In honoring proper requests, the releasing authority should disclose only information relative to the request. In the following three instances, for example, departments and agencies, both federal and state, may have a legitimate need for the information:

1. Health care information is required to process a governmental action involving an individual. (The Veterans Administration and the Bureau of Employees' Compensation process claims in which the claimant's medical or dental history is relevant). If an agency requests health care information solely for employment purposes, a written authorization is required from the individual concerned.

2. Health care information is required to treat an individual in the department's custody. (Federal and state hospitals and prisons may need the medical or dental history of their patients and inmates.)

3. Release to federal or state courts or other administrative bodies. The preceding limitations are not intended to prevent compliance with lawful court orders for health records in connection with civil litigation or criminal proceedings, or to prevent release of information from health records when required by law. If you have doubts about the validity of record requests, ask the Judge Advocate General (JAG) for guidance.

RELEASING MEDICAL INFORMATION FOR RESEARCH

Commanding officers of MTFs are authorized to release information from medical records located within the command to members of their staff who are conducting research projects. Where possible, the names of parties should be deleted. Other requests from research groups should be forwarded to Bureau of Medicine and Surgery (BUMED) for guidance.

FILING HEALTH RECORDS

LEARNINGOBJECTIVE: Recall filing procedures for health records.

The Navy Medical Department uses the Terminal Digit Filing System (TDFS) to file health records. In this system, health records are filed according to the terminal digits (last two numbers) of the service member's social security number (SSN), color coding of the health record jacket, and use of a block filing system.

To understand the TDFS filing system, you will need to view the SSN in a different way. As you know, the nine digits of the SSNare divided into three number groups for ease in reading. This practice reduces the chance of transposing numbers. For example, in the TDFS system the SSN 123-45-6789 is visually grouped and read from right to left (instead of left to right), as follows:

On the health record, the family member prefix (FMP) is added to the patient's social security number. The FMP is a system used by the Navy to show a beneficiary's relationship to the sponsor. For instance, the FMPfor active duty personnel is 20, while the FMP for a spouse is 30 (fig. 12-1).

Under the Terminal Digit Filing System, the central files are divided into 100 approximately equal sections. Each section is identified by a maximum of 100 file guides bearing the 100 primary numbers, 00 consecutively through 99. Each of these 100 sections contain records whose terminal digits correspond to the section's primary number (fig. 12-1). For example, every record with the SSN ending in 56 is filed in section 56.

Within each of these 100 sections, health records are filed in numerical sequence according to their secondary numbers. The secondary number is the pair of digits immediately left of the primary number (fig. 12-1).

To make filing of health records easier, health record jackets are color-coded. The second to the last digit of the SSN is preprinted on the jacket. The color of the health record jacket corresponds to the preprinted digit as follows:

Centralized files having records based upon more than 200 SSNs, or a file of more than 200 records, may need to use the TERTIARY(third) NUMBERin filing. In a properly developed and maintained terminal-digit, color-coded and block-filing system, it is almost impossible to misfile a record. Arecord misfiled with respect to the left digit of its primary number (for example, a 45 that has been inserted among the 55s) will attract attention because of its different record jacket color. Arecord jacket misfiled in respect to the right primary number (for example, a 45 that has been inserted among the 42s) causes a break in the diagonal pattern formed by the blocking within a color group.

Authorized exemptions from the requirements of the TDFS are discussed in detail in the MANMED.