Sierra Pacific Network (VISN 21)

Report ID: PSETS0000086314, U.S. Department of Veterans Affairs

Reported Entity: VISN 21 San Francisco, CA

Issue:

While attending therapy, a Veteran completed a "PCL-M" checklist. Per the psychology intern who reported the incident, it is a checklist used to identify problems and complaints that Veterans sometimes have in response to stressful military experience. The checklist does not contain a field for Veterans to annotate their identifying information, however a patient annotate his full last name, first initial of his first name and last four of SSN on a checklist that was subsequently found by another Veteran who gave it to the patient's twin brother, who has the same last name and first initial and is also a SFVAMC patient. The psychology intern explained she collected all of the checklists at the conclusion of the group visit, and that it must have fallen out of her folder. During a subsequent meeting with a post doctorate psychologist she discovered the checklist was missing from her folder. She searched but did not locate the checklist. Update: 03/04/13:No data breach has occurred. There was Personally Identifiable Information (PII) involved, but not the required criteria for credit protection services or HIPAA notification.

Outcome:

1. The psychology intern received retraining (TMS VA Privacy and Information Security and Rules of Behavior) on 2/14/132. In the future, she will scan the group visit room to ensure all documents have been retrieved. 3. HIPAA notification letter mailed

Related Reports:

4 other violations reported on the same date. Note that other citations may be about the same event: PSETS0000086316, PSETS0000086317, PSETS0000086318, PSETS0000086319