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Traditionally, employees had little expectation of privacy in their occupational medical information. While the Code of Ethics for occupational medicine practitioners requires that employee medical information be kept confidential, this could be waived by the employee and thus provided only limited protection. OSHA regulations and the Americans with Disabilities Act of 1990 (ADA) have greatly limited the employer's access to an employee's medical information. The ADA will have a great impact on occupational medicine practice because, among other provisions, it greatly restricts preemployment fitness evaluations. Employers continue to have access to data concerning workplace injuries and illnesses and other data that must be collected to comply with governmental regulations. They also retain the right to information about the use of alcohol and illegal drugs. Except as it is related to the workplace, the employer does not have a right to the employee's general medical and personal information. Occupational medicine physicians are also required to report work-related conditions or exposures to OSHA and the state health department.

Since OSHA rules require that the entire employee occupational medical record be disclosed in several situations, it is important that nonworkplace information be maintained separate from workplace information when possible. Physicians who treat patients for both general medical conditions and occupational health problems often keep the work-related information in the same chart as the patient's other medical information. If the physician has treated the patient for non-work-related problems such as marital conflict or pregnancy termination and that information is in the same file as workplace information, it may be available to OSHA and other entities that are authorized to have access to the employee's occupational medical information.

If the employee files a claim for worker's compensation, the worker's compensation insurer or state agency will be entitled to the information necessary to evaluate the claim. In general, when employees file a worker's compensation claim, they waive their rights to confidentiality for any medical information involved in the claim. The physician may also be required to file special reports or give testimony as the agency investigates the worker's claim. This waiver of confidentiality does not include information that is protected by federal laws protecting substance abuse and psychiatric information. Physicians handling worker's compensation should investigate their state's rules on filing and investigating such claims so that they may help their patients obtain appropriate compensation. Physicians who do not want to participate in filing worker's compensation claims should inform their patients before treating them for work-related conditions.

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