https://armypubs.army.mil/epubs/DR_pubs/DR_a/ARN31083-ARMY_DIR_2020-13-000-WEB-1.pdf
MEMORANDUM FOR SEE DISTRIBUTION
SUBJECT: Army Directive 2020-13 (Disclosure of Protected Health Information to Unit
Command Officials)
1. References. See enclosure 1.
2. Purpose. Pursuant to Department of Defense Manual (DoDM) 6025.18, this
directive clarifies the circumstances and prescribes the procedures under which a
Soldier’s protected health information (PHI) may be disclosed to the Soldier’s unit
command officials.
3. Background. Military and civilian medical treatment facilities may use and disclose
PHI without a Soldier’s authorization for activities deemed necessary by the Soldier’s
commander, or a unit command official designated by the commander, to ensure the
proper execution of the military mission. This “military command exception” does not
apply to the Family members of military personnel, retirees and their Families, Civilian
employees, or other government officials. Use and disclosure of nonmilitary personnel
PHI must be pursuant to Title 45, Code of Federal Regulations (CFR), Part 164;
DoDM 6025.18; and Army Regulation (AR) 40–66 (Medical Record Administration and
Healthcare Documentation).
4. Policy. The Army supports the chain of command’s need to access Soldier health
information to ensure proper mission execution to the maximum extent possible
consistent with law and regulations. The Surgeon General will coordinate with the
Defense Health Agency to ensure that timely and accurate information is provided to
support decision making for Soldier medical readiness, fitness for duty, or effects on
safety or the mission, pursuant to the disclosure authorizations set forth in enclosure 2
and the procedures for requesting and receiving PHI described in enclosure 3.
a. Authorized recipients of PHI. Any commander who exercises authority over a
Soldier may receive PHI that is necessary to ensure proper execution of the mission. At
the Department of the Army level, the Chief of Staff of the Army, Vice Chief of Staff of
the Army, and Director of the Army Staff are authorized to request and receive PHI
when necessary to ensure the proper execution of the military mission.
b. Command authorities are not authorized unfettered access to a Soldier’s PHI,
nor are they given direct access to a Soldier’s medical records. Federal regulations
(45 CFR 164) and DoD policy (DoDM 6025.18 and DoD Instructions 6490.04 and
6490.08) require medical treatment facilities to take reasonable steps to limit the use or
S E C R E T A R Y O F T H E A R M Y
W A S H I N G T O N
SUBJECT: Army Directive 2020-13 (Disclosure of Protected Health Information to Unit
Command Officials)
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disclosure of PHI to the minimum necessary to accomplish the authorized purpose. The
“minimum necessary” rule applies to all uses and disclosures of PHI except as noted in
DoDM 6025.18, paragraph 4.5.b(2).
c. In the event of a disagreement between a commander and the staff of an
Army-managed medical treatment facility, the commander of the facility (or designee)
will, before making a determination, seek the advice of the facility’s servicing legal
advisor, Health Insurance Portability and Accountability Act (HIPAA) privacy officer, or
both, as appropriate.
d. Pursuant to Army Directives 2016-07 and 2018-11, the Medical Readiness
Commander Portal in the Medical Operational Data System enables commanders to
monitor medical readiness by accessing their Soldiers’ physical profiles and individual
medical readiness information. Commanders may designate other unit command
officials to have access as support staff to monitor the duty limitations and individual
medical readiness for their Soldiers (see enclosure 3).
e. The Privacy Act of 1974, as implemented by AR 40–66, requires commanders
and all personnel in possession of PHI to protect and safeguard it as they would any
other personally identifiable information. Unless otherwise authorized under AR 40–66,
further disclosures of PHI may be made only to DoD employees who need the
information for the performance of official duties.
