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Daycare Center and Family Home Forum>HIPAA & Drs Sick Notes RI
WBee 03:36 PM 02-26-2018
Are there any Rhode Island daycare providers out there that have had an issue with doctors writing sick notes and the HIPAA law? I've been in this business for 6 years on my own now and today was the first time I had an issue with getting a child's diagnosis written on their sick note. Per my illness policy which has never changed when I send a child home sick they need a doctor's note prior to their return stating the illness diagnosis, length of exclusion from care, any medications the child needs to be on and time and date of doctor appointment. I received a note today stating the child needed to be out all of last week with no diagnosis. When I asked that the doctor add a diagnosis I was told under the HIPAA law I have no right to ask but the doctor was "kind enough" to provide the fact that the child had a cold. I explained to the parent that this was to protect myself as well as other individuals in my care. It is also stated and signed in my illness policy by each parent. I also mentioned that any communicable disease needs to be reported to each family as well as the state so where am I wrong or what am I missing here? It just seems very odd and extreme to me that the doctor would hide the fact that the child had a cold under HIPAA law.
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TheMisplacedMidwestMom 04:01 PM 02-26-2018
So the doctor would be providing the note to the individual, which is not a violation of HIPPA. The individual would be providing the note to you, so them providing you with a doctor's note would not be a HIPPA violation. The "right" to ask for a diagnosis though is a very interesting question.

My knee-jerk reaction is that she agreed to your policies and need to comply if she expects you to provide care. If they have a protected diagnosis, then that would fall under ADA and be a different can of worms, but would not be minor acute illness.
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WBee 04:23 PM 02-26-2018
Thank you! Great points!
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Country Kids 04:48 PM 02-26-2018
That's a tough one! I think you can ask for a dr's note but not the diagnosis. The diagnosis is between the doctor and patient.

My daughter had a doctor's note for work, recently and all the doctor put in was date seen and needed time off for work. No diagnosis was given.

A friend of mine that works with things like this just last week told me employers can't even legally anymore ask for a doctor's note. You as a patient can ask for one but employers can't ask for one. So I'm wondering if we can legally ask for one and was going to try and find out if there is something written on childcares.
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Cat Herder 05:51 PM 02-26-2018
http://pediatrics.aappublications.or...0/6/1046.short - Released 2012

http://www.aappublications.org/news/...Snapshot110117 - Released this month

All I want on a doctors note is proof the child actually saw one. I have asked for 3 in the last 10 years. I only ask for one when I no longer trust the parents words due to their actions.
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Blackcat31 07:57 AM 02-27-2018
Originally Posted by WBee:
Are there any Rhode Island daycare providers out there that have had an issue with doctors writing sick notes and the HIPAA law? I've been in this business for 6 years on my own now and today was the first time I had an issue with getting a child's diagnosis written on their sick note. Per my illness policy which has never changed when I send a child home sick they need a doctor's note prior to their return stating the illness diagnosis, length of exclusion from care, any medications the child needs to be on and time and date of doctor appointment. I received a note today stating the child needed to be out all of last week with no diagnosis. When I asked that the doctor add a diagnosis I was told under the HIPAA law I have no right to ask but the doctor was "kind enough" to provide the fact that the child had a cold. I explained to the parent that this was to protect myself as well as other individuals in my care. It is also stated and signed in my illness policy by each parent. I also mentioned that any communicable disease needs to be reported to each family as well as the state so where am I wrong or what am I missing here? It just seems very odd and extreme to me that the doctor would hide the fact that the child had a cold under HIPAA law.
I have very similar policies.
I require a doctor's note WITH diagnosis prior to returning to care.

This is NOT a HIPAA violation as the parent is asking the doctor to fill out the form themselves. The parent can give permission for anything they want regarding their medical information.

The only issue I see is you as the provider talking directly to the doctor. Unless the doctor has some sort of written permission from the parent, he/she IS violating HIPAA rules by disclosing that information.

