Name three purposes for which PHI can be used or disclosed without patient authorization under the Privacy Rule.

• A. Treatment, Payment, Healthcare Operations.
• B. Research, Marketing, Fundraising.
• C. Family requests, Scheduling, Billing.
• D. Public health reporting, Marketing, Legal proceedings.

Answer: (A)

PHI can be used or disclosed without patient authorization for activities that keep health care moving and care coordinated. The key idea is that certain routine operations are allowed to run the system and support patient care without needing a separate consent for each disclosure.

For treatment, PHI may be shared with other providers involved in the patient’s care to coordinate and continue medical services. This includes sharing test results or summaries with specialists, hospitals, or clinics that are part of the patient’s care team.

For payment, PHI can be used to determine coverage, process claims, obtain payment, and send bills. This covers interactions with health plans, insurers, or other entities responsible for paying for services, as well as verifying eligibility.

For healthcare operations, PHI can be used in internal activities that help run the organization and improve care. Examples include quality assessment and improvement, case management, credentialing, audits, and certain risk or legal compliance activities. When third parties are involved, safeguards and minimum-necessary considerations apply to protect privacy.

These uses are allowed without separate authorization because they support the delivery, administration, and improvement of health care while maintaining appropriate privacy protections.