By Keith Carrington & Chuck Wright
While the patient sign-in sheet is used at the front desks of most clinicians’ offices, many doctors do not have a clear understanding of its legal importance. Contrary to what the lay public may believe, it is not just used to track a patient’s arrival.
The patient sign-in sheet protects the doctor. This important document proves the patient was in the office on a particular date. This is necessary to avoid any question of fraud from insurance companies, including Medicare and state programs, such as Medicaid. Also, a disgruntled patient may claim that he was billed for services rendered on a day he was not in the doctor’s office. A report to a disciplinary board because of such a claim can cause incredible problems.
Proof of the patient’s presence cannot be achieved by any other method that is as simple and low-cost. Office notes, an appointment book with check marks next to a name, or even a signed patient’s receipt, are not considered adequate proof, since they can be easily falsified. A sign-in sheet, on the other hand, preserves that patient’s handwritten verification and the date of the office visit. To protect the clinician, the patient’s signature must appear on a sheet with several other patients’ signatures bearing the same date.
The HIPAA Privacy Rule (see 45 CFR 164.502(a)(1)(III) explicitly permits the incidental disclosures that may result from the check-in process, for example, when other patients in a waiting room hear the identity of the person whose name is called. However, these incidental disclosures are permitted only when the covered entity has implemented reasonable safeguards and the minimum necessary standard, where appropriate.
Based on recent guidance issued by the US Department of Health and Human Services, in response to inquiries from clinicians and their attorney’s, the sign-in sheet must not contain any information not absolutely necessary for the sole purpose of signing in a patient. Furthermore, despite the use of large black markers, sign in sheets can still be read as the pen impression made on the form is not obscured with the marker ink. As such, the common act of crossing out the names and leaving the day’s form in plain view of other patients of office visitors can present a compliance issue and would subject the practice to possible audits and fines by both federal and state regulators if a patient compliant is registered.
While sign-in sheets are an important part of office documentation, it should seem obvious in light of this guidance that displaying the day’s patient list is a clear violation of a patient’s privacy and confidentiality. In addition, many patients are uncomfortable signing an open sign-in sheet given the current risk in identity theft and privacy concerns.
The clinician faces a dilemma: You need the sign-in sheet to protect your practice, but an open patient sign-in sheet, where patients’ names can be viewed by all, violates patient confidentiality and privacy laws.
Confidential Patient Sign-In Systems such as those available from your local medical printing companies (see example above) solve this problem and comply with the states privacy laws and the HIPAA Privacy Rule. Best of all, on the peel-off sheets, the patient’s data is never left exposed for unauthorized viewing and a carbonless hard copy in the patients handwriting is created below the labels (out of the patients sight) that can be detached filed away at the end of the day for your records.
Try erasing your black marker to expose the names when an audit comes up…They call them permanent for a reason!