Privacy Act: [DODDS 25] DODDS Internal Review Office Project File....

	Web GovRecords.org

Record source categories: 
  Medical facilities of the military departments.
Exemptions claimed for the system:
  None.

<DOC>
 

DEPARTMENT OF DEFENSE

DHA 02

System name: Adverse Clinical Privilege Actions Data File.

System location: 
  Office of the Assistant Secretary of Defense (Health Affairs), Office 
  of Professional Affairs and Quality Assurance, The Pentagon, 
  Washington, DC 20301-1200.
Categories of individuals covered by the system: 
  All privileged health care providers in the DOD Health Care System.
Categories of records in the system: 
  Files consist of case reports to the Assistant Secretary of Defense 
  (Health Affairs) (ASD(HA)) concerning permanent actions on the 
  limitation, revocation, or reinstatement of clinical privileges of DOD 
  military and civilian health care providers.
Authority for maintenance of the system: 
  10 U.S.C. 1102 and E.O. 9397.
Purpose(s): 
  To collect and update adverse clinical privilege data provided by the 
  military services to the ASD(HA). The consolidation of Service data is 
  used by ASD(HA) to conduct trend analyses of DOD Medical Quality 
  Assurance Programs.
  To an officer, employee, or contractor of the Department of Defense 
  who has a need for such record or testimony to perform official 
  duties.
Routine uses of records maintained in the system, including categories 
    of users and the purposes of such uses: 
  To a Federal executive agency or private organization, if such medical 
  quality assurance record or testimony is needed by such agency or 
  organization to perform licensing or accreditation functions related 
  to Department of Defense Health care facilities or to perform 
  monitoring, required by law, or Department of Defense health care 
  facilities.
  To an administrative or judicial proceeding commenced by a present or 
  former Department of Defense health care provider concerning the 
  termination, suspension, or limitation of clinical privileges of such 
  health care provider.
  To a governmental board or agency or to a professional health care 
  society or organization, if such medical quality assurance record or 
  testimony is needed by such board, agency, society, or organization to 
  perform licensing, credentialing, or the monitoring of professional 
  standards with respect to any health care provider who is or was a 
  member or an employee of the Department of Defense.
  To hospital, medical center, or other institution that provides health 
  care services, if such medical quality assurance record or testimony 
  is needed by such institution to assess the professional 
  qualifications of any health care provider who is or was a member or 
  employee of the Department of Defense and who has applied for or been 
  granted authority or employment to provide health care services in or 
  on behalf of such institution.
  To a criminal or civil law enforcement agency or instrumentality 
  charged under applicable law with the protection of the public health 
  or safety, if a qualified representative of such agency or 
  instrumentality makes a written request that such record or testimony 
  be provided for a purpose authorized by law.
  In an administrative or judicial proceeding commenced by a criminal or 
  civil law enforcement agency or instrumentality referred to in the 
  above paragraph, but only with respect to the subject of such 
  proceeding.
  The `Blanket Routine Uses' set forth at the beginning of OSD's 
  compilation of systems of records notices apply to this system.
Policies and practices for storing, retrieving, accessing, retaining, 
    and disposing of records in the system:  
Storage: 
  Records are maintained on paper in file folders and on a microcomputer 
  system.
Retrievability: 
  Hard copy is filed by medical practitioner's Social Security Number. 
  Electronic records may be accessed by searching on any information 
  field. Retrievable fields are health care provider's Social Security 
  Number, pay grade of provider, years of Federal service of provider, 
  name of medical treatment facility, reason for clinical privileges 
  action and status of Federation of State Medical Boards or State 
  notification, provider specialty, source of accession, and action 
  taken.
Safeguards: 
  Records are accessed by authorized personnel with an official need-to-
  know who have been trained for handling Privacy Act data. Hard copy 
  records are maintained in locked cabinets in restricted access areas. 
  Computer files are accessed on a password-protected stand alone 
  microcomputer system with mechanical lock for additional protection.
Retention and disposal: 
  Paper records are destroyed after five years. The microcomputer 
  database files are destroyed after five years. Conversion of data to 
  aggregate form with stripping of data fields, not to include personal 
  identifiers, is performed on older records for statistical and other 
  data analysis uses.
  Destruction of paper records is by tearing into pieces, shredding, 
  pulping, macerating, or burning.
System manager(s) and address: 
  Assistant Secretary of Defense (Health Affairs), Office of 
  Professional Affairs and Quality Assurance, Room 3D360, The Pentagon, 
  Washington, DC 20301-1200.
Notification procedure: 
  Individuals seeking to determine whether information about themselves 
  is contained in this system should address written inquiries to the 
  Assistant Secretary of Defense (Health Affairs), Office of 
  Professional Affairs and Quality Assurance, Room 3D360, The Pentagon, 
  Washington, DC 20301-1200, where a log of these requests will be 
  maintained.
  The request should contain the full name, subject individual's social 
  security number, Military Department, hospital or medical facility and 
  signature of the requester, and the approximate period of time, by 
  date, during which the case record was developed.
Record access procedures: 
  Individuals seeking access to information about themselves contained 
  in this system should address written inquiries to the Assistant 
  Secretary of Defense (Health Affairs), Office of Professional Affairs 
  and Quality Assurance, Room 3D360, The Pentagon, Washington, DC 20301-
  1200.
Contesting record procedures: 
  The OSD's rules for accessing records, for contesting contents and 
  appealing initial agency determinations are published in OSD 
  Administrative Instruction 81; 32 CFR part 311; or may be obtained 
  from the system manager.
Record source categories: 
  Medical facilities of the military departments.
Exemptions claimed for the system:
  None.

