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Question 1Professionalism and Regulatory Compliance
A medical assistant witnesses a coworker disclose a patient's lab result to the patient's neighbor in the waiting room. Which action best reflects professional and regulatory obligations?
- Post a reminder about privacy in the staff break room
- Confront the coworker loudly at the front desk
- Report the disclosure through the practice's privacy incident process Correct answer.
- Ignore the event because no written record was created
Explanation
HIPAA requires covered entities to have policies for reporting and mitigating unauthorized disclosures, and workforce members are expected to follow those channels. Reporting through the designated privacy process allows the practice to document, investigate, and mitigate harm. Informal or public responses do not satisfy the reporting obligation.
Question 2Professionalism and Regulatory Compliance
Under HIPAA, which of the following is considered protected health information (PHI)?
- A patient's name combined with a diagnosis code Correct answer.
- Aggregate census data with no individual identifiers
- A public health statistic published by a government agency
- A de-identified dataset with all 18 identifiers removed
Explanation
PHI is individually identifiable health information transmitted or maintained in any form by a covered entity. Combining a direct identifier such as a name with health information creates PHI. De-identified and aggregate data fall outside the definition.
Question 3Professionalism and Regulatory Compliance
A patient asks to see a copy of their medical record. Under HIPAA, what is the practice generally required to do?
- Require the patient to explain why the record is needed
- Release records only through the patient's attorney
- Provide access within a reasonable timeframe and may charge a reasonable cost-based fee Correct answer.
- Refuse until the treating clinician gives written permission
Explanation
HIPAA gives patients a right of access to their records and requires covered entities to act within a defined timeframe, charging only a reasonable cost-based fee. The patient does not need to justify the request, and clinician approval is not a precondition.
Question 4Professionalism and Regulatory Compliance
Which practice best demonstrates the minimum necessary standard when handling PHI?
- Emailing records to a personal account for convenience
- Sharing the full chart with any staff member who asks
- Keeping printed records in an unlocked drawer
- Accessing only the information needed to complete an assigned task Correct answer.
Explanation
The minimum necessary standard limits use and disclosure of PHI to what is needed for the intended purpose. Accessing only task-relevant information is the operational expression of that rule. Broad access, personal email, and unsecured storage all violate privacy and security expectations.
Question 5Professionalism and Regulatory Compliance
What is the primary purpose of the OSHA Bloodborne Pathogens Standard in a medical office?
- To require employers to protect workers from occupational exposure to blood and body fluids Correct answer.
- To regulate the disposal of general office trash
- To set reimbursement rates for infection control supplies
- To mandate patient vaccination schedules
Explanation
The Bloodborne Pathogens Standard requires employers to implement exposure control measures such as training, engineering controls, and personal protective equipment. Its focus is worker protection from bloodborne pathogens. It does not set payment rates, vaccination schedules, or general trash rules.
Question 6Professionalism and Regulatory Compliance
A medical assistant is asked to sign a document as a witness to a patient's signature on a consent form. What is the assistant's role?
- Decide whether the procedure is medically appropriate
- Explain all procedural risks in place of the clinician
- Confirm the patient signed voluntarily and that the signature is authentic Correct answer.
- Guarantee the patient fully understood every detail
Explanation
Witnessing a signature attests that the signature was made by the patient and appears voluntary. It does not transfer the clinician's duty to obtain informed consent or explain risks. The witness does not certify medical appropriateness or comprehension.
Question 7Professionalism and Regulatory Compliance
Which of the following best describes the purpose of a compliance program in a medical practice?
- To detect and prevent violations of law and internal policy Correct answer.
- To eliminate the role of the compliance officer
- To replace the need for staff training
- To increase patient volume through marketing
Explanation
A compliance program establishes policies, training, monitoring, and reporting channels designed to prevent and detect legal and policy violations. It supports, rather than replaces, training and oversight roles. Marketing and staffing elimination are not its purpose.
Question 8Professionalism and Regulatory Compliance
A patient's family member calls and asks for the patient's test results. What should the medical assistant do first?
- Ask the caller to come in without checking authorization
- Verify whether the patient has authorized disclosure to that person Correct answer.
- Read the results over the phone to save time
- Refuse all family inquiries under any circumstance
Explanation
Disclosure to family members requires confirming that the patient has authorized sharing or that another permitted exception applies. Verifying authorization protects both privacy and patient preference. Blanket refusal and unverified disclosure both fail the standard.
