NRPM: Standards for Privacy of Individually Identifiable Health Information. i. Importance of Foreign Service determinations and the need for protected health information.


The Secretary of State administers and directs the Foreign Service. As contemplated in the Foreign Service Act, the Foreign Service is “to serve effectively the interests of the United States” and “provide the highest caliber of representation in the conduct of foreign affairs;” members of the Foreign Service are to be available to serve in assignments throughout the world. As called for under the Foreign Service Act, the DOS has established a health care program to promote and maintain the physical and mental health of members of the Service and that of other Government employees serving abroad under chief of mission authority, as well as accompanying family members. The DOS provides health care services to thousands of Foreign Service officers, other government employees and their families serving abroad, many of whom are frequently changing posts or assignments.

Worldwide availability for service is a criterion for entrance into the Foreign Service, so that applicants with conditional offers of employment must undergo medical clearance examinations to establish their physical fitness to serve in the Foreign Service on a worldwide basis prior to entrance into the Foreign Service. Employees and accompanying family members also must be medically cleared before assignments overseas, to preclude assignment to posts where existing medical conditions would be exacerbated or where resources to support an existing medical condition are inadequate.

The DOS uses protected health information gained through its role as a health care provider to fulfill its other responsibilities. The information is used to make medical clearance and fitness decisions as well as other types of determinations requiring medical information (such as fitness for duty or eligibility for disability retirement of Foreign Service members). Such information is also used to determine whether to immediately evacuate an individual for evaluation or treatment, or to determine whether to allow an employee or family member to remain in a position or at post abroad. An individual’s record can include medical information provided to the DOS with the individual’s authorization by outside health care providers, protected health information about treatment provided or paid for by the DOS, and medical information collected from non- treatment processes such as the clearance process.