**Release of Information From Department of Veterans Affairs Records**

**Relating to Drug Abuse, Alcoholism or Alcohol Abuse,**

**Infection With the Human Immunodeficiency**

**Virus (HIV), or Sickle Cell Anemia**

**Note**: Sections 1.460 through 1.499 of this part concern the
confidentiality of information relating to drug abuse, alcoholism or
alcohol abuse, infection with the human immunodeficiency virus, or
sickle cell anemia in VA records and are applicable in combination with
other regulations pertaining to the release of information from VA
records. Sections 1.500 through 1.527, Title 38, Code of Federal
Regulations, implement the provisions of 38 U.S.C. §§5701 and 5702.
Sections 1.550 through 1.559 implement the provisions of 5 U.S.C. §552
(The Freedom of Information Act). Sections 1.575 through 1.584 implement
the provisions of 5 U.S.C. §552a (The Privacy Act of 1974).

The provisions of §§1.460 through 1.499 of this part pertain to any
program or activity, including education, treatment, rehabilitation or
research, which relates to drug abuse, alcoholism or alcohol abuse,
infection with the human immunodeficiency virus, or sickle cell anemia.
The statutory authority for the drug abuse provisions and alcoholism or
alcohol abuse provisions of §§1.460 through 1.499 is §111 of Pub. L.
94-581, the Veterans Omnibus Health Care Act of 1976 (38 U.S.C. §§7331
through 7334), the authority for the human immunodeficiency virus
provisions is §121 of Pub. L. 100-322, the Veterans' Benefits and
Services Act of 1988 (38 U.S.C. §7332); the authority for the sickle
cell anemia provisions is §109 of Pub. L. 93-82, the Veterans Health
Care Expansion Act of 1973 (38 U.S.C. §§1751-1754).

**Authority**: 38 U.S.C. §§1751--1754 and 7331--7334.

**Source**: §§1.460--1.499 published at 60 FR 63929, Dec. 13, 1995,

unless otherwise indicated.

**§1.460 Definitions.**

For purposes of §§1.460 through 1.499 of this part, the following
definitions apply:

*Agreement*. The term "agreement" means a document that a VA health care
facility develops in collaboration with an Organ Procurement
Organization, eye bank or tissue bank with written, detailed
responsibilities and obligations of the parties with regard to
identifying potential donors and facilitating the donation process.

*Alcohol abuse*. The term "alcohol abuse" means the use of an alcoholic
beverage which impairs the physical, mental, emotional, or social
well-being of the user.

*Contractor*. The term "contractor" means a person who provides services
to VA such as data processing, dosage preparation, laboratory analyses
or medical or other professional services. Each contractor shall be
required to enter into a written agreement subjecting such contractor to
the provisions of §§1.460 through 1.499 of this part; 38 U.S.C. 5701 and
7332; and 5 U.S.C. 552a and 38 CFR 1.576(g).

*Deceased*. The term "deceased" means death established by either
neurological criteria (brain death) or cardiopulmonary criteria (cardiac
death). Brain death is the irreversible cessation of all brain function.
Cardiac death is the irreversible cessation of circulatory and
respiratory function. In both cases, "irreversible" means that function
will not resume spontaneously and will not be restarted artificially.

*Diagnosis*. The term "diagnosis" means any reference to an individual's
alcohol or drug abuse or to a condition which is identified as having
been caused by that abuse or any reference to sickle cell anemia or
infection with the human immunodeficiency virus which is made for the
purpose of treatment or referral for treatment. A diagnosis prepared for
the purpose of treatment or referral for treatment but which is not so
used is covered by §§1.460 through 1.499 of this part. These regulations
do not apply to a diagnosis of drug overdose or alcohol intoxication
which clearly shows that the individual involved is not an alcohol or
drug abuser (e.g., involuntary ingestion of alcohol or drugs or reaction
to a prescribed dosage of one or more drugs).

*Disclose or disclosure*. The term "disclose" or "disclosure" means a
communication of patient identifying information, the affirmative
verification of another person's communication of patient identifying
information, or the communication of any information from the record of
a patient who has been identified.