Question 9Professionalism and Regulatory Compliance
Which situation most likely requires reporting to a state agency or authorities?
- A patient declines a recommended screening
- A patient reports suspected abuse of a child Correct answer.
- A patient asks to reschedule an appointment
- A patient requests a copy of their billing statement
Explanation
Suspected child abuse is subject to mandatory reporting laws in every state. Administrative requests and personal health decisions do not trigger mandatory reporting. Recognizing reportable conditions is a core compliance responsibility.
Question 10Professionalism and Regulatory Compliance
A medical assistant accidentally sends an email containing PHI to the wrong patient. Which response best aligns with security incident procedures?
- Delete the sent email and take no further action
- Discuss the error with other patients to gather opinions
- Notify the designated privacy or security contact promptly Correct answer.
- Wait to see whether the recipient complains
Explanation
Suspected or actual breaches of unsecured PHI must be assessed and handled through the practice's incident response process. Prompt notification enables risk assessment and any required breach notification. Silence or informal handling can compound harm and violate policy.
Question 11Professionalism and Regulatory Compliance
Under HIPAA, which of the following is generally a permitted disclosure without patient authorization?
- Selling patient lists to a vendor
- Sharing PHI with a friend who is curious about the patient
- Disclosure required by law, such as a mandated report Correct answer.
- Posting patient photos on social media for marketing
Explanation
HIPAA permits certain disclosures without authorization, including those required by law such as mandated public health or abuse reporting. Disclosures to curious friends, marketing use of photos, and sale of lists generally require authorization or are restricted.
Question 12Professionalism and Regulatory Compliance
A medical assistant is unsure whether a requested release of information complies with policy. What is the most appropriate action?
- Ask another patient what they would prefer
- Pause the release and consult the designated privacy officer Correct answer.
- Release only part of the record without documenting the decision
- Release the information and document the uncertainty later
Explanation
When a disclosure's permissibility is uncertain, the safest compliant step is to pause and consult the designated privacy or compliance resource. This prevents unauthorized release while the question is resolved. Proceeding without guidance or relying on other patients is inappropriate.
Question 13Professionalism and Regulatory Compliance
Which element is typically required for a valid authorization to disclose PHI?
- Approval by the patient's employer
- A description of the information to be disclosed and the purpose Correct answer.
- A witness signature from an unrelated patient
- A verbal agreement recorded by a receptionist
Explanation
A valid HIPAA authorization must describe the information, the recipients, the purpose, and include required statements and signatures. Verbal agreements and unrelated approvals do not meet the core content requirements.
Question 14Professionalism and Regulatory Compliance
A clinician asks a medical assistant to enter a diagnosis code that the assistant believes does not match the documented visit. What is the best professional response?
- Refuse to code any visits in the future
- Enter a different code of the assistant's choosing
- Raise the discrepancy with the clinician and document the clarification Correct answer.
- Enter the code as instructed and say nothing
Explanation
Accurate coding must reflect the documented clinical encounter, and staff should clarify discrepancies rather than guess or comply blindly. Raising the issue and documenting the resolution supports compliance and integrity. Unilateral coding changes or blanket refusal are not appropriate.
Question 15Professionalism and Regulatory Compliance
Which action best protects PHI when using a shared workstation in a clinical area?
- Leaving the session open for the next user
- Logging off or locking the screen when stepping away Correct answer.
- Writing passwords on a note attached to the monitor
- Sharing passwords with coworkers for convenience
Explanation
Locking or logging off prevents unauthorized viewing of PHI on shared devices. Password sharing and visible password notes undermine access controls and accountability. Session hygiene is a basic security safeguard.
Question 16Professionalism and Regulatory Compliance
A patient asks the medical assistant to correct an error in their medical record. What is the appropriate first step?
- Tell the patient records can never be amended
- Alter the record without documenting the change
- Delete the original entry from the system
- Follow the practice's amendment request process and route it for review Correct answer.
Explanation
HIPAA gives patients a right to request amendment of their records, and practices must have a process to review such requests. Proper handling preserves an audit trail and honors patient rights. Unauthorized alteration or deletion destroys record integrity.
Question 17Professionalism and Regulatory Compliance
Which best describes the role of a covered entity under HIPAA?
