一位19歲女性大學生因骨盆腔發炎入院。她的父親走到護理站要求得知她的診斷，並說：「我替她付健保費和學費。馬上告訴我她到底怎麼了，否則我拒絕支付這筆住院費用！」病患並未簽署授權家屬查詢資訊的同意書。護理師最恰當的回應為何？
A 19-year-old female college student is admitted for pelvic inflammatory disease. Her father approaches the nurses' station demanding to know her diagnosis, stating, "I pay her health insurance and tuition. Tell me what is wrong with her right now, or I am refusing to pay this hospital bill!" The patient has not signed an authorization to release information to her parents. What is the most appropriate response by the nurse?
- A“I will write down the provider's phone number so you can discuss the billing and diagnosis with them directly.”我會寫下醫師的聯絡電話，以便您直接與他們討論帳單和診斷問題。
- B“Because you are the primary policyholder for her insurance, I can explain the general treatment plan.”因為您是其保險的主要持有人，我可以解釋一般治療計劃。
- C“I cannot confirm or deny whether she is a patient here, nor can I share medical information without her explicit consent.”✓ 正解在未經其明確同意的情況下，我無法確認或否認她是否為本院病人，也無法分享醫療資訊。
- D“I understand your frustration, but she has pelvic inflammatory disease and needs your support.”我理解您的挫折感，但她患有骨盆發炎，需要您的支持。
本題測驗病患隱私權與 HIPAA（健康保險流通與責任法案）規範。HIPAA 嚴格規定，一旦病患達到法定成年年齡（多數州為 18 歲），其所有的醫療資訊（包括是否在院、診斷、治療計畫等）完全專屬於病患本人。任何家屬（包括父母、配偶及保險支付者）若未獲得病患本人的明文授權，皆無權獲取這些資訊。選項D直接洩漏了診斷，嚴重違法；選項B錯誤地認為保險支付者擁有知情權，支付醫療費用並不代表購買了隱私權；選項A將父母轉介給醫師，並未解決隱私保護的問題，且醫師同樣受 HIPAA 規範不得透露。正確作法是選項C：堅定地回絕，甚至不證實其住院事實，以最高層級保護成年病患的隱私。
Under HIPAA, patients aged 18 and older have strict privacy rights regarding their medical information, including diagnosis and even their presence in the facility. Insurance payment or family status does not grant parents access to these records without the patient's explicit consent. Therefore, the nurse must refuse to confirm the patient's identity or share any details to comply with federal regulations.
台灣與美國在成年人隱私權概念相似。但台灣臨床文化重視「家屬知情」，實務上醫師或護理師常私下告知繳費家屬病情；而美國對於 HIPAA 的執行極為嚴厲，若護理師在無同意書下透露19歲病患的性病隱私，將面臨高額聯邦罰款甚至吊銷執照。