Three Records for One Client
You are the administrative coordinator at a community health centre with four sites. While preparing the monthly service report, you notice that one client, M. Okafor, has three active records: record A shows date of birth 14 March 1988 and a mobile number ending 4471; record B shows 14 March 1989 with the same mobile number; record C was created last week by a locum, has no date of birth, and lists an address that matches record A. Each record carries different appointments and a different billing number. A clinician has already written progress notes in records A and B. Centre policy requires two verified identifiers and a supervisor's approval before any demographic change, and every merge must be recorded in an audit log. The IT merge tool is unavailable until tomorrow. The report is due at 4 pm today, and the clinic manager says, 'Just clean it up before the report.'
1. What should happen with the three records before the report is submitted, and why?
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Do not merge or delete anything today. The safe sequence is:
- Flag, do not alter. Place a temporary alert on all three records noting 'possible duplicate - verify identity before clinical or billing action'. This preserves access for clinicians while preventing a fourth record being created.
- Verify with the client, not from the file. Contact M. Okafor and confirm two identifiers, such as full name plus date of birth, or address plus mobile. The 1988/1989 difference may be a typo, but it may also be two different people; a shared family mobile number is not proof of identity.
- Protect clinical content. Ask the treating clinician which record holds the current care plan and check that no appointment or note would be orphaned by a merge.
- Get supervisor approval and record it. Nominate a primary record, add cross-references in the others, and log the decision, the identifiers used, the approver and the time.
- Wait for the merge tool unless a clinician needs urgent access; in that case, the clinician can review the flagged records without an irreversible merge.
The reason is risk: an incorrect merge can attach one person's notes, allergies or billing history to another, and deleted records cannot be audited. Same-phone and similar-address evidence is suggestive, not conclusive, and policy requires two identifiers plus approval.
2. How should the duplicates be handled in the report and in your reply to the clinic manager?
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The report should count M. Okafor once, with a footnote such as 'three records under identity reconciliation; client counts and billing figures are provisional and may change after merge.' Explain to the manager in person or by email why the number cannot be presented as final: the report may be used for funding or service planning, and an inflated count or split billing history would misstate activity.
Offer options rather than a flat refusal. You can deliver the report on time with the footnote and a reconciliation note, or deliver it tomorrow after the merge if the deadline can move. If the manager insists on a 'clean' figure today, ask for that instruction in writing and copy your supervisor. Do not silently delete two records to make the number look tidy, and do not merge using the locum's incomplete record as the survivor just because it is newest.
Separate the reporting pressure from the records decision. The 4 pm deadline affects how the number is labelled; it does not change the evidence required to merge client identities. A short, factual explanation of the clinical and billing consequences is usually more persuasive than quoting policy alone.
3. What should you document, and what should you refuse to do?
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Document the discovery (date, time, records A/B/C, matching and conflicting fields), the temporary flags applied, the client contact attempts and identifiers verified, the clinician consulted, the supervisor's approval, the merge or cross-reference performed, and the final report treatment. Keep the manager's request and your response in the file, because a later auditor or privacy officer will want to see who decided what and on what evidence.
Refuse three things: deleting any record that contains clinical notes, merging without two verified identifiers and supervisor approval, and altering the report to hide the reconciliation. Deleting or merging early would breach the audit requirement and could cause clinical harm; changing the report would misrepresent service data.
If the manager continues to pressure you, escalate to the privacy officer or your supervisor rather than arguing indefinitely. Frame it as protecting the centre, not as insubordination. Also check whether the locum's record was created because the client gave a different name or date of birth - that may indicate a registration-process problem worth fixing, not just a one-off duplicate.