Q&A: Sending patient history notes

Q. I work for a hospital with a geriatric psychiatry unit. Many patients are discharged to nursing homes. Often, nursing homes contact the hospital for patient information, but we have only the patients' psychiatric records and are hesitant to send them. We usually send a psychiatric discharge summary that includes history and physical notes, any ancillary test results, and a medication list. However, we exclude the psychotherapy notes. Is it permissible under HIPAA to send this information to a nursing home for continued care?

A. Psychotherapy notes are very narrowly defined under the Privacy Rule, and very few organizations have notes that actually meet this definition. The Privacy Rule defines psychotherapy notes as:

Notes recorded in any medium by a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session that are separate from the rest of the individual’s medical record. Psychotherapy notes exclude medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.

If you maintain counseling notes separate from the rest of the patient’s record, they are considered psychotherapy notes and may only be released with the patient’s authorization. All other information that is part of the patient’s medical record may be released for treatment purposes without patient authorization.