- Any person who visits a clinic
- Only a federal government agency
- A health plan, clearinghouse, or provider that transmits health information electronically in covered transactions Correct answer.
- A vendor that sells office supplies to a clinic
Explanation
Covered entities include health plans, healthcare clearinghouses, and providers that transmit health information electronically in connection with covered transactions. The definition is tied to these categories, not to patients or unrelated vendors.
Question 18Professionalism and Regulatory Compliance
A practice discovers that a laptop containing unencrypted PHI was stolen. Which factor is most relevant to determining whether breach notification is required?
- The color of the laptop case
- The brand of the laptop
- The risk of compromise to the affected individuals Correct answer.
- Whether the laptop was new or used
Explanation
Breach notification obligations hinge on a risk assessment of the probability that PHI was compromised. Encryption can create a safe harbor, but physical characteristics of the device are irrelevant. The analysis focuses on risk to individuals.
Question 19Professionalism and Regulatory Compliance
Which behavior best reflects professional boundaries with patients?
- Accepting a large cash gift from a patient
- Sharing personal social media contact information with a patient
- Borrowing money from a patient
- Maintaining a therapeutic relationship and avoiding personal entanglements Correct answer.
Explanation
Professional boundaries protect both patients and staff by keeping the relationship focused on care. Personal entanglements, gifts of significant value, and financial dealings can create conflicts and exploitation risk. Maintaining clear boundaries is an ethical and regulatory expectation.
Question 20Professionalism and Regulatory Compliance
A medical assistant is asked to perform a task that is outside their scope of practice. What is the most appropriate response?
- Perform the task because a coworker asked
- Perform the task and ask for training afterward
- Decline and refer the task to a qualified team member Correct answer.
- Perform the task only if the patient agrees
Explanation
Scope of practice rules protect patients and staff, and tasks must be performed by qualified individuals. Declining and routing the task appropriately is the compliant response. Patient agreement or informal requests do not expand legal scope.
Question 21Professionalism and Regulatory Compliance
Which statement best describes the purpose of the HIPAA Security Rule?
- It sets standards for safeguarding electronic PHI Correct answer.
- It establishes clinical treatment protocols
- It governs workplace injury reporting
- It determines insurance eligibility criteria
Explanation
The Security Rule establishes administrative, physical, and technical safeguards for electronic PHI. It does not set clinical protocols, eligibility rules, or workplace injury reporting requirements. Understanding the rule's scope supports correct security decisions.
Question 22Professionalism and Regulatory Compliance
A medical assistant notices that a colleague routinely documents care before it is performed. Which action best addresses this compliance concern?
- Report the observation through the appropriate compliance channel Correct answer.
- Join the practice to keep the workflow consistent
- Confront the colleague in front of patients
- Ignore the pattern because the care is eventually delivered
Explanation
Documenting care before it is delivered creates false records and can affect billing and patient safety. Reporting through the compliance channel allows investigation and correction. Following the practice, public confrontation, or ignoring the issue all perpetuate risk.
Question 23Professionalism and Regulatory Compliance
A researcher asks a medical assistant to provide a list of patients with a specific diagnosis for a study. Which condition must generally be met before releasing this information?
- The list will be stored on a personal device
- The patients have authorized the use or an IRB waiver applies Correct answer.
- The researcher is a licensed clinician
- The study is funded by the practice
Explanation
Use or disclosure of PHI for research generally requires patient authorization or a documented waiver of authorization approved by an IRB or privacy board. Licensure, storage location, or funding source does not substitute for that requirement.
Question 24Professionalism and Regulatory Compliance
An auditor finds that staff sometimes share login credentials to speed up workflow during busy periods. Which analysis best captures the compliance risk?
- The risk is limited to slower system performance
- Shared credentials destroy individual accountability and weaken access controls Correct answer.
- The practice is compliant if the shared account is used only at peak hours
- The practice saves time, so the risk is minimal
Explanation
Unique credentials support individual accountability, audit trails, and access restrictions required by the Security Rule. Shared logins make it impossible to attribute actions and can expose PHI to unauthorized users. Time savings or peak-hour limits do not mitigate the core risk.
Question 25Professionalism and Regulatory Compliance
A practice wants to send appointment reminders to patients by text message. Which approach best supports compliance?
