HIPAA (45 CFR Part 164) 164.510(b)(2) — Uses and disclosures with the individual present

What this control requires

Standard: Uses and disclosures for involvement in the individual's care and notification purposes (2) Uses and disclosures with the individual present. If the individual is present for, or otherwise available prior to, a use or disclosure permitted by paragraph (b)(1) of this section and has the capacity to make health care decisions, the covered entity may use or disclose the protected health information if it: (i) Obtains the individual's agreement; (ii) Provides the individual with the opportunity to object to the disclosure, and the individual does not express an objection; or (iii) Reasonably infers from the circumstances, based on the exercise of professional judgment, that the individual does not object to the disclosure.

In plain English

Standard: Uses and disclosures for involvement in the individual's care and notification purposes (2) Uses and disclosures with the individual present. In practice, this means you can prove you information management-level controls on a defined cadence.

Why it matters

HIPAA non-compliance is a strict-liability matter: OCR civil monetary penalties are assessed per-record per-violation (up to USD 1.9 million per identical-violation calendar year as of 2024), and willful neglect can trigger criminal referral.

What an auditor looks for

HHS OCR investigators and SOC-2+HIPAA auditors look for the specific 45 CFR § citation, whether the safeguard is required vs addressable (and if addressable, the documented decision), the implementation specification, the workforce member responsible, and the records that show it runs.

Within Privacy Rule, the assessor will trace your implementation back to the catalogue reference (§ 164.510(b)(2)) and look for objective evidence on the latest two assessment cycles.

How to implement

Policy Management

Docs. Keep each policy in version-controlled Markdown alongside the code that implements it; ship a signed PDF snapshot at each annual review and link the SHA into the SoA.

Operational checklist

• Information. Document the trigger, the owner and the cadence.
• Policy. Document the trigger, the owner and the cadence.
• Notification. Document the trigger, the owner and the cadence.
• Uses. Document the trigger, the owner and the cadence.
• Disclosures. Document the trigger, the owner and the cadence.
• Scope: management, notification, policy, i, section, uses, b, ii.

Evidence to collect

• Policy Document. A signed and version-controlled policy / standard / procedure document.

Signed policy or standard documents the safeguard. Focus: Uses and disclosures with the individual present.

Common pitfalls

• Policies that no engineer has read; the version in Confluence drifts from the version that's actually being enforced.

How it maps to other frameworks

Computed from shared tags, control component and key-operation subjects — handy when you are reconciling controls across an audit.

• NIST SP 800-53 Rev. 5 CM-3(1) — Automated Documentation, Notification, And Prohibition Of Changes
• BSI C5:2020 SP-01 — Documentation, communication and provision of policies and instructions
• ISO/IEC 27001:2022 A.5.5 — Contact with authorities
• SOC 2 (2017 TSC) CC2.3 — External Communication on Internal Control Matters

Related controls in HIPAA (45 CFR Part 164)

• § 164.510(a)(3) — Uses and Disclosures for Facility Directories in Emergency Circumstances
• § 164.510(b)(3) — Limited uses and disclosures when the individual is not present
• § 164.510(b)(4) — Uses and disclosures for disaster relief purposes
• § 164.512(a) — Uses and disclosures required by law
• § 164.508(b)(4) — Prohibition on conditioning of authorizations
• § 164.512(k)(4) — Uses and disclosures for specialized government functions - Medical Suitability Determinations

References

• U.S. HHS Office for Civil Rights — HIPAA (45 CFR Part 164)
• Catalogue identifier: § 164.510(b)(2)

Topics: governance riskpolicy management