid written Authorization for Use or Disclosure of PHI requires:
        1. All usual elements of a valid authorization (DMH Policy 500.01).
        2. A specific statement authorizing the disclosure of HIV test results.
        3. A separate written authorization shall be obtained for each disclosure of an HIV test result. 
      3. If the client does not consent or is not available to consent to the disclosure:
        1. HIV/AIDS information shall be redacted before the record is released and shall be accompanied by a cover letter explaining that sensitive information, which requires special consent, has been redacted from the record.
        2. As an alternative to redacting information, clinicians may respond with summary information accompanied by a cover letter stating that sensitive information, which requires special consent, was not included in the summary.