- Use unsecured personal phones for all messages
- Include full diagnosis details in every reminder
- Send reminders to any number found in public directories
- Obtain and document patient consent and offer an opt-out Correct answer.
Explanation
Reminder communications should respect patient preferences and privacy, which means obtaining and documenting consent and providing an opt-out. Including sensitive details or using unsecured devices increases risk, and public directory numbers are not verified patient contacts.
Question 26Professionalism and Regulatory Compliance
Which federal law primarily governs the privacy and security of protected health information (PHI)?
- The Health Insurance Portability and Accountability Act (HIPAA) Correct answer.
- The Clinical Laboratory Improvement Amendments (CLIA)
- The Occupational Safety and Health Act (OSHA)
- The Americans with Disabilities Act (ADA)
Explanation
HIPAA is the federal law that sets national standards for protecting the privacy and security of health information. OSHA addresses workplace safety, CLIA regulates laboratory testing, and the ADA prohibits discrimination based on disability.
Question 27Professionalism and Regulatory Compliance
What is the primary purpose of the HIPAA Privacy Rule?
- To protect the privacy of individually identifiable health information Correct answer.
- To ensure the security of electronic PHI through technical safeguards
- To regulate the licensing of healthcare providers
- To set standards for the electronic exchange of health information
Explanation
The Privacy Rule establishes national standards for the protection of individually identifiable health information. The Security Rule specifically addresses electronic PHI, while the other options are not the focus of the Privacy Rule.
Question 28Professionalism and Regulatory Compliance
A medical assistant receives a subpoena for a patient's medical records without a patient authorization. What is the most appropriate action?
- Release only the portions of the record that are specifically requested
- Verify that the subpoena is valid and that proper notice was given to the patient Correct answer.
- Immediately release the complete record as requested
- Ignore the subpoena because it is not a court order
Explanation
Before releasing PHI in response to a subpoena, the practice must ensure the subpoena is valid and that the patient has been given notice or that a court order authorizes the disclosure. Releasing records without this verification can violate HIPAA.
Question 29Professionalism and Regulatory Compliance
Which of the following is an example of a HIPAA administrative safeguard?
- Implementing a security management process Correct answer.
- Installing firewalls
- Using biometric access controls
- Encrypting data at rest
Explanation
Administrative safeguards are policies and procedures, such as a security management process, workforce training, and access management. Encryption, firewalls, and biometric controls are technical safeguards.
Question 30Professionalism and Regulatory Compliance
A patient requests an amendment to their medical record because they believe a diagnosis is incorrect. What must the practice do?
- Review the request and respond in writing within a specified time frame Correct answer.
- Refuse the request without explanation
- Immediately change the record as requested
- Forward the request to the patient's insurance company
Explanation
HIPAA gives patients the right to request an amendment, and the practice must act on the request within a set time (generally 60 days). The practice may deny the request but must provide a written explanation and inform the patient of their rights.
Question 31Professionalism and Regulatory Compliance
What is the primary purpose of the HIPAA Breach Notification Rule?
- To establish penalties for HIPAA violations
- To ensure that individuals are notified when their unsecured PHI is breached Correct answer.
- To mandate the use of encryption for all electronic PHI
- To require covered entities to report all security incidents to the FBI
Explanation
The Breach Notification Rule requires covered entities to notify affected individuals, HHS, and sometimes the media when a breach of unsecured PHI occurs. It does not require reporting to the FBI, mandate encryption, or set penalties.
Question 32Professionalism and Regulatory Compliance
A medical assistant is asked to release a patient's records to a family member who is not involved in the patient's care. What is the most appropriate response?
- Release the records because the family member is a relative
- Decline unless the patient has provided authorization or the disclosure is otherwise permitted by law Correct answer.
- Release only a summary of the records
- Ask the family member to provide a written request
Explanation
HIPAA generally requires patient authorization before disclosing PHI to family members who are not involved in the patient's care. Releasing records without authorization can violate privacy rules.
Question 33Professionalism and Regulatory Compliance
Which of the following best describes the role of the Office for Civil Rights (OCR) in HIPAA enforcement?
- It investigates complaints and can impose civil monetary penalties for HIPAA violations Correct answer.
