This statement serves to inform you of the purpose for collecting personal information required by the Centralized Credentials Quality Assurance System (CCQAS) and how it will be used.
AUTHORITY: 10 U.S.C. 1102, Confidentiality of medical quality assurance records: qualified immunity for participants; 42 U.S.C. Chapter 117, Encouraging good faith professional review activities; DoD Instruction 6025.13, Medical Quality Assurance (MQA) and Clinical Quality Management in the Military Health System (MHS); DoD Regulation 6025.13-R, Military Health System (MHS) Clinical Quality Assurance (CQA) Program Regulation; and E.O. 9397 (SSN), as amended.
PURPOSE: To obtain information necessary to credential a health care provider and determine whether that individual should have privileges to work, or continue working, in a military treatment facility (MTF) or otherwise within the Military Health System (MHS), including information on malpractice claims and adverse privilege actions. Information is also collected to report malpractice claims or adverse privilege actions filed against a health care provider in connection with a service performed at an MTF or within the MHS.
ROUTINE USES: Information collected may be used and disclosed generally as permitted under 45 CFR Parts 160 and 164, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, as implemented by DoD 6025.18-R, the DoD Health Information Privacy Regulation. Information may be used and disclosed in accordance with 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended, which incorporates the DoD "Blanket Routine Uses" published at: http://dpcld.defense.gov/privacy/sornsindex/blanketroutineuses.aspx. Collected information may be shared with government boards, agencies, professional societies, or organizations if needed to license or monitor professional standards of health care practitioners. It may be released to civilian medical institutions or organizations where the practitioner is applying for staff privileges, or already privileged, regardless of whether the practitioner is still privileged at an MTF. Information may also be used to conduct trend analysis for medical quality assurance programs.
DISCLOSURE: Voluntary. However, failure to provide information may result in an individual’s ineligibility to serve at an MTF or within the MHS.

CCQAS includes Sensitive but Unclassified (SBU) information that is subject to the Privacy Act of 1974, as amended. Consequently, copying, printing, or distributing data from CCQAS to support administrative functions is authorized by, and subject to the limitations of, DoD Regulation 5400.11-R, Department of Defense Privacy Program. Certain information contained within CCQAS is accessible under the Freedom of Information Act. The use and disclosure of some information in CCQAS is protected from legal discovery under 10 U.S.C. 1102. No other distribution is permitted without the express written permission of the Tricare Management Activity Functional Proponent or Service CCQAS Representatives, who will coordinate with appropriate legal counsel prior to rendering an opinion regarding release of information.

This system contains protected health information as defined in the Health Information Portability and Accountability Act of 1996 (HIPAA) and the HIPAA Privacy Rule (45 CFR Parts 160 and 164). DoD’s implementation of the HIPAA Privacy Rule is in DoD 6025.18-R, DoD Health Information Privacy Regulation. The HIPAA Privacy Rule and DoD 6025.18-R apply to protected health information and may place additional procedural requirements on uses and disclosures of such information beyond those found in the Privacy Act or mentioned elsewhere in this notice. This information may only be used and/or disclosed in strict conformance with that authority. The MHS is required to, and will, appropriately sanction individuals who fail to comply with its privacy policies and procedures.