In what situation must a covered entity disclose PHI to an individual?

A covered entity is required to disclose protected health information (PHI) to an individual when that individual requests access to their own health information. This requirement is rooted in the Health Insurance Portability and Accountability Act (HIPAA), which grants individuals specific rights regarding their health information, including the right to access, inspect, and obtain a copy of their medical records.

Under HIPAA regulations, individuals can review their own health records and obtain copies for personal use, ensuring they are informed about their medical history and can participate actively in their healthcare decisions. This right to access is fundamental to patient autonomy and supports transparency in the healthcare system.

The other situations provided do not fall under the mandatory disclosure requirements to the individual. For example, disclosures to another healthcare provider or an insurance company typically require a different basis, such as treatment, payment, or operations, and are not automatically required by the individual's request. Similarly, conducting a health audit might involve reviewing records, but it does not entitle individuals to access their own information in that context unless they specifically request it. Therefore, the requirement to disclose PHI directly to an individual is specifically tied to their own request for their health information.