- It accredits healthcare organizations for quality and safety
- It provides legal representation to patients in malpractice lawsuits
- It sets the reimbursement rates for Medicare and Medicaid services
Explanation
OCR is the federal agency responsible for enforcing HIPAA privacy and security rules. It investigates complaints, conducts compliance reviews, and can impose civil penalties.
Question 34Professionalism and Regulatory Compliance
A medical assistant discovers that a coworker is accessing the medical records of a celebrity patient out of curiosity. What is the most appropriate action?
- Confront the coworker and ask them to stop
- Ignore the situation because it is not the assistant's responsibility
- Report the coworker's access to the privacy officer or supervisor Correct answer.
- Access the records as well to verify the coworker's activity
Explanation
Unauthorized access to PHI is a privacy violation and must be reported to the appropriate authority, such as the privacy officer. Confronting the coworker or ignoring the issue does not fulfill the obligation to protect patient privacy.
Question 35Professionalism and Regulatory Compliance
A practice is evaluating whether to use a cloud service to store patient records. Which factor is most critical for compliance with HIPAA?
- The cost of the cloud service
- The cloud provider's physical location
- The cloud provider's willingness to sign a business associate agreement Correct answer.
- The cloud provider's experience with other industries
Explanation
A business associate agreement (BAA) is required when a vendor handles PHI on behalf of a covered entity. Without a BAA, the practice cannot ensure the vendor will appropriately safeguard the information.
Question 36Professionalism and Regulatory Compliance
A patient asks a medical assistant why the practice requires a signed authorization before releasing records to the patient's employer. Which explanation best reflects the applicable rule?
- The employer may receive the records without authorization if the patient is an employee of that company.
- Any disclosure of records to a third party is prohibited without a court order, so the employer must obtain one first.
- Uses and disclosures for purposes other than treatment, payment, or health care operations generally require a valid patient authorization unless a specific exception applies. Correct answer.
- Authorization is required only when the records contain mental health or substance use information, not for general records.
Explanation
The HIPAA Privacy Rule permits disclosures for treatment, payment, and health care operations without authorization, but most other purposes require a valid, specific patient authorization or a recognized exception. Releasing records to an employer for employment purposes is not a treatment, payment, or operations function, so authorization is the standard pathway.
Question 37Infection Control and Safety
What is the single most effective routine practice for preventing the spread of infectious agents in a healthcare setting?
- Wearing gloves for every patient contact
- Disinfecting the floor between patients
- Performing hand hygiene at the appropriate moments Correct answer.
- Wearing a surgical mask during all shifts
Explanation
Hand hygiene is the primary, most effective measure for interrupting transmission of pathogens between patients and staff. Gloves, masks, and environmental cleaning are adjuncts and do not replace hand hygiene.
Question 38Infection Control and Safety
A medical assistant is about to enter a patient room and perform hand hygiene. Which action correctly describes proper use of an alcohol-based hand rub?
- Apply rub to palms only and allow to air dry for a few seconds
- Apply rub and immediately wipe hands on a paper towel
- Apply rub over visible blood without washing first
- Apply rub to all hand surfaces and rub until hands are dry Correct answer.
Explanation
Alcohol-based hand rub must cover all surfaces of the hands and be rubbed until completely dry to achieve full antimicrobial effect. Visible soil or blood requires soap-and-water washing first.
Question 39Infection Control and Safety
According to standard precautions, which of the following is the minimum barrier protection required when contact with blood or body fluids is anticipated?
- Barriers selected based on the anticipated exposure task Correct answer.
- Gloves and a gown
- Gloves and eye protection
- Gloves only
Explanation
Standard precautions require selecting barriers based on the anticipated task and exposure risk, which may include gloves, gown, mask, and eye protection. A fixed combination is not correct for every situation.
Question 40Infection Control and Safety
A medical assistant is preparing to draw blood. Which action reflects correct glove use?
- Wash gloved hands with soap and water between patients
- Remove gloves and perform hand hygiene after the procedure Correct answer.
- Apply hand sanitizer to the gloves to reuse them
- Wear the same gloves to answer the phone and draw the next patient
Explanation
Gloves are single-use; they are removed after the task and followed by hand hygiene. Gloves are never washed, sanitized, or reused between patients.
Question 41Infection Control and Safety
Which term describes precautions applied to all patients regardless of known infection status when contact with blood or body fluids is possible?
