A nurse presents this situation to an ethicist:
I am a nurse-midwife. Some of my pregnant clients are illegal immigrants from Mexico who are treated under a federally financed migrant-workers' health-care program using their real names. They are sometimes employed under an alias. When they miss work for appointments or their deliveries, I'm asked to write excuses using those aliases. I would ordinarily write such an excuse, but must I refuse unless I can use a real name?
Jun 21, '09
As Central intake Manager for a homecare agency entering 24,000 patients and 6,000 doctors/year I run across this issue frequently.
Patients will often use one name (when divorcing spouse, newly married/remarried, common law relationship, religious name) and yet have a different name under insurance provider.
How our organization handles it is list name per insurance program paying for care. Other name is listed in parenthesis.
Referral comes in: Luke Skywalker. Insurance listed as Lucas Skywalker-Brown.
Computer entry Last Name: Skywalker Brown (Skywalker) First Name: Lucas (Luke)
Referral name: Smith, Lucy. Computer has existing patient with same DOB SS#, and insurance listed as Grushiem, Lucy. Check of insurance policy shows name is: Smith, Lucy
Computer entry changed to Last Name: Smith (Grushiem); First Name: Lucy
Doctor listed as Grace Ali MD. State Board of medicine website lists: Gracia Fernandez el Ali
Compute entry: Last name: Fernandez el Ali (Ali), First Name: Gracia (Grace).
When DOB is different between insurance payers: initially covered under Medical assistance or insurance with 11/04/1939 and later Medicare shows 11/05/1929 --date on birth/baptismal certificate we place notation in insurance section and change DOB listing to reflect info new payer has ---also inform patient in case honest mistake made in transcribing handwriting at insurance company.
Other organizations choose to use AKA.
We also fill out "Change of Information" form to document that we've changed name in system and accounts for difference in prior documents/billing, including insurance verification printout.
This way covers all bases. We also fill out "Change of Information" form to document that we've changed name in system and accounts for difference in prior documents/billing, including insurance verification printout.
This simple method could work for both situations.
Leaving name off a form, is leaving practitioner open to being abused and photocopied for other users unless patient specific identifier like episode number included on form.
Pactice name + providers listed
Pracrice address = Phone#.
Name: _________________________________ EP: 076245
The above named patient has been under my care. They may return to work /school effective abc date.
Suzy Nurse CRNP
Last edit by NRSKarenRN on Jun 21, '09