Patient Rights, Informed Consent, Confidentiality, and Mandatory Reporting
Patient-rights questions combine informed consent, confidentiality, and mandatory reporting. Oregon expects OTs to protect client autonomy while complying with legal reporting duties that override ordinary confidentiality.
Informed consent and rights
Before evaluation or treatment, the OT explains the purpose, expected benefits, material risks, alternatives, and the right to refuse or withdraw. Consent may be verbal or written depending on setting and risk; document what was discussed. Clients have rights to dignity, privacy, participation in planning, access to records, and freedom from abuse or retaliation.
Confidentiality
Confidential information may be shared only with authorization, for treatment/payment/operations as permitted, or as required by law. Use minimum necessary disclosure and secure communication. HIPAA sets a floor, not a ceiling; Oregon law and Board rules may add protections. Discussing a client in a public area or on social media can be a confidentiality breach and unprofessional conduct.
Mandatory reporting
Oregon requires health care professionals to report suspected child abuse and abuse of elders or adults with developmental disabilities. The duty is personal and arises from reasonable suspicion, not proof. Report promptly to the designated Oregon authority; do not investigate. Good-faith reports are protected. Confidentiality does not block a legally required report, and a client's request not to report does not override the duty.
Worked example
A client discloses that a caregiver hits her and begs the OT not to tell anyone. The OT explains the limits of confidentiality and reports the suspected abuse to the appropriate agency. The OT documents the disclosure, the report, and the safety plan, but does not promise secrecy.
Traps
Do not assume HIPAA prevents an abuse report. Do not treat one consent as covering every future service. Do not ignore a report because another provider says they will handle it; the duty is individual.