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COMMUNITY HOSPITAL OF SAN BERNARDINO 1805 MEDICAL CENTER DRIVE SAN BERNARDINO, CA 92411 April 10, 2012
VIOLATION: PATIENT RIGHTS: CONFIDENTIALITY OF RECORDS Tag No: A0147
Based on interview and record review, the facility failed to ensure that Patient B's personal health information (PHI) was kept private from Patient A, when patient B's face sheet was mixed in with Patient A's consent forms.

Findings:

On 4/10/12 at 1:10 PM, an investigation was initiated into an entity reported event of a possible breach of Patient B's demographics to Patient A on 3/29/12, while they were both patients in the emergency room (ER).

During an interview with the Facility Privacy Officer by phone on 4/10/12 at 1:20 PM, she stated , "Patient A was handed a packet with a consent for him to sign while he was in the ER. He noted as he went through the packet that there was a face sheet that had another patient (Patient B's) name on it. Patient A pulled out the face sheet and gave it to the nurse. We notified Patient B of the mix up".

A review of the information indicated that the face sheet for Patient B contained the following personal information: Patient B's name, home address and phone number, date of birth, race, religion, address and phone number of his next of kin, his medical record number, reason for visit and insurance information.

This was a breach of PHI for Patient B.