If you seek help from the troop medical clinic for a medical condition, will your commander be told about your condition' Could this be embarrassing for you, perhaps even damage your career or lead to disciplinary action' Such concerns can lead a Soldier to avoid medical care, perhaps until a condition becomes a serious health hazard.

On the other hand, a commander certainly needs to know if a Soldier cannot perform his or her duties, or has a condition that might present a hazard to that Soldier or others in the unit.

Army leaders are trying to resolve these competing needs by clarifying and emphasizing requirements and procedures for informing commanders about Soldiers' Protected Health Information (PHI).

"Commanders play a critical role in the health and well-being of their Soldiers, and therefore require sufficient information to make informed decisions about fitness and duty limitations," stated Vice Chief of Staff of the Army GEN Peter W. Chiarelli in a message distributed in May.

"We must balance the Soldier's right to the privacy of her/her protected health information (PHI) with mission requirements and the commander's right to know. It would be counterproductive for Soldiers to perceive increased stigma, or not seek medical care, because of the inappropriate release of PHI," Chiarelli continued.

As a general rule, PHI cannot be released without authorization by the patient. But privacy laws and regulations recognize that the military mission sometimes requires commanders to know information that otherwise is protected.

Commanders have unrestricted access to the following medical information:
Aca,!Ac DoD drug testing results.
Aca,!Ac Medical readiness and fitness for deployability (for example, immunization status, profile, flight status, etc.).
Aca,!Ac Medical line of duty investigation determinations.
Aca,!Ac Changes in duty status due to medical conditions (appointments, hospitalization).
Aca,!Ac Army weight control program documentation.
Aca,!Ac Medical conditions or treatments that are duty limiting. Providers will notify commanders about medication side effects that affect duty performance, but are not required to identify the medication or diagnosis.
Aca,!Ac Any perceived threat to life or health, such as violent or suicidal behavior.

Commanders will not be notified of conditions that do not affect a Soldier's ability to perform duties, such as a self-referral for behavioral health services, or a prescription for birth control.

Warrior Transition Units are a special case, where commanders have access to PHI without authorizations. Using PHI in a WTU is considered treatment and/or care coordination.

A Family member's PHI is not ordinarily provided to a commander. A Family member's PHI can only be released to a commander when the Family is enrolled in the Family Advocacy Program (FAP) or when they are enrolled in the Exceptional Family Member Program and their condition affects the Soldier's fitness for duty.

Medical Command has prepared training packages for medical treatment facilities (MTF) to use in ensuring medical providers and administrative personnel know the rules about communicating with commanders.

"What we want is to enhance communication between the providers and the commanders regarding the health of Soldiers," said Tom Leonard of the Patient Administration Division at MEDCOM Headquarters.

Providers must inform Soldiers when they will share information with the commander.

Specific procedures for transmitting PHI to commanders are listed in OTSG/MEDCOM Policy Memo 10-042, issued on June 30, 2010.

Chiarelli's message also requires medical treatment facilities to inform commanders when Soldiers don't show up for medical appointments, and that Soldiers should process through behavioral health when changing stations so treatments will continue uninterrupted at the new station.

The average rate of no-shows among active-duty Soldiers is 11 percent, according to Michael P. Griffin, senior managed care specialist in the TRICARE division at MEDCOM Headquarters.

"Each no-show appointment represents a lost opportunity to provide health-care services to our population, and hampers our ability to meet access to care standards and beneficiary expectations," Griffin said.

Griffin cited no-show notification programs at Fort Stewart, Ga., and Fort Hood, Texas, as good examples to follow. Both programs inform commanders of pending appointments for their Soldiers as well as appointments that were not kept. Fort Stewart's program can be studied at https://www.us.army.mil/suite/page/336433 on Army Knowledge Online.

MEDCOM published a revised Policy Memo 10-064 for procedures for transferring care during permanent change of station for Soldiers involved with the Family Advocacy Program or behavioral health care.

"The purpose of this Policy Memo was to further refine the standardization of communication between MTFs in order to ensure a positive hand-off to gaining installations and improve continuity of care (FAP, BH to include Medical Addiction Programs) for Soldiers and their Families who are transitioning between assignments," said Dr. Yamile A. Jana, a clinical psychologist for the Behavioral Health Division of the Office of The Surgeon General.

Leonard said MEDCOM is developing a report through the CHCS electronic medical record system that will list behavioral health appointments in the past 60 days.

"Soldiers who are outprocessing will be screened against that report. The losing MTF will then call the gaining MTF, which will set up a tentative appointment," he said.

"Collaborative communication between commanders (or their designated representatives) and health-care providers is critical to the health and well-being of our Soldiers," Chiarelli noted in his message.