HIPPA - Engaging for Change - Joint Superintendent Retreat



APPENDIX 1§ 913. ?Medical examinations of teachers and other employeesIn order to safeguard the health of children attending the public schools, the board of education or trustees of any school district or a board of cooperative educational services shall be empowered to require any person employed by the board of education or trustees or board of cooperative educational services to submit to a medical examination by a physician or other health care provider of his or her choice or the director of school health services of the board of education or trustees or board of cooperative educational services, in order to determine the physical or mental capacity of such person to perform his or her duties. The person required to submit to such medical examination shall be entitled to be accompanied by a physician or other person of his or her choice. The determination based upon such examination as to the physical or mental capacity of such person to perform his or her duties shall be reported to the board of education or trustees or board of cooperative educational services and may be referred to and considered for the evaluation of service of the person examined or for disability retirement.APPENDIX 2SAMPLE EDUCATION LAW §913 BOARD RESOLUTION XE "General:Section 913 Examinations" \i BE IT HEREBY RESOLVED, that the Board of Education of the ____________ Central School District hereby designates Dr. (Name) as school medical inspector for the purpose of preparing a (medical or psychological) examination pursuant to Education Law Section 913 regarding an employee's capacity to perform his/her duties. The doctor's report shall be given to the Board of Education in executive session after the examination is complete.BE IT FURTHER RESOLVED that the Superintendent is delegated the authority to coordinate such examination.SAMPLE LETTERAPPENDIX 3EDUCATION LAW §913 – TO EXAMINING DOCTORHAND DELIVERED OR FIRST CLASS, REGISTERED OR CERTIFIED MAIL, RETURN RECEIPT REQUESTEDDateNameAddressCity, State ZipRe:Medical Examination of (Name of Employee)Dear Dr.__________________:This office serves as employer to (name). I am writing to furnish you with information regarding the school district referral of (name) whose appointment is scheduled for (date) at (time).As you know, the Board of Education of the (name) School District has directed (name) to submit to a medical examination, pursuant to Section 913 of the Education Law. I have enclosed a copy of the law for your information. The purpose of the examination is to determine (name) capacity to perform his/her duties as a (title).(Name) has been employed by (name) School District as a (title) since (date). (Name) has missed approximately (number) school days. A review of (name) attendance records indicates that (he/she) has (specific problem which calls capacity into question).In an effort to ascertain the legitimacy of (name’s) illness, the district requested that he/she furnish a note from a doctor. Upon your examination of (name), please forward to this office a written report addressing the following: whether (name) suffers from (illness); whether this condition will prevent (name) from performing his/her duties for the school district; whether (illness) is likely to interfere with (name) performance of his/her duties only at certain times during the course of the school day and finally, whether there is any justification for (name) to absent himself/herself from his/her duties.Please forward the results of your examination along with your bill to our office. Our procedure is that the employee is entitled to a copy of the report from the school district, but not from the examining physician. If you have any questions or need clarification of any facts regarding this matter, please feel free to call me.Very truly yours,Superintendent of SchoolsSAMPLE LETTERAPPENDIX 4EDUCATION LAW §913 LETTER – Notice to EmployeeHAND DELIVERED, FIRST CLASS, REGISTERED OR CERTIFIED MAIL, RETURN RECEIPT REQUESTED DATE \@ "MMMM d, yyyy" October 10, 2013Employee’s NameAddressCity, State ZipRe:Medical ExaminationDear __________:Please be advised that pursuant to Section 913 of the Education Law, you are hereby directed to submit to a medical examination at the office of (name of doctor), (address), on (date) , 2013, at (time). In preparation for the examination, please forward all your medical records to Dr. _________________'s office no later than (date). You will be relieved of your duties on that date to the extent necessary to keep the appointment. You will be charged the full fee if you fail to reschedule in an adequate amount of time. We will allow only one rescheduling. [You will remain on paid leave pending the examination OR you will continue to work pending the examination.]Please sign the attached release form and return it to this office immediately.Very truly yours,Superintendent of Schoolscc:Personnel FileNOTE – The law provides the employee may be accompanied by a physician or person of choice during the exam. However, if that person will compromise or invalidate the results the district’s physician can exclude the person. Where that happens the District is not obligated to suppress or exclude the psychological report from evidence at a hearing. [Gardner v. Niskayune, (3rd Dept. 2007), where presence of the husband would compromise the questions during the psychological examination.]HIPPA COMPLIANT AUTHORIZATION FOR EDUATION LAW §913 PURPOSESAPPENDIX 5Authorization to Disclose Protected Health InformationFederal law, Health Insurance Portability and Accountability Act (HIPAA) requires your health care provider to complete this form before he/she can disclose protected health information about you to (Name of School) or discuss protected health information about you with (Name of School).Authorization:I authorize the following health care providers to disclose the protected health information indicated below:Name______________________________ Tel. No.______________________ Fax No._____________________Name______________________________ Tel. No.______________________ Fax No._____________________Name______________________________ Tel. No.______________________ Fax No._____________________ Name:____________________________Date of Birth________________________Address:________________________________________ Title_______________________________Telephone No.________________________________________Please read, sign and date this form and give it to your health care provider(s).Protected Health Information (check all that apply)Health appraisals (i.e. physicals, evaluations)Past/current medical conditionsMental health evaluationsOther ________________________________Purpose (check all that apply)This protected health information may be used and/or disclosed for the purpose of: To assess the impact of the medical conditions(s) professional duties, including attendanceAt patient's request with no specified purposeOther_____________________________________Release to EmployeesThe protected health information about you may be disclosed to any of the following (Name of School) personnel: medical officer, school physician, human resource director, school attorney, district superintendent, assistant superintendent, or board of education.Validity DateThis authorization is valid for: (check one)_______, 20XX through ______ 20XX Will expire on __________ This request only_____I understand:I may revoke this authorization at anytime by sending written notification to the privacy officer at my health care provider's office and to (Name of School), except where disclosure has already been made in reliance on my prior authorization.My treatment is not conditioned on this authorization.(Name of School) is an educational institution. _______________________________________Date _______________SignatureAPPENDIX 6SAMPLE LETTEREDUCATION LAW §913 - EMPLOYEE RETURNS TO WORK AFTER 913 EXAMINATION FOUND EMPLOYEE FIT TO RETURN TO DUTYHAND DELIVERED OR FIRST CLASS, REGISTERED OR CERTIFIED MAIL, RETURN RECEIPT REQUESTEDDateNameAddressCity, State ZipRe:Dear _____________:This is to advise you that Dr. (Name) has certified that you are fit to perform your duties. Effective immediately (date), you will be reinstated to your position. You will be deemed to have abandoned your position if you fail to return to work on (date) without notifying the district. The district may terminate your services if you abandon your position.Very truly yours,Superintendent of Schoolscc:Personnel FileSAMPLE LETTEREDUCATION LAW §913 - EMPLOYEE FOUND UNFIT TO RETURN TO DUTYConsult with Labor Relations Service or school attorney. How the employee is handled when found to be unfit to return to duty depends on probationary versus tenured or permanent status and ADA considerations. ................
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