<DOC>
 

DEPARTMENT OF DEFENSE

DHA 03

System name: Pentagon Employee Referral Service (PERS) 
      Counseling Records.

System location: 
  Pentagon Employee Referral Service, c/o Civilian Employees Health 
  Services Clinic, Room 1E356, The Pentagon, Washington, DC 20310-6800.
Categories of individuals covered by the system: 
  All civilian DOD employees assigned to duty in the Pentagon and 
  environ who are referred by management for, or voluntarily request, 
  counseling assistance.
Categories of records in the system: 
  Records on patients which are generated in the course of professional 
  counseling. Records consist of information on condition, current 
  status, progress and prognosis for patients who have personal, 
  emotional, alcohol or drug dependency problems, including admitted or 
  urinalysis-detected illegal drug abuse.
Authority for maintenance of the system: 
  5 U.S.C. 43; 5 U.S.C. 310; 5 U.S.C. 7301; 10 U.S.C. 3012; 42 U.S.C. 
  290dd-3 and 290ee-3; 42 U.S.C. 4582; Pub. L. 100-71; E.O. 12564, Drug-
  Free Federal Workplace; and E.O. 9397.
Purpose(s): 
  To record counselor's observations concerning patient's condition, 
  current status, progress prognosis and other relevant treatment 
  information regarding patients in an employee assistance treatment 
  facility.
Routine uses of records maintained in the system, including categories 
    of users and the purposes of such uses: 
  In order to comply with provisions of 5 U.S.C. 7301 and 42 U.S.C. 
  290dd-3 and 290ee-3, the Office of the Secretary of Defense `Blanket 
  Routine Uses' do not apply to this system of records.
  Records in this system may not be disclosed without the prior written 
  consent of such patient, unless the disclosure would be:
  To medical personnel to the extent necessary to meet a bona fide 
  medical emergency;
  To qualified personnel for the purpose of conducting scientific 
  research, management audits, financial audits, or program evaluation, 
  but such personnel may not identify, directly or indirectly, any 
  individual patient in any report of such research, audit, or 
  evaluation, or otherwise disclose patient identities in any manner; 
  and
  If authorized by an appropriate order of a court of competent 
  jurisdiction granted after application showing good cause therefor.
Policies and practices for storing, retrieving, accessing, retaining, 
    and disposing of records in the system:  
Storage: 
  Paper records in file folders are stored in filing cabinets. Extracts 
  of treatment records are entered into an electronic database on a 
  microcomputer.
Retrievability: 
  Manual and automated records are retrieved by patient's last name, 
  Client Case Number, and Social Security Number.
Safeguards: 
  Paper records are maintained in file cabinets that are locked when the 
  office is not occupied by authorized personnel. The automated database 
  files are on a password-protected, stand alone microcomputer. All 
  patient records are maintained and used with the highest regard for 
  patient privacy. Only persons on a need-to-know basis and trained in 
  the handling of information protected by the Privacy Act have access 
  to the system.
Retention and disposal: 
  Paper records are destroyed five years after termination of 
  counselling. Destruction is by shredding, pulping, macerating, or 
  burning.
  Electronic records are purged of identifying data five years after 
  termination of counselling. Aggregate data without personal 
  identifiers is maintained for management/statistical purposes until no 
  longer required.
System manager(s) and address: 
  Director, Pentagon Employee Referral Service, Room 1E356, The 
  Pentagon, Washington, DC 20310-6800.
Notification procedure: 
  Individuals seeking to determine whether information about themselves 
  is contained in this system should address written inquiries to the 
  Director, Pentagon Employee Referral Service, Room 1E356, The 
  Pentagon, Washington, DC 20310-6800.
  The request should contain the full name, address, Social Security 
  Number and the signature of the subject individual.
Record access procedures: 
  Individuals seeking access to information about themselves contained 
  in this system should address written inquiries to the Director, The 
  Pentagon Employee Referral Service, Room 1E356, Pentagon, Washington, 
  DC 20310-6800.
  The request should contain the full name, address, Social Security 
  Number and the notarized signature of the subject individual.
Contesting record procedures: 
  The OSD's rules for accessing records, for contesting contents and 
  appealing initial agency determinations are published in OSD 
  Administrative Instruction 81; 32 CFR part 311; or may be obtained 
  from the system manager.
Record source categories: 
  Patient, counselors, supervisors, co-workers or other agency or 
  contractor-employee personnel; private individuals to include family 
  members of patient and outside practitioners.
Exemptions claimed for the system:
  None.