*Drug abuse*. The term "drug abuse" means the use of a psychoactive
substance for other than medicinal purposes which impairs the physical,
mental, emotional, or social well-being of the user.

*Eye bank and tissue bank*. The term "eye bank and tissue bank" means an
"establishment" as defined in 21 CFR 1271.3, pursuant to section 361 of
the Public Health Service Act (42 U.S.C. 264) that has a valid, current
registration with the Federal Food and Drug Administration (FDA) as
required under 21 CFR part 1271.

*Individual*. The term "individual" means a veteran, as defined in 38
U.S.C. 101(2), or a dependent of a veteran, as defined in 38 U.S.C.
101(3) and (4)(A).

*Infection with the human immunodeficiency virus* (*HIV*). The term
"infection with the human immunodeficiency virus (HIV)" means the
presence of laboratory evidence for human immunodeficiency virus
infection. For the purposes of §§1.460 through 1.499 of this part, the
term includes the testing of an individual for the presence of the virus
or antibodies to the virus and information related to such testing
(including tests with negative results).

*Informant*. The term "informant" means an individual who is a patient
or employee or who becomes a patient or employee at the request of a law
enforcement agency or official and who at the request of a law
enforcement agency or official observes one or more patients or
employees for the purpose of reporting the information obtained to the
law enforcement agency or official.

*Near death*. The term "near death" means that in the clinical judgment
of the patient's health care provider based on defined clinical
triggers, the patient's death is imminent.

*Organ Procurement Organization*. The term "Organ Procurement
Organization" (OPO) means an organization that performs or coordinates
the procurement, preservation, and transportation of organs and
maintains a system of locating prospective recipients for available
organs.

*Patient*. The term "patient" means any individual or subject who has
applied for or been given a diagnosis or treatment for drug abuse,
alcoholism or alcohol abuse, infection with the human immunodeficiency
virus, or sickle cell anemia and includes any individual who, after
arrest on a criminal charge, is interviewed and/or tested in connection
with drug abuse, alcoholism or alcohol abuse, infection with the human
immunodeficiency virus, or sickle cell anemia in order to determine that
individual's eligibility to participate in a treatment or rehabilitation
program. The term patient includes an individual who has been diagnosed
or treated for alcoholism, drug abuse, HIV infection, or sickle cell
anemia for purposes of participation in a VA program or activity
relating to those four conditions, including a program or activity
consisting of treatment, rehabilitation, education, training,
evaluation, or research. The term "patient" for the purpose of infection
with the human immunodeficiency virus or sickle cell anemia, includes
one tested for the disease.

*Patient identifying information*. The term "patient identifying
information" means the name, address, social security number,
fingerprints, photograph, or similar information by which the identity
of a patient can be determined with reasonable accuracy and speed either
directly or by reference to other publicly available information. The
term does not include a number assigned to a patient by a treatment
program, if that number does not consist of, or contain numbers (such as
social security, or driver's license number) which could be used to
identify a patient with reasonable accuracy and speed from sources
external to the treatment program.

*Person*. The term "person" means an individual, partnership,
corporation, Federal, State or local government agency, or any other
legal entity.

*Procurement organization*. The term "procurement organization" means an
organ procurement organization, eye bank, and/or tissue bank as defined
in this section.

*Records*. The term "records" means any information received, obtained
or maintained, whether recorded or not, by an employee or contractor of
VA, for the purpose of seeking or performing VA program or activity
functions relating to drug abuse, alcoholism, tests for or infection
with the human immunodeficiency virus, or sickle cell anemia regarding
an identifiable patient. A program or activity function relating to drug
abuse, alcoholism, infection with the human immunodeficiency virus, or
sickle cell anemia includes evaluation, treatment, education, training,
rehabilitation, research, or referral for one of these conditions.
Sections 1.460 through 1. 499 of this part apply to a primary or other
diagnosis, or other information which identifies, or could reasonably be
expected to identify, a patient as having a drug or alcohol abuse
condition, infection with the human immunodeficiency virus, or sickle
cell anemia (e.g., alcoholic psychosis, drug dependence), but only if
such diagnosis or information is received, obtained or maintained for
the purpose of seeking or performing one of the above program or
activity functions. Sections 1.460 through 1.499 of this part do not
apply if such diagnosis or other information is not received, obtained
or maintained for the purpose of seeking or performing a function or
activity relating to drug abuse, alcoholism, infection with the human
immunodeficiency virus, or sickle cell anemia for the patient in
question. Whenever such diagnosis or other information, not originally
received or obtained for the purpose of obtaining or providing one of
the above program or activity functions, is subsequently used in
connection with such program or activity functions, those original
entries become a "record" and §§1.460 through 1.499 of this part
thereafter apply to those entries. Segregability: these regulations do
not apply to records or information contained therein, the disclosure of
which (the circumstances surrounding the disclosure having been
considered) could not reasonably be expected to disclose the fact that a
patient has been connected with a VA program or activity function
relating to drug abuse, alcoholism, infection with the human
immunodeficiency virus, or sickle cell anemia.