More information about HIPAA


Another thread about HIPAA
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WBee 08:27 AM 02-28-2018
Yes I only asked the parents for the note per my policy. I still find it odd that they put up such a stink about it. I did remind her about the policy she signed as well.
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ColorfulSunburst 11:31 AM 02-28-2018
I do not care about diagnoses. It is not my business. I need a notice from the doctor that a child may attend the school. That's it.
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Play Care 11:54 AM 02-28-2018
Originally Posted by ColorfulSunburst:
I do not care about diagnoses. It is not my business. I need a notice from the doctor that a child may attend the school. That's it.
Eh, I disagree. Doctors write "return to care" notes all.the.time. for illnesses that we generally exclude for. They don't have to deal with the sick child all day and don't realize (or care) what an imposition it is on a provider who has several other kiddos in care whilst caring for an unwell child. And maybe some of those other kids have conditions that wouldn't jive with the illness that kid has.
We've had providers here have to turn clients away, even as the client was waving the "return to care" note in their face, as it was clear the child was too ill to be at day care.
For me a return to care notice usually isn't worth the paper it's printed on.
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Blackcat31 12:17 PM 02-28-2018
Originally Posted by ColorfulSunburst:
I do not care about diagnoses. It is not my business. I need a notice from the doctor that a child may attend the school. That's it.
I require a diagnosis because I feel it IS my business what the child may be exposing or has already exposed myself and my group to.

I also think given the opportunity, "most" parents would not be entirely truthful as to what (illness) their child has if it means additional exclusion time. Strep, Influenza and/or a 101F fever suddenly becomes "nothing but a virus" or worse..."just teething".

Kinda sad that we can't trust parents but it is what it is.
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ColorfulSunburst 09:43 PM 02-28-2018
If a child is not contagious and can participate our activities I do not care what kind of sickness (s)he has had.
If kid's parents share the information it is good if they do not share I do not ask. Most of times parents share.
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daycarediva 04:37 AM 03-01-2018
Originally Posted by Blackcat31:
I have very similar policies.
I require a doctor's note WITH diagnosis prior to returning to care.

This is NOT a HIPAA violation as the parent is asking the doctor to fill out the form themselves. The parent can give permission for anything they want regarding their medical information.

The only issue I see is you as the provider talking directly to the doctor. Unless the doctor has some sort of written permission from the parent, he/she IS violating HIPAA rules by disclosing that information.

More information about HIPAA


Another thread about HIPAA
YES, all of this.

Sorry, but this mom is full of crap OP. She just didn't want to give you the note and will be saying "the dr refused to put a diagnosis this time due to HIPAA" when the child has a contagious/condition you would exclude for.

Originally Posted by Play Care:
Eh, I disagree. Doctors write "return to care" notes all.the.time. for illnesses that we generally exclude for. They don't have to deal with the sick child all day and don't realize (or care) what an imposition it is on a provider who has several other kiddos in care whilst caring for an unwell child. And maybe some of those other kids have conditions that wouldn't jive with the illness that kid has.
We've had providers here have to turn clients away, even as the client was waving the "return to care" note in their face, as it was clear the child was too ill to be at day care.
For me a return to care notice usually isn't worth the paper it's printed on.

Yep, don't trust doctors to follow best practice. The worst parents I have ever had in care have been medical professionals. One pediatrician was the WORST in questioning my illness policy. Dope and drops, him trying to write me notes, sending child with obvious pink eye, 12 hours after vomiting WITH diarrhea, etc.

JUST had a child with strep throat. Diagnosed Monday with fast acting strep, prescribed antibiotics, and left with a return to care THAT DAY note. "Child was seen in my office and may return to childcare 2/26/2018." Thankfully the parent laughed that off and kept child home. She returns TODAY.
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nannyde 06:22 AM 03-01-2018
I love it when I hear something new. I think an angel gets it's wings when a parent comes up with one I haven't heard yet.

It's not a HIPPA violation for the doctor to give the mother the note. The mother can choose not to give it to the provider. If that happens then the child is terminated.

The mother can sign forms to give the provider all medical information at the time of the visit. If she choses not to do that then she chose to loose her daycare spot... unless of course she brings a note with a diagnosis.

I would be VERY suspicious with the doctor excluding the child for so many days that whatever the kid had was highly contagious.
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Tags:doctor's note, hipaa, sick policy
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