5. Responsibilities. Leaders at all levels bear responsibility for promoting and
safeguarding the overall health and welfare of their Soldiers. Engaged leadership builds
trust and can enhance Soldiers’ willingness to make leaders aware of issues that affect
their physical and mental well-being. By remaining engaged with Soldiers on their
health, leaders foster a climate of cohesion and improve readiness.
a. The Surgeon General will coordinate with the Defense Health Agency to ensure
that unit commanders receive information about the medical treatment facility points of
contact authorized to disclose PHI on their installations. Pursuant to AR 40–66, unit
surgeon and behavioral health assets, where assigned, available, and appropriate, will
facilitate the communication process.
b. Unit commanders will—
(1) Designate individuals by name (such as executive officers, command
sergeants major, first sergeants, platoon leaders, and platoon sergeants), in writing,
who are authorized to receive PHI from the medical treatment facility for Soldiers under
their authority. Commanders should strongly consider authorizing leaders down to the
SUBJECT: Army Directive 2020-13 (Disclosure of Protected Health Information to Unit
Command Officials)
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platoon level to request and receive PHI for Soldiers under their authority using the
procedures described in enclosure 2.
(2) Establish appropriate administrative, technical, and physical safeguards
to protect PHI in the possession of unit command officials pursuant to Army
Directive 2016-07.
6. Applicability. The provisions of this directive apply to the Regular Army, Army
National Guard/Army National Guard of the United States, and U.S. Army Reserve.
7. Proponent. The Surgeon General is the proponent for this policy and will incorporate
its provisions into AR 40–66 within 2 years of the date of this directive.
8. Duration. This directive is rescinded on publication of the revised regulation.
Encls Ryan D. McCarthy
DISTRIBUTION:
Principal Officials of Headquarters, Department of the Army
Commander
U.S. Army Forces Command
U.S. Army Training and Doctrine Command
U.S. Army Materiel Command
U.S. Army Futures Command
U.S. Army Pacific
U.S. Army Europe
U.S. Army Central
U.S. Army North
U.S. Army South
U.S. Army Africa/Southern European Task Force
U.S. Army Special Operations Command
Military Surface Deployment and Distribution Command
U.S. Army Space and Missile Defense Command/Army Strategic Command
U.S. Army Cyber Command
U.S. Army Medical Command
U.S. Army Intelligence and Security Command
U.S. Army Criminal Investigation Command
U.S. Army Corps of Engineers
(CONT)
SUBJECT: Army Directive 2020-13 (Disclosure of Protected Health Information to Unit
Command Officials)
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DISTRIBUTION: (CONT)
U.S. Army Military District of Washington
U.S. Army Test and Evaluation Command
U.S. Army Human Resources Command
Superintendent, U.S. Military Academy
Director, U.S. Army Acquisition Support Center
Superintendent, Arlington National Cemetery
Commandant, U.S. Army War College
Director, U.S. Army Civilian Human Resources Agency
CF:
Director of Business Transformation
Commander, Eighth Army
Enclosure 1
REFERENCES
a. Privacy Act of 1974; Title 5, United States Code, section 552a
b. The Health Insurance Portability and Accountability Act of 1996, Public
Law 104-191, 110 Stat 2033–2034
c. National Defense Authorization Act for Fiscal Year 2017, Public Law 114-328,
130 Stat. 2193–2245
d. Title 45, Code of Federal Regulations, Part 164 (Security and Privacy)
e. Department of Defense (DoD) Manual 6025.18 (Implementation of the Health
Insurance Portability and Accountability Act (HIPAA) Privacy Rule in DoD Health Care
Programs), 13 March 2019
f. DoD Instruction 6490.04 (Mental Health Evaluations of Members of the Military
Services), 4 March 2013
g. DoD Instruction 6490.08 (Command Notification Requirements to Dispel Stigma in
Providing Mental Health Care to Service Members), 17 August 2011
h. Army Directive 2016-07 (Redesign of Personnel Readiness and Medical
Deployability), 1 March 2016
i. Army Directive 2018-11 (Update to Redesign of Personnel Readiness and Medical
Deployability), 10 September 2018
j. Army Regulation 25–22 (The Army Privacy Program), 22 December 2016
k. Army Regulation 40–66 (Medical Record Administration and Healthcare
Documentation), 17 June 2008, including Rapid Action Revision issued 4 January 2010
Enclosure 2
DISCLOSURE AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH
INFORMATION TO UNIT COMMAND OFFICIALS
1. General purposes. The minimum necessary protected health information (PHI) may
be disclosed to unit command officials exercising authority over the Soldier, without the
Soldier’s authorization, for these purposes:
a. to determine the Soldier’s fitness for duty
b. to determine the Soldier’s fitness to perform any particular mission, assignment,
order, or duty, including compliance with any actions required as a precondition to
performance of such mission, assignment, order, or duty
c. to carry out any other activity necessary to ensure the proper execution of the
mission of the Armed Forces
2. Disclosures authorized or required by regulation. These regulatory and command
management programs do not require a Soldier’s authorization to disclose PHI. Medical
information under these programs will be disclosed pursuant to their governing policy for
these purposes:
a. to coordinate sick call, routine and emergency care, quarters, hospitalization, and
care from civilian providers using DD Form 689 (Individual Sick Slip), pursuant to
AR 40–66 (Medical Record Administration and Health Care Documentation) and
AR 40–400 (Patient Administration)
b. to report results of physical examinations and physical profiles pursuant to
AR 40–501 (Standards of Medical Fitness)
c. to screen and provide periodic updates for individuals in personnel reliability and
special programs, such as those described in AR 190–17 (Biological Select Agents and
Toxins Security Program), AR 50–5 (Nuclear Surety), AR 50–6 (Chemical Surety), and
AR 380–67 (Personnel Security Program)
d. to review and report pursuant to AR 600–9 (The Army Body Composition
Program)
e. to assist investigating officers pursuant to AR 600–8–4 (Line of Duty Policy,
Procedures, and Investigations)
f. to conduct medical evaluation boards and administer physical evaluation board
findings pursuant to AR 635–40 (Disability Evaluation for Retention, Retirement, or
Separation)
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g. to review and report in accordance with AR 600–110 (Identification, Surveillance,
and Administration of Personnel Infected with Human Immunodeficiency Virus)
h. to carry out activities under the authority of DoD Directive 6490.02E
(Comprehensive Health Surveillance) and AR 40–5 (Army Public Health Program) to
safeguard the health of the military community
i. to report on casualties in any military operation or activity pursuant to AR 638–8
(Army Casualty Program) or local installation procedures
j. to medically administer flying restrictions pursuant to AR 40–8 (Temporary Flying
Restrictions Due to Exogenous Factors Affecting Aircrew Efficiency) and AR 40–501
k. to participate in aircraft accident investigations pursuant to AR 4–21 (Medical
Aspects of Army Aircraft Accident Investigation)
l. to respond to queries from accident investigation officers to complete
accident reporting under the Army Safety Program pursuant to AR 385–10 (The Army
Safety Program)
m. to report mental status evaluations pursuant to DoD Instruction 6490.04 (Mental
Health Evaluations of Members of the Military Services) and U.S. Army Medical
Command Regulation 40-38 (Command-Directed Mental Health Evaluations)
n. to report special interest patients pursuant to AR 40–400
o. to report the Soldier’s dental classification pursuant to AR 40–3 (Medical, Dental,
and Veterinary Care)
p. to assist in serious incident reporting pursuant to AR 190–45 (Law Enforcement
Reporting)
q. to carry out the Soldier Readiness Program and mobilization processing
requirements pursuant to AR 600–8–101 (Personnel Readiness Processing) and any
applicable combatant command guidance
r. to provide initial and follow-up reports pursuant to AR 608–18 (The Army Family
Advocacy Program)
s. to determine eligibility for assignment or attachment to a Warrior Transition Unit
pursuant to AR 40–58 (Army Recovery Care Program)
t. to provide medical records to investigating officers or boards of officers pursuant
to AR 15–6 (Procedures for Administrative Investigations and Boards of Officers)
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u. to comply with other regulations carrying out any other activity necessary for the
proper execution of the Army mission.
3. Disclosures related to behavioral health. Pursuant to DoD Instruction 6490.08
(Command Notification Requirements to Dispel Stigma in Providing Mental Health Care
to Service Members), healthcare providers will follow a presumption that they are not to
notify a Soldier’s commander when the Soldier obtains behavioral health (BH) care
unless one of the following criteria are met or the Soldier consents. When one or more
of these criteria are met, healthcare providers will proactively notify the commander or
commander’s designee and provide the minimum necessary information to satisfy the
purpose of the disclosure.
a. Harm to self and/or harm to others. The provider believes the Soldier is at
serious risk of self-harm or harm to others as a result of the condition itself or medical
treatment of the condition. This includes any disclosures concerning child abuse or
domestic violence consistent with DoD Instruction 6400.06 (Domestic Abuse Involving
DoD Military and Certain Affiliated Personnel).
b. Harm to mission. The provider believes the Soldier is at serious risk to harm a
specific military operational mission. Such serious risk may include conditions that
significantly affect impulsivity, insight, reliability, and judgment, and may include
deployment-limiting BH conditions and medications.
c. Special personnel. The Soldier is in the Personnel Reliability Program or in a
position that has been pre-identified by regulation or the command as having mission
responsibilities of such potential sensitivity or urgency that normal notification standards
would significantly risk mission accomplishment.
d. Inpatient care. The Soldier is admitted or discharged from any inpatient BH or
substance abuse treatment facility.
e. Acute medical conditions interfering with duty. The Soldier is experiencing an
acute mental health condition or an acute medical treatment regimen that impairs the
Soldier’s ability to perform assigned duties (For example, the Soldier is on medication
that could impair duty performance.) This may include deployment-limiting BH
conditions and medications.
f. Substance abuse treatment program. The Soldier has entered into or is being
discharged from a formal outpatient or inpatient treatment program pursuant to
AR 600–85 (The Army Substance Abuse Program).
g. Command-directed behavioral health evaluation. The BH services are obtained
as a result of a command-directed BH evaluation consistent with DoD Manual 6025.18.
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h. Other special circumstances. The notification is based on other special
circumstances, where proper execution of the military mission outweighs the interests
served by avoiding notification, as determined on a case-by-case basis by a healthcare
provider (or other authorized official of the military medical treatment facility) at the O-6
or equivalent level or above, or by a commanding officer at the O-6 level or above.
Enclosure 3
PROCEDURES FOR REQUESTING AND RECEIVING PROTECTED HEALTH
INFORMATION
1. Designation of authorized unit command officials:
a. Commanders will provide a copy of their assumption of command orders to the
military medical treatment facility (MTF). Written designation of additional unit command
officials to whom protected health information (PHI) may be disclosed will be provided to
the MTF as appropriate.
b. Commanders will designate, in writing, the unit command officials to whom the
PHI of Soldiers under their authority may be disclosed. Although the number of unit
command officials who can be designated is not limited, commanders should make the
designation based on a determination of each official’s need to know. At a minimum, the
following information must be included in the written request:
(1) grade and name of designated individual
(2) duty position
(3) official phone and email contact information
(4) any limitations the commander places on the individual’s authority, such as—
(a) duration (for example, “This designation expires on 31 December 2019.”)
(b) category of Soldiers for whom PHI may be disclosed (for example, “all
Soldiers assigned to 1st Platoon, C Company”)
(c) categories of PHI that can be disclosed to the designee (for example, “PHI on
Soldier’s physical profile and individual medical readiness information”)
c. Commanders are encouraged to designate a unit command official to obtain
access to the Medical Readiness Portal–Commander Portal as the “commander
designee.” The commander designee is authorized to make deployability determinations
on behalf of the commander. Additionally, commanders may designate an unlimited
number of personnel in the “Unit Command Support Staff” role to access the Medical
Readiness Commander Portal in the Medical Operational Data System (MODS) to
ensure mission readiness.