<DOC>
 

DEPARTMENT OF DEFENSE

DHA 04

System name: DOD Bone Marrow Donor Program.

System location
  Primary system: Naval Medical Research Institute, Bethesda, MD 20814-
  5055.
  National Marrow Donor Program (NMDP) Collection Centers at the 
  following locations:
  Alta Bates-Herrick Hospital, Bone Marrow Transplant Program, 3001 
  Colby Street, Berkeley, CA 94705.
  Baylor University Medical Center, Bone Marrow Transplant Program, 
  Sammons Tower, Suite 410, 3500 Gaston Avenue, Dallas, TX 75246.
  Children's Hospital Medical Center, Division of Hematology/Oncology, 
  Bone Marrow Donor Program, Elland and Bethesda Avenues, Cincinnati, OH 
  45229.
  City of Hope National Medical Center, Blood Transfusion Services, 1500 
  E. Duarte Road, Duarte, CA 91010.
  Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44106.
  Dana Farber Cancer Institute, Dana 1838, 44 Binney Street, Boston, MA 
  02115.
  Dartmouth/Hitchock Medical Center, Hematology/Oncology Department, 
  Vail Building, Room 56, PO Box HB-7923, Hanover, NH 03756.
  Emory Clinic, Department of Hematology, 1365 Clifton Road, Northeast, 
  Atlanta, GA 30322.
  Georgetown University Hospital, Lombardi Cancer Research Center, Bone 
  Marrow Transplantation Program, 3800 Reservoir Road, Northwest, 
  Washington, DC 20007.
  Genesee Hospital, 224 Alexander Street, Rochester, NY 14607, HCA 
  Weslery Medical Center, 3243 East Murdock, Suite 300, Wichita, KS 
  67208.
  Hahnemann University Hospital, Broad and Vine Street, 8102 N.C.B., 
  Philadelphia, PA 19102.
  The Johns Hopkins Oncology Center, Bone Marrow Transplant Program, 600 
  North Wolfe Street, Baltimore, MD 21205.
  Kaiser Health Center East, 3414 North Kaiser Center Drive, Portland, 
  OR 97227.
  Kansas City Internal Medicine, 6420 Prospect Avenue, T101, Kansas 
  City, MO 64132.
  LSU Medical School, Department of Medicine, 1524 Tulane Avenue, New 
  Orleans, LA 70112.
  Medical College of Wisconsin, Department of Medicine, Milwaukee County 
  Medical Complex, 8700 West Wisconsin Avenue, Milwaukee, WI 53233.
  Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 
  10021.
  Mercy General Hospital, 3939 `J' Street 300, Sacramento, CA 95819.
  Methodist Hospital of Indiana, Inc., Bone Marrow Transplantation 
  Program, 1701 North Senate Boulevard, Indianapolis, IN 46202.
  Montefiore Hospital, Hematology/Oncology Unit, 3459 Fifth Avenue, 
  Pittsburgh, PA 15213.
  The Ohio State University, Bone Marrow Transplant Program, 10 North 
  Doan Hall, 410 West Tenth Avenue, Columbus, OH 43210-1228.
  Ohio State University Hospital, 410 West Tenth Avenue, N1025 Doan 
  Hall, Columbus, OH 43210.
  Pacific Presbyterian Hospital, Division of Bone Marrow Transplant, 
  2351 Clay Street, Suite 414, San Francisco, CA 94115.
  Poudre Valley Hospital, Bone Marrow Transplant Program, 1024 LeMay 
  Avenue, Fort Collins, CO 80524.
  St. Frances Hospital, Cancer Care Associates, 6835 South Canton, 
  Tulsa, OK 74136.
  Scripps Clinic Research Foundation, Weingart Center for Bone Marrow 
  Transplantation, 10666 North Torrey Pines Road, Maildrop MS-312, 

Other Popular 1995 Privacy Act Documents Documents:

Other Documents:

1995 Privacy Act Documents Records and Documents