MPJE Patient Counseling and Confidentiality 5 — Questions and Answers
Question 1: A patient on methadone maintenance therapy asks the pharmacist to provide their dispensing records to their spouse. The pharmacist should:
- Provide the records since methadone is not a controlled substance in maintenance programs
- Require written authorization from the patient before releasing the records (Correct answer)
- Refuse all requests for methadone records as they are permanently sealed
- Contact the methadone clinic before releasing any information
Correct answer: Require written authorization from the patient before releasing the records
Substance abuse treatment records are protected by both HIPAA and 42 CFR Part 2, requiring written patient authorization before any disclosure.
Question 2: During a medication therapy management (MTM) consultation, a pharmacist identifies that a patient is taking a medication for a condition not listed in their medical history. The pharmacist should:
- Ignore the discrepancy to avoid embarrassing the patient
- Document the medication and counsel the patient to ensure safety and comprehensiveness (Correct answer)
- Immediately contact all of the patient's prescribers without the patient's consent
- Refuse to continue the MTM session until complete records are provided
Correct answer: Document the medication and counsel the patient to ensure safety and comprehensiveness
Comprehensive MTM requires complete medication reconciliation; documenting and counseling ensures patient safety without violating confidentiality.
Question 3: A pharmacist who fails to offer counseling for a new prescription to a Medicaid patient could face consequences under:
- DEA enforcement action for improper controlled substance handling
- State Medicaid agency sanctions for violating OBRA '90 participation requirements (Correct answer)
- FDA enforcement for failing to provide required medication guides
- FTC action for deceptive business practices
Correct answer: State Medicaid agency sanctions for violating OBRA '90 participation requirements
OBRA '90 established patient counseling as a condition of Medicaid participation, making violations subject to state Medicaid agency sanctions.
Question 4: A 16-year-old patient presents a prescription for oral contraceptives. Regarding confidentiality and parental notification:
- The pharmacist must notify the parents since the patient is a minor
- State law governs whether minors can consent to and receive confidential reproductive health services (Correct answer)
- The prescriber must obtain parental consent before the pharmacist can dispense
- HIPAA requires parental access to all minor patient records without exception
Correct answer: State law governs whether minors can consent to and receive confidential reproductive health services
State laws vary widely on minor consent and confidentiality for reproductive health services, and pharmacists must follow their specific state's requirements.
Question 5: Which element is specifically required when documenting a patient counseling session per best practice standards?
- The pharmacist's personal assessment of patient intelligence and ability to understand
- The date, patient name, medication, information provided, and patient's response or questions (Correct answer)
- A verbatim transcript of all communication between pharmacist and patient
- The prescriber's authorization for the pharmacist to provide counseling
Correct answer: The date, patient name, medication, information provided, and patient's response or questions
Effective counseling documentation includes the date, patient identification, medication involved, information covered, and any patient feedback or questions raised.
Question 6: A pharmacy's security camera footage showing a patient picking up a prescription containing PHI. Under HIPAA, this footage is:
- Not covered by HIPAA since it is video, not medical records
- Potentially PHI if it links an identifiable individual to receipt of health services (Correct answer)
- Covered only if the pharmacy specifically uses it for medical record-keeping
- Not PHI because it is collected incidentally, not intentionally
Correct answer: Potentially PHI if it links an identifiable individual to receipt of health services
Video footage can constitute PHI if it contains individually identifiable information related to health services, such as a patient picking up medication.
Question 7: A pharmacist receives a verbal prescription over the phone and must counsel a caregiver picking up the medication. Who must receive the counseling offer?
- Only the patient, so counseling must be deferred until the patient can be reached directly
- The caregiver picking up the medication, with information appropriate to convey to the patient (Correct answer)
- The prescriber's office since they authorized the verbal order
- No counseling is required for medications picked up by someone other than the patient
Correct answer: The caregiver picking up the medication, with information appropriate to convey to the patient
When a caregiver picks up medication, the pharmacist should counsel the caregiver and provide information relevant for them to safely assist the patient.
MPJE Patient Counseling and Confidentiality 5
A patient on methadone maintenance therapy asks the pharmacist to provide their dispensing records to their spouse.
The pharmacist should: