HIPAA standards have established five one-word conditions reports which are meant to describe a patient's current condition.

Undetermined: Patient is awaiting physician and/or assessment.

Good: Vital signs are stable and within normal limits. Patient is conscious and comfortable. Indicators are excellent.

Fair: Vital signs are stable and within normal limits. Patient is conscious, but may be uncomfortable. Indicators are favorable.

Serious: Vital signs may be unstable and not within normal limits. Patient is acutely ill. Indicators are questionable.

Critical: Vital signs are unstable and not within normal limits. Patient may be unconscious. Indicators are unfavorable.

Clinicians find the "critical, but stable" term useful when discussing cases among themselves because it helps them differentiate patients who are expected to recover from those whose prognosis is worse. But a critical condition means that at least some vital signs are unstable, so this is inherently contradictory. The term "stable" should not be used as a condition. Furthermore, this term should not be used in combination with other conditions, which by definition, often indicate a patient is unstable.

Note: A prognosis will not be given to the media or the public, except by the patient's physician with the patient's consent.

Death: The death of a patient may be reported to the authorities by the hospital, as required by law. Any release of information to the public by the hospital about a death will only be made following the notification of next-of-kin and upon receipt of a request about the specific patient. Information about the cause of death must come from the patient's physician, and a legal representative of the deceased must approve its release.

* Regional Health uses two condition report terms not listed in the South Dakota Code of Cooperation - A Public Relations Handbook for Hospitals, Physicians and Media. Hospitals throughout the state that are members of the South Dakota Association of Healthcare Organizations (SDAHO) use the "Code" and its condition report terms to provide continuity in information provided to news media.

• Discharged: This term will be used when a patient has been listed in the patient directory, has either received medical treatment in the Emergency Department or as an inpatient, and has been released from the facility. This term will also be applied to patients who have been listed in the directory and have been transferred to another facility. Time and date of discharge, the term "transferred" or disclosure of place of transfer, cannot be released due to federal Health Insurance Portability and Accountability Act (HIPAA) regulations.

• Not in the Directory: In accordance with HIPAA regulations, patients at Regional Health facilities are asked if they want to be listed in our patient directory. If the patient wants to be listed in the directory, we can provide reporters with a one-word condition report listed above. If the patient does not want to be listed in the directory, news media will be told the individual is not listed in the patient directory.

Therefore, when reporters are told that an individual is not listed in the facility directory, it could mean that either the patient is not in that facility, or that the patient is in the facility, but has chosen, for privacy reasons, not to be listed in the directory. Members of the Regional Health Public Relations and Marketing Department will not have direct knowledge of whether the patient is actually in the facility or not.

If an individual arrives at one of our health care facilities, and is unconscious, or unable to decide whether he/she would like to be listed in the directory, they will not be listed in the directory unless they have been a patient in the past and have chosen to be listed in the directory. If the individual is accompanied by a legal representative (for example: a parent, guardian, spouse, or someone with a Medical Power of Attorney) that can make the decision for the individual, they will be offered the option of listing the person on the directory. At such time when a patient is conscious, or can make a decision regarding the directory listing, they will be asked their preference.

This means that news media might call at one time/date and be told that an individual is not listed on the directory, but at a later time/date be told a condition report. (Or vice versa.) Patients can choose to be listed in the directory one day and then opt not to be listed the next - it is their choice, or that of their legal representative.

Due to federal regulations, Regional Health Facilities cannot disclose the date/time of hospitalization, discharge, transfer, or death. In the case of a deceased patient, authorization to disclose the death must be first obtained from a personal representative of the deceased.