\(1\) The following are examples of instances whereby records or
information related to alcoholism or drug abuse are covered by the
provisions of §§1.460 through 1.499 of this part:

\(i\) A patient with alcoholic delirium tremens is admitted for
detoxification. The patient is offered treatment in a VA alcohol
rehabilitation program which he declines.

\(ii\) A patient who is diagnosed as a drug abuser applies for and is
provided VA drug rehabilitation treatment.

\(iii\) While undergoing treatment for an unrelated medical condition, a
patient discusses with the physician his use and abuse of alcohol. The
physician offers VA alcohol rehabilitation treatment which is declined
by the patient.

\(2\) The following are examples of instances whereby records or
information related to alcoholism or drug abuse are not covered by the
provisions of §§1.460 through 1.499 of this part:

\(i\) A patient with alcoholic delirium tremens is admitted for
detoxification, treated and released with no counseling or treatment for
the underlying condition of alcoholism.

\(ii\) While undergoing treatment for an unrelated medical condition, a
patient informs the physician of a history of drug abuse fifteen years
earlier with no ingestion of drugs since. The history and diagnosis of
drug abuse is documented in the hospital summary and no treatment is
sought by the patient or offered or provided by VA during the current
period of treatment.

\(iii\) While undergoing treatment for injuries sustained in an
accident, a patient's medical record is documented to support the
judgment of the physician to prescribe certain alternate medications in
order to avoid possible drug interactions in view of the patient's
enrollment and treatment in a non-VA methadone maintenance program. The
patient states that continued treatment and follow-up will be obtained
from private physicians and VA treatment for the drug abuse is not
sought by the patient nor provided or offered by the staff.

\(iv\) A patient is admitted to the emergency room suffering from a
possible drug overdose. The patient is treated and released; a history
and diagnosis of drug abuse may be documented in the hospital summary.
The patient is not offered treatment for the underlying conditions of
drug abuse, nor is treatment sought by the patient for that condition.

*Third party payer*. The term "third party payer" means a person who
pays, or agrees to pay, for diagnosis or treatment furnished to a
patient on the basis of a contractual relationship with the patient or a
member of his or her family or on the basis of the patient's eligibility
for Federal, State, or local governmental benefits.

*Treatment*. The term "treatment" means the management and care of a
patient for drug abuse, alcoholism or alcohol abuse, infection with the
human immunodeficiency virus, or sickle cell anemia, or a condition
which is identified as having been caused by one or more of these
conditions, in order to reduce or eliminate the adverse effects upon the
patient. The term includes testing for the human immunodeficiency virus
or sickle cell anemia.

*Undercover agent*. The term "undercover agent" means an officer of any
Federal, State, or local law enforcement agency who becomes a patient or
employee for the purpose of investigating a suspected violation of law
or who pursues that purpose after becoming a patient or becoming
employed for other purposes. (Authority: 38 U.S.C. 7334)

*VHA health care facility*. The term "VHA health care facility" means a
VA medical center, VA emergency room, VA nursing home or other facility
as defined in 38 U.S.C. 1701(3).

\[60 FR 63929, Dec. 13, 1995, as amended at 72 FR 48241, Aug. 23, 2007;
73 FR 65260, Nov. 3, 2008\]

**Supplement *Highlights* references**: 78(1), 86(1).

Reserved