(1) Unit commanders and their designated command staff must have an active
common access card to access the Commander Portal. All users must complete the
Personnel Readiness Transformation Training (course number DHA-US062) on Joint
Knowledge Online (available at https://jkodirect.jten.mil/) before they can access the
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system. The course completion date transfers to the MODS User Management
application in 1–3 days. Command Portal Access Managers (CPAMs) can then view
and approve user access.
(2) Unit commanders and their designated command staff must register for
access to the Commander Portal at www.mods.army.mil. Users will select the Medical
Readiness Portal application to load their home page. They can select “settings” to load
user management and “help” to access the Commander’s Portal Access Guide for
step-by-step instructions (or find the guide from the help menu). After registration, the
CPAM can approve the user application.
(3) Documentation verifying the user’s role (assumption of command orders for
commanders or commander’s designation memorandum for other users) will be
provided to the CPAM.
2. Communication between the MTF and authorized unit command officials.
a. The Office of the Surgeon General will coordinate with the Defense Health
Agency to ensure that installation unit commanders receive current point of
contact (POC) information for each MTF. Authorized unit command officials will contact
MTF POCs with questions or concerns about the status of a Soldier.
b. Pursuant to AR 40–66, Army-managed MTF providers or other designated
Army-managed staff will proactively inform a commander of a Soldier’s minimum
necessary PHI, such as the following:
(1) information to avert a serious and imminent threat to health or safety of a
person, such as suicide, homicide, or other violent action
(2) medications or conditions that could impair the Soldier’s duty performance
(3) injuries that indicate a safety problem or battlefield trend
(4) information about risks for heat or cold injury
(5) requirement for hospitalization (If the Soldier’s condition is deemed not
urgent, the commander will be notified no later than 24 hours after admission.)
(6) diagnosis of serious or very serious illness
c. The following modes of communication between Army-managed MTF staff and
authorized unit command officials are available:
(1) The Medical Readiness Portal–Commander Portal is the primary mechanism
for communicating PHI on duty limitations and individual medical readiness. The
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Commander Portal synthesizes and displays the data from the Medical Protection
System and other MODS applications into actionable information for the command.
(2) The e-Profile is the Army profiling system of record and will be used to
communicate all temporary and permanent duty limitations. Commanders and providers
can use the secure messaging feature in the Commander Portal to communicate profile
clarifications or concerns.
(3) Army-managed MTF personnel will use DD Form 689 to inform commanders
about the status of a Soldier after sick call. This form is used for a condition limited to
acute, minor, or self-limited illnesses. Soldiers are required to deliver the DD Form 689
to unit command officials. Army-managed providers will include, in block 12 of the form,
their contact information or an alternate POC at the MTF where commanders may direct
questions about the Soldier’s status.
(4) Army-managed BH providers will use DA Form 3822 (Report of Mental
Status Evaluation) to report the findings of a mental status evaluation of a Soldier for
command-directed BH evaluations conducted pursuant to DoD Manual 6025.18 or other
regulations. Army-managed BH providers will transmit the completed DA Form 3822 to
the unit commander via encrypted email and will include the BH provider’s contact
information for commanders to address any concerns about the Soldier’s status.
(5) Army-managed providers will use official memorandums to communicate
the results of a commander’s request for a fitness-for-duty evaluation of a Soldier.
Army-managed providers will transmit the memorandums to the unit commander via
encrypted email and will include the provider’s contact information or an alternate POC
at the MTF for commanders to address any concerns about the Soldier’s status.
(6) The Army-managed MTF will provide weekly rosters to unit command
officials of appointment no-shows, including the name, unit, date, and time of the
missed appointment. The reason for medical appointments or clinical service, however,
cannot be disclosed. The no-show rosters will be transmitted to unit command officials
via encrypted email.
(7) All other requests for Soldier PHI will be submitted using DA Form 4254
(Request for Private Medical Information) and must include the requestor’s ink or digital
signature. Requests submitted electronically will be sent via encrypted email. Requests
by an individual other than a commander must include a copy of the commander’s
authorization or other appropriate documentation verifying the requestor’s authority to
receive PHI.