Counseling Records

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1. MEDICAL RECORDS SHOULD COME DIRECTLY TO ME FROM THE PROVIDER, NOT THROUGH THE PILOT

Safety assessments consider the validity of records through a chain of custody procedure. If the file comes through an non-medical intermediary, the file hypothetically could altered and this limits its usefulness.

Some medical records systems allow the client to print medical records at home. Not only would this break the chain of custody, most states do not allow a client to access mental health records without approval from the clinic.

Legal records can come directly from the pilot.

2. WHERE DOES THE CLINIC SEND RECORDS?

Aviation Psychiatry, LLC
Gregory L. Kirk, MD
2036 East 17th Avenue
Denver, Colorado, 80206

Emailed records should be to sent to

gregkirk@avipsy-secure.org

3. YOU SHOULD REQUEST THE ENTIRE FILE, NOT A TYPE- OR DATE-LIMITED SUBSET

Requesting the entire records ensures that no critical component of the safety assessment has been overlooked or ignored.

Most clinics prefer that you use their own release forms. You may be able to download a form from the clinic website, if they have one, or you can call the clinic and ask about the records release procedure.

You should request the complete record of care, which includes ALL notes of these types:

  • Individual counseling notes, including psychotherapy notes
  • Psychological test results and reports, if any
  • Notes that include any and all information about the use of drugs or alcohol
  • Intake assessment notes

WHY DO WE NEED THE RECORDS, ISN’T A CLINICAL SUMMARY GOOD ENOUGH?

In the FAA Specification Sheet for a psychiatric examination, one of the core duties that the aviation psychiatrist must complete is

A review of all available records, including academic records, records of prior psychiatric hospitalizations, and records of periods of observation or treatment (e.g., psychiatrist, psychologist, social worker, counselor, or neuropsychologist treatment notes). Records must be in sufficient detail to permit a clear evaluation of the nature and extent of any previous mental disorders.

  • A summary of treatment, whether by a letter or phone call, most of the time fails to meet the  “sufficient detail” standard as described in the FAA’s specification sheet.
  • A psychiatric summary letter, which by rule highlights some content and excludes other information, unwittingly places your treating doctor as a decision maker in an  aeromedical safety assessment.
  • By contrast, releasing the file without restrictions keeps the responsibility for aeromedical safety assessments focused on the aviation psychiatrist.
  • The records have the same HIPAA psychotherapy protections when held in this office as when kept by the originator. The file can be released only with your written consent or a court order. If your psychiatrist asks that I not release the file to you, in order to preserve the therapeutic alliance, I have an ethical obligation to honor that request and would not release the file to you without a court order.
  • I also have an ethical obligation to de-identify my report so that the assessment does not reveal protected health information (PHI) of others. For example, I am not allowed to quote something from the psychotherapy record that inadvertently identifies any other person, such as a spouse, child, or companion.

WHAT HIPAA SAYS ABOUT THERAPY NOTES

HIPAA rules gives special protections to psychotherapy records. Among the protections is that a therapist can refuse to release a psychotherapy file, without giving you a reason, unless a valid court order compels a release of the record. To address a few common concerns you or your therapist might have, please know that:

  • The FAA advisory, stated above, specifically says that the psychiatrist must review treatment notes (not summaries) from your counseling provider.
  • A summary of treatment, whether by a letter or phone call, most of the time fails to meet the  “sufficient detail” standard as described in the FAA’s specification sheet.
  • A therapist’s summary letter, which by definition as a summary of a record, highlights some content and excludes other information, unwittingly places the therapist as a decision maker in a public safety assessment.
  • By contrast, releasing the file without restrictions keeps the responsibility for aeromedical safety assessments focused on the aviation psychiatrist.
  • The records have the same HIPAA psychotherapy protections when held in this office as when kept by the originator. The file can be released only with your written consent or a court order. If your therapist asks that I not release the file to you, in order to preserve the therapeutic alliance between you and your therapist, I have an ethical obligation to honor that request and would not release the file to you without a court order.
  • I also have an ethical obligation to de-identify my report so that the assessment does not reveal protected health information (PHI) of others. For example, I am not allowed to quote something from the psychotherapy record that inadvertently identifies any other person, such as a spouse, child, or companion.
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