- Contact precautions
- Reverse isolation
- Transmission-based precautions
- Standard precautions Correct answer.
Explanation
Standard precautions apply to every patient because any patient may carry an undiagnosed transmissible agent. Transmission-based precautions are added when a specific organism is suspected or confirmed.
Question 42Infection Control and Safety
A patient is diagnosed with active pulmonary tuberculosis. Which transmission-based precaution is indicated?
- Contact precautions
- Droplet precautions
- Airborne precautions Correct answer.
- Standard precautions only
Explanation
Tuberculosis is transmitted by airborne droplet nuclei that remain suspended and travel on air currents, so airborne precautions with an N95 respirator are required. Droplet and contact precautions do not address airborne spread.
Question 43Infection Control and Safety
A patient has an infection with a pathogen spread by large respiratory droplets, such as influenza. Which precaution is appropriate when entering the room within close range?
- N95 respirator
- Surgical mask Correct answer.
- Gown and gloves only
- No barrier if the patient is afebrile
Explanation
Droplet precautions require a surgical mask for close contact, since large droplets are generated by coughing and settle near the patient. N95 respirators are reserved for airborne pathogens.
Question 44Infection Control and Safety
A medical assistant is caring for a patient with Clostridioides difficile infection. Which action is most important in preventing transmission?
- Using an alcohol-based hand rub after glove removal
- Washing hands with soap and water after glove removal Correct answer.
- Wearing a surgical mask during all patient contact
- Disinfecting the room with an alcohol wipe
Explanation
C. difficile spores are not reliably killed by alcohol, so soap-and-water hand washing is required after glove removal. Spores also resist alcohol-based environmental wipes, and bleach-based products are preferred.
Question 45Infection Control and Safety
Which item is classified as a sharp that must be placed in a puncture-resistant sharps container immediately after use?
- Disposable syringe with attached needle Correct answer.
- Soiled patient gown
- Empty medication vial
- Used gauze sponge
Explanation
Needles and other sharps must be disposed of immediately in a puncture-resistant, closable sharps container without recapping. Soft or non-sharp items go in regular or biohazard waste as appropriate.
Question 46Infection Control and Safety
A medical assistant accidentally sustains a needlestick injury. What is the first action to take?
- Apply a tight tourniquet above the site
- Continue working and monitor for symptoms
- Wash the site with soap and water and report immediately Correct answer.
- Report to a supervisor at the end of the shift
Explanation
Immediate washing of the wound with soap and water, followed by prompt reporting and evaluation for post-exposure prophylaxis, is the correct response. Delaying reporting can compromise timely prophylaxis.
Question 47Infection Control and Safety
Which practice is correct for handling a used needle after administering an injection?
- Recap the needle using two hands
- Do not recap and place the needle directly into a sharps container Correct answer.
- Break the needle off the syringe before disposal
- Recap the needle using one hand before disposal
Explanation
Needles should never be recapped or manipulated; they are placed directly into a sharps container to prevent injury. Recapping and needle breaking are common causes of needlesticks.
Question 48Infection Control and Safety
Which of the following is considered personal protective equipment (PPE)?
- Stethoscope
- Thermometer
- Blood pressure cuff
- Exam gloves Correct answer.
Explanation
PPE includes specialized clothing or equipment worn to protect against hazards, such as gloves, gowns, masks, and eye protection. Patient-care instruments are not PPE.
Question 49Infection Control and Safety
When removing PPE after patient care, which sequence best prevents self-contamination?
- Remove gloves first, then perform hand hygiene, then remove other PPE Correct answer.
- Remove mask first, then gloves, then gown
- Remove eye protection, then mask, then gloves, then gown
- Remove gown and gloves together, then mask, with hand hygiene after removal
Explanation
Gloves are the most contaminated item and are removed first, followed by hand hygiene, then remaining PPE such as gown, mask, and eye protection, with hand hygiene at the end. This minimizes transfer of organisms to the face and hands.
Question 50Infection Control and Safety
A medical assistant must dispose of a blood-soaked dressing. How should it be handled?
- Rinse it in the sink and discard in regular trash
- Flush it down the toilet
- Place it in regular trash
- Place it in a biohazard-labeled bag or container Correct answer.
Explanation
Items saturated with blood or body fluids are regulated medical waste and must go into biohazard-labeled containers. Regular trash and sink disposal are not acceptable.