Patient Rights, Confidentiality, and Mandatory Reporting
This domain tests how client rights interact with legal duties. The exam often presents a conflict between privacy and protection, and the correct answer usually follows the specific reporting statute rather than general caution.
Patient rights
- Clients have rights to privacy, dignity, informed consent, access to their records as permitted by law, and refusal of treatment.
- Care should be delivered without discrimination and with respect for cultural, language, and decision-making needs.
- Clients should understand the plan, fees, and alternatives before consenting.
Confidentiality
- Protected health information may be shared for treatment, payment, and operations, or with valid authorization, subject to HIPAA and Nevada law.
- Disclose only the minimum necessary information.
- Do not discuss clients in hallways, elevators, or social media.
Mandatory reporting
- Nevada requires reporting suspected child abuse or neglect under the child-protection statutes, and suspected abuse, neglect, or exploitation of older or vulnerable adults under NRS 200.5091 and related provisions.
- Reporting duties are personal and may not be delegated to a supervisor or an agency.
- HIPAA does not prevent a report that is required by state law.
Worked example
An OT notices unexplained bruising and fearfulness in an older adult living with a relative. The OT documents the findings but decides to "watch" for another week before reporting.
Reasoning: Suspicion triggers the reporting duty; the OT need not investigate or confirm abuse. Waiting risks further harm. The therapist should report to the appropriate agency, document the report, and continue providing care within scope.
Traps that cost marks
- Investigating before reporting.
- Assuming HIPAA blocks a mandated report.
- Delegating the report to a colleague.
- Sharing details with people who do not need to know.