OTR Professional Ethics & Standards 3 — Questions and Answers
Question 1: Under HIPAA, an OTR may share a client's protected health information without authorization when:
- The client's family requests it out of concern
- Required for treatment coordination with the care team (Correct answer)
- The employer requests it for performance review
- A friend of the client asks about progress
Correct answer: Required for treatment coordination with the care team
HIPAA permits disclosure of PHI for treatment, payment, and healthcare operations without explicit authorization.
Question 2: An OTR is treating a client in a setting where the employer requires use of a non-evidence-based intervention. The OTR should:
- Follow the employer's directive without question
- Refuse to treat the client
- Discuss concerns with the supervisor and advocate for evidence-based practice (Correct answer)
- Document disagreement but comply fully
Correct answer: Discuss concerns with the supervisor and advocate for evidence-based practice
OTRs have a professional duty to advocate for evidence-based care while working within the system to effect change.
Question 3: A student OT fieldwork intern asks an OTR to co-sign notes for treatment the OTR did not supervise. The OTR should:
- Co-sign as a professional courtesy
- Refuse, as this would misrepresent supervisory involvement (Correct answer)
- Ask the intern to revise the note to reflect less supervision
- Report the intern to the academic program immediately
Correct answer: Refuse, as this would misrepresent supervisory involvement
Co-signing notes for unsupervised treatment constitutes fraudulent documentation and violates veracity and professional standards.
Question 4: Which of the following best describes 'informed consent' in occupational therapy?
- A one-time signature obtained before any treatment begins
- An ongoing process where the client understands and agrees to the nature and risks of treatment (Correct answer)
- Consent provided by the insurance company to authorize services
- A form completed only when interventions carry significant physical risk
Correct answer: An ongoing process where the client understands and agrees to the nature and risks of treatment
Informed consent is an ongoing process requiring that clients understand the nature, benefits, risks, and alternatives of proposed interventions.
Question 5: A client with mild cognitive impairment wants to make a treatment decision that the OTR believes is not in the client's best interest. The OTR should:
- Override the client's choice because the therapist knows best
- Honor the client's decision after ensuring they have the capacity to make it and understand the consequences (Correct answer)
- Immediately consult legal counsel
- Transfer care to another practitioner
Correct answer: Honor the client's decision after ensuring they have the capacity to make it and understand the consequences
Autonomy requires respecting clients' self-determination when they have decision-making capacity, even when the therapist disagrees with the choice.
Question 6: The AOTA Standards of Practice specify that OT evaluations must:
- Be completed within 24 hours of admission
- Be conducted only by an OTR, not an OTA
- Be based on referral, client needs, and results of the evaluation process (Correct answer)
- Include a minimum of three standardized assessments
Correct answer: Be based on referral, client needs, and results of the evaluation process
AOTA Standards of Practice state that the OT evaluation is directed by referral or request and guided by the client's occupational needs.
Question 7: When an OTR has a personal values conflict with a client's lifestyle choices that may affect care, the ethical response is to:
- Refuse to treat the client
- Provide unbiased care or refer to another qualified provider if objectivity cannot be maintained (Correct answer)
- Discuss personal values openly with the client to resolve the conflict
- Continue treatment without addressing the internal conflict
Correct answer: Provide unbiased care or refer to another qualified provider if objectivity cannot be maintained
Justice requires equitable treatment; if personal values interfere with objectivity, the OTR must either provide unbiased care or arrange for a qualified referral.
OTR Professional Ethics & Standards 3
Under HIPAA, an OTR may share a client's protected health information without authorization when: