Solution Manual for Basic Clinical Laboratory Techniques, 6th Edition

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U N I T 1The Clinical LaboratoryUNIT OBJECTIVESAfter studying this unit, the student will:•Discuss the regulation, organization, and function of the clinical laboratory.•Discuss the qualifications, job functions, and ethical responsibilities of clinical laboratorypersonnel.•Identify and define selected abbreviations and acronyms commonly used in the clinicallaboratory.•Identify, define, and use prefixes, suffixes, and stems in selected medical terms.•Discuss and implement laboratory safety rules that must be followed to guard againstbiological, chemical, and physical hazards.•Identify common types of labware and demonstrate their correct uses.•Discuss and demonstrate safe use of general laboratory equipment.•Use the metric system to perform measurements and calculations.•Use laboratory math to prepare simple laboratory reagents.•Discuss the importance and use of quality assessment programs in the clinical laboratory.•Use the compound bright-field microscope.•Perform a capillary puncture.•Perform a venipuncture.UNIT OVERVIEWThe clinical laboratory is a place where blood, body fluids, and other biological specimens aretested, analyzed, or evaluated. The observations can be qualitative or quantitative. The tests can beperformed manually or using automated analyzers. Precise measurements are made and the results

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are calculated and interpreted. Because of this, laboratory workers must have the skills necessary toperform a variety of tasks.Unit 1 is an introduction to the laboratory environment as a workplace and to the professionofclinicallaboratoryscience,alsocalledmedicallaboratoryscience.Keyconceptsandprocedures laboratory professionals need to know to work in the laboratory are described in theintroductory unit.The regulation, organization, and function of the clinical laboratory are addressed in Lesson 1-1.Qualifications and job functions of laboratory personnel are reviewed in Lesson 1-2.As an introduction to the structure of medical terms, Lesson 1-3 gives basic informationabout medical terminology and abbreviations and acronyms used in the laboratory. As other unitsare studied, additional vocabulary terms will be introduced and defined.Two lessons on laboratory safety (Lessons 1-4 and 1-5) are included in Unit 1 becauseworkers must understand and follow all safety procedures and practices before any laboratoryexercises can be performed. Every worker in the clinical laboratory must be thoroughly aware ofpotential hazards in the workplace and must perform tasks in a manner that keeps them,coworkers, and patients safe.The correct and safe use of general laboratory equipment such as centrifuges, pH meters,autoclaves, and laboratory balances is described in Lesson 1-6. Also explained is the care, use,and cleaning of frequently used labware such as beakers, cylinders, test tubes, and flasks.Because laboratory analyses use metric units, a brief introduction to the metric system isgiven in Lesson 1-7. Knowledge of the metric system is required for exercises in other units.Basic laboratory calculations, methods of reagent preparation, and the correct use of pipets areexplained in Lesson 1-8.Principles, methods, and procedures for ensuring the reliability and accuracy of laboratoryanalyses are presented in Lesson 1-9, Quality Assessment. These quality assessment principlesare included in Unit 1 because they must be integrated into all aspects of laboratory operations,fromemployeetrainingandevaluationtospecimencollectionandprocessing,specimenanalysis, and interpretation and reporting of results.The proper care and use of the microscope is included in Unit 1 (Lesson 1-10) becauseknowledge of its use is required for lessons in the microbiology, hematology, urinalysis, andparasitology units. Lessons 1-11 and 1-12 introduce techniques for collecting capillary andvenous blood.Unit 1 is an introduction to the techniques, rules, and skills needed to perform the exercisesin Units 2 through 8. Unit 1 can also be used alone as an introduction to the profession of clinicallaboratory science. After Unit 1 has been completed, the remaining units can be studied in orderof the instructor’s preference depending on available time, laboratory space, and equipment.

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LESSON1-1Introduction to theClinical LaboratoryLESSON OBJECTIVESAfter studying this lesson, the student will:•Explain the function of a medical or clinical laboratory.•Discuss the organization of a typical hospital clinical laboratory.•Describe the functions of the different levels of laboratory personnel.•List the major departments of a typical clinical laboratory and name a test thatwould be performed in each department.•List three examples of nonhospital clinical laboratories and describe the function ofeach.•Explain how clinical laboratories are regulated.•Explain the relationships between Centers for Medicare and Medicaid Services(CMS), Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88), andclinical laboratories.•Discuss benefits of point-of-care (POC) testing.•Explain how the Health Insurance Portability and Accountability Act (HIPAA)affects the laboratory and laboratory workers.•Discuss the use and value of electronic health records (EHRs).•Describe the purpose and scope of quality assessment programs in the clinicallaboratory.•Explain the reason for proficiency testing.•Explain the purpose of laboratory accreditation.•Define the glossary terms.

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4Lesson 1-1●Introduction to the Clinical LaboratoryGLOSSARYaccessioning/ the process by which specimens are logged in, labeled, and assigned a specimenidentification codeaccreditation/ a voluntary process in which an independent agency grants recognition toinstitutions or programs that meet or exceed established standards of qualityAmerican Association of Blood Banks (AABB)/ international association that sets blood bankstandards, accredits blood banks, and promotes high standards of performance in the practiceof transfusion medicineanticoagulant /a chemical or substance that prevents blood coagulationbacteriology /the study of bacteriablood bank/ clinical laboratory department where blood components are tested and stored untilneeded for transfusion; immunohematology department; transfusion services; also therefrigerated unit used for storing blood componentsCenters for Disease Control and Prevention (CDC)/ central laboratory for the national publichealth systemCenters for Medicare and Medicaid Services (CMS)/ the agency within the Department ofHealth and Human Services (DHHS) responsible for implementing CLIA ‘88Clinical and Laboratory Standards Institute (CLSI)/ an international, nonprofit organizationthat establishes guidelines and standards of best current practice for clinical laboratories;formerly National Committee for Clinical Laboratory Standards (NCCLS)clinical chemistry/ the laboratory section that uses chemical principles to analyze blood andother body fluidsClinical Laboratory Improvement Amendments of 1988 (CLIA ’88)/ a federal act thatspecifies minimum performance standards for clinical laboratoriescoagulation /the process of forming a fibrin clotCollege of American Pathologists (CAP)/ organization that offers accreditation to clinicallaboratories and certification to clinical laboratory personnelCOLA /agency that offers accreditation to physician office laboratories, hospitals, clinics andother healthcare facilities; formerly the Commission on Office Laboratory AccreditationDepartment of Health and Human Services (DHHS) /the governmental agency that overseespublic healthcare matters; also called HHSelectronic health record (EHR) /comprehensive, portable electronic patient health recordelectronic medical record (EMR) /a digital form of a patient chart created in a physician’soffice or a hospital where a patient received treatmentepidemiology /the study of the factors that cause disease and determine disease frequency anddistributionFood and Drug Administration (FDA) /the division of the Department of Health and HumanServices (DHHS) responsible for protecting the public health by ensuring the safety andefficacy of foods, drugs, biological products, medical devices, and cosmeticsHealth Care Financing Administration (HCFA) /see Centers for Medicare and MedicaidServices (CMS)

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Lesson 1-1●Introduction to the Clinical Laboratory5hematology /the study of blood and the blood-forming tissuesHIPAA /Health Insurance Portability and Accountability Act of 1996immunohematology /the study of the human blood groups; in the clinical laboratory, oftencalled blood banking or transfusion servicesimmunology /the branch of medicine encompassing the study of immune processes andimmunityJoint Commission (JC) /an independent agency that accredits hospitals and large healthcarefacilities; formerly known as the Joint Commission on Accreditation of HealthcareOrganizations (JCAHO)Laboratory Response Network (LRN)/ a nationwide network of public and privatelaboratories coordinated by Centers for Disease Control and Prevention (CDC) with theability for rapid response to threats to public healthmicrobiology/ the branch of biology dealing with microbesmycology/ the study of fungiNational Committee for Clinical Laboratory Standards (NCCLS)/ see Clinical andLaboratory Standards Institute (CLSI)pathologist/ a physician specially trained in the nature and cause of diseasephlebotomist /a healthcare worker trained in blood collectionphysician office laboratory (POL)/ small medical laboratory located within a physician office,group practice, or clinicplasma/ the liquid portion of blood in which the blood cells are suspended; the straw-coloredliquid remaining after blood cells are removed from anticoagulated bloodpoint-of-care testing (POCT)/ testing outside the traditional laboratory setting; also calledbedside testing, off-site testing, near-patient testing, or alternative-site testingproficiency testing (PT)/ a program in which a laboratory’s accuracy in performing analyses isevaluated at regular intervals and compared to the performance of similar laboratoriesProvider-Performed Microscopy Procedures (PPMP)/ a certificate category under CLIA ’88that permits a laboratory to perform waived tests and also permits specified practitioners toperform on-site microscopy proceduresquality assessment (QA)/ in the laboratory, a program that monitors the total testing processwith the aim of providing the highest-quality patient carereference laboratory /an independent regional laboratory that offers routine and specializedtesting services to hospitals and physiciansserology /the study of antigens and antibodies in serum using immunological methods;laboratory testing based on the immunological properties of serumserum /the liquid obtained from blood that has been allowed to clotstandard operating procedure (SOP) /established procedure to be followed for a givenoperation or in a given situation with the purpose of ensuring that a procedure is alwayscarried out correctly and in the same mannervirology/ the study of viruseswaived test /a category of test defined under CLIA ’88 as being simple to perform and havingan insignificant risk for error

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6Lesson 1-1●Introduction to the Clinical LaboratoryTEACHING AIDS AND RESOURCES•Examples of hospital and laboratory organizational charts•Examples of various laboratory requisition forms•Transparencies or overheads of Figures 1-1 through 1-9•Transparencies or overheads of Tables 1-1 through 1-5•’s Resources CD accompanyingBasic Clinical Laboratory Techniques,6th edition,including computerized test bank and PowerPointLESSON CONTENTI.IntroductionII.Regulation of Clinical LaboratoriesA. CLIA ’88B. Centers for Medicare and Medicaid Services (CMS)III.Types of Clinical LaboratoriesA. Hospital LaboratoriesB. Nonhospital Clinical Laboratories1.Physician office laboratories2.Reference laboratories3.Government laboratories—federala.Centers for Disease Control and Preventionb.Consultationc.Educationd.Epidemiologye.Laboratory Response Network4.Government Laboratories—Statea.Specialty testsb.Confirmation of reportable infectious diseasesc.Environmental testingIV.CLIA Certificate CategoriesA. Certificate of WaiverB. Certificate of RegistrationC. Certificate of ComplianceD. Certificate of Accreditation—Moderate or High-Complexity TestsE.Certificate for Provider-Performed Microscopy Procedures (PPMP)

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Lesson 1-1●Introduction to the Clinical Laboratory7V.Organization of the Hospital LaboratoryA. Clinical Laboratory Personnel1.Laboratory director2.Technical supervisor/laboratory manager3.General supervisor/department head4.Testing personnelB. Departments of the Clinical Laboratory1.Hematologya.Coagulationb.Urinalysis2.Clinical Chemistry3.Immunology4.Blood Bank/Transfusion Services5.Microbiologya.Bacteriologyb.Virologyc.Mycologyd.Parasitology6.Laboratory Support Servicesa.Specimen collectionb.Accessioningc.Specimen sorting and processing7.Laboratory information systems8.Point-of-care testing (POCT)VI.Electronic Health RecordsA. Electronic Health Records vs. Electronic Medical RecordsB. BenefitsC. ConcernsVII. Quality Assessment in the LaboratoryA. Proficiency TestingB. AccreditationVIII. Privacy IssuesA. HIPAAB. ComputersC. ConfidentialityIX.Critical Thinking ProblemX.Summary

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8Lesson 1-1●Introduction to the Clinical LaboratoryCritical Thinking Problem and AnswerTimothy is a medical assistant working in a small POL. His laboratory operates under acertificate of waiver. The physician requests a microscopic examination of urine for patient MarySmith. During Timothy’s medical assistant training, he learned to perform microscopicexamination of urine, classified by CLIA as a moderate complexity test.1.What is the appropriate action for Timothy to take?a.Tell the physician that it is not possible to have the test performed.b.Send the specimen to a laboratory approved for performing moderate- to high-complexity testing.c.Perform the test and report the results to the physician.2.Explain your answer.Even though Timothy has been trained to perform the requested test, which is ofmoderate complexity, the laboratory where he is employed only has permission toperform waived tests. Laboratories with certificates of waiver use reference laboratoriesto perform tests that are beyond their permitted level.STUDENT ACTIVITIES1.Complete the written examination for this lesson.2.Interview an employee of a clinical laboratory and report on your interview. Inquire aboutthe laboratory’s organization, the types of tests performed, how specimens are received, andhow results are recorded and delivered to physicians. Obtain various laboratory test reportforms and note the types of tests performed in each department.3.Tour a hospital laboratory or reference laboratory in your area.4.Visit a POL and find out the types of tests performed there.Web Activities1.Select five analytes from Table 1-2. Find information about the analytes from the CMS orFDA web site. List two brands of test kits that qualify as waived for each of the five analytes.2.Find web sites of three clinical laboratories. Note the types of information provided on eachweb site. Look for organizational charts for the laboratories and compare them with what youhave learned in this lesson about how laboratories are organized.REVIEW QUESTIONS AND ANSWERS1.What is the function of a clinical laboratory?Clinical laboratories perform chemical and microscopic tests on body fluids andtissues to aid in diagnosis of diseases.2.Draw an organizational chart of a typical hospital laboratory.See Figure 1-2 in the textbook.

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Lesson 1-1●Introduction to the Clinical Laboratory93.Name five major departments found in a hospital laboratory.Any 5 of the following are acceptable:a.Chemistryb.Microbiologyc.Hematologyd.Blood banke.Immunologyf.Laboratory support services (Specimen collection and processing)g.Laboratory information systems4.Name two procedures performed in the hematology department.Any twoof the following are acceptable:a.Blood cell countsb.Hemoglobin determinationsc.Hematocritd.Examinations of blood smearse.Coagulation tests5.Name two tests performed in the chemistry department.Any two of the following are acceptable:a.Glucoseb.Electrolytesc.Cholesterold.Enzymese.Drug levelsf.Hormone levels6.How does the HIPAA affect workers in the laboratory?Much communication in laboratories is facilitated by computers. Patient informationstored in computers must be password-protected so that only authorized personnelcan access information. Computer monitors must be positioned so that visitors, otherpatients, and other nonauthorized personnel cannot view the screen. All patientinformation must remain private and confidential and must be shared only withauthorized persons to facilitate and improve patient care.7.Name three benefits of electronic health records.Any three of the following are acceptable:a.Better coordination of patient careb.Improved follow-up after hospitalizationc.Maintain comprehensive information about patient’s health in one filed.Provide a secure way to share patient informatione.Motivate patient to comply with recommendations

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10Lesson 1-1●Introduction to the Clinical Laboratory8.List three locations of clinical laboratory facilities other than in hospitals.Any three of the following are acceptable:a.Physician officesb.State and federal government facilities (public health)c.Universitiesd.Research institutions or facilitiese.Reference laboratories9.Explain the job functions of the laboratory director, technical supervisor, and departmenthead or general supervisor.The laboratory director has ultimate responsibility for all laboratory operations; thedirector may be a pathologist, a qualified M.D., or a doctoral scientist. The technicalsupervisor handles the day-to-day operation of the laboratory, sets personnelstandards, and supervises employee performance. The department head is responsiblefor work within a specific department and for training and evaluating employeeperformance.10.Who is responsible for creating the laboratory’s SOP manual?The technical supervisor (or laboratory manager) is responsible for the informationand keeping the manual up-to-date.11.What is contained in the SOP manual?It contains the up-to-date instructions for all procedures performed in the laboratory.12.What is the purpose of CLIA ’88?CLIA ’88 specifies minimum standards for all clinical laboratories. The objective ofCLIA ’88 is to ensure quality laboratory testing.13.What federal agency is responsible for implementing CLIA ’88?CMS (formerly known as HCFA) is responsible for implementing CLIA ’88.14.What are waived tests?Waived tests are those that are determined by CDC or FDA to be so simple that thereis insignificant risk for error.15.List the five certificates issued under CLIA ’88, and state the activities each certificatepermits.a.Certificate of Waiver—permits a laboratory to perform CLIA-waived tests onlyb.Registration Certificate—permits the laboratory to (temporarily) conductmoderate- or high-complexity laboratory testing (or both) until the laboratory isdetermined by survey to be in compliance with CLIA regulationsc.Certificate of Compliance—issued to a laboratory holding a Certificate ofRegistration after an inspection finds the laboratory to be in compliance with allapplicable CLIA regulations

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Lesson 1-1●Introduction to the Clinical Laboratory11d.Certificate of Accreditation—issued to a laboratory that has been accredited by aCMS-approved accrediting organizatione.Certificate for PPMP—permits the laboratory to perform waived tests and allowsa physician, midlevel practitioner, or dentist to perform microscopy proceduresbut no other tests of complexity.16.What is the advantage of proficiency testing?Proficiency testing programs evaluate a laboratory’s performance for accuracy andcompare it to that of other laboratories. This allows the laboratory to have confidencein testing methods and to identify deficient areas.17.How do laboratories become accredited?A facility desiring accreditation invites the accrediting agency to inspect its facility andevaluate its performance to determine if established standards are being met.18.Define accessioning, accreditation, American Association of Blood Banks (AABB),anticoagulant, bacteriology, blood bank, Centers for Disease Control and Prevention (CDC),Centers for Medicare and Medicaid Services (CMS), Clinical and Laboratory StandardsInstitute (CLSI), clinical chemistry, Clinical Laboratory Improvement Amendments of 1988(CLIA ’88), coagulation, College of American Pathologists (CAP), COLA, Department ofHealth and Human Services (DHHS), electronic health record (HER), electronic medicalrecord (EMR), epidemiology, Food and Drug Administration (FDA), Health Care FinancingAdministration (HCFA), hematology, HIPAA, immunohematology, immunology, JointCommission (JC), Laboratory Response Network (LRN), microbiology, mycology,National Committee for Clinical Laboratory Standards (NCCLS), parasitology, pathologist,phlebotomist, physician office laboratory (POL), plasma, point-of-care testing (POCT),proficiency testing, Provider-Performed Microscopy Procedure (PPMP), quality assessment,reference laboratory, serology, serum, standard operating procedure (SOP), virology, andwaived test.See Glossary.

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LESSON1-2The Clinical LaboratoryProfessionalLESSON OBJECTIVESAfter studying this lesson, the student will:•Give a brief history of medical technology.•List five personal qualities that are desirable in a clinical laboratory professional.•Describe the educational requirements for medical laboratory scientists andtechnicians.•Explain the functions of accrediting agencies and credentialing agencies.•Discuss the relationship between the laboratory professional and the patient.•Explain the laboratory professional’s responsibility in relation to patient privacy.•Explain the purpose and benefits of professional societies.•Discuss the importance of ethical conduct by laboratory professionals.•Name five areas of employment for clinical laboratory professionals other than inhospital laboratories.•Define the glossary terms.GLOSSARYAmerican Association of Medical Assistants (AAMA)/ professional society and credentialingagency for medical assistantsAmerican Medical Technologists (AMT)/ professional society and credentialing agency forseveral categories of medical laboratory personnelAmerican Society for Clinical Laboratory Science (ASCLS)/ professional society formedical/clinical laboratory personnelAmerican Society for Clinical Pathology (ASCP)/ professional society for medical/clinicallaboratory personnel and allied health personnelAmerican Society of Phlebotomy Technicians (ASPT)/ professional society and credentialingagency for phlebotomists, as well as credentialing agency for specialty areas such as point-of-care technician

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Lesson 1-2●The Clinical Laboratory Professional13ASCP Board of Certification (ASCP BOC) /a separate body within the ASCP organizationalstructure, formed in 2009 by merging NCA with the ASCP BOR and providing certificationfor medical laboratory personnelclinical laboratory science/ the health profession concerned with performing laboratoryanalyses used in diagnosing and treating disease, as well as in maintaining good health;synonymous with medical laboratory science and medical (laboratory) technologyclinical laboratory scientist (CLS)/ the NCA term for a professional who has a baccalaureatedegree from an accredited college or university, has completed clinical training in anaccredited clinical/medical laboratory science program, and has passed a national certifyingexamination; also called medical laboratory scientist (MLS) or medical technologist (MT)clinical laboratory technician (CLT)/ the NCA term for a professional who has completed aminimum of 2 years of specific training in an accredited clinical/medical laboratorytechnician program and has passed a national certifying examination; also called medicallaboratory technician (MLT)Commission on Accreditation of Allied Health Education Programs (CAAHEP)/ agencythat accredits educational programs for allied health personnel; formerly CAHEAethics/ a system of conduct or behavior; rules of professional conductHealth Insurance Portability and Accountability Act (HIPAA)/ 1996 Act of Congress, a partof which guarantees protection of privacy of an individual’s health informationmedical laboratory science /the health profession concerned with performing laboratoryanalyses used in diagnosing and treating disease, as well as in maintaining good health;synonymous with clinical laboratory science and medical (laboratory) technologymedical laboratory scientist (MLS)/ a professional who has a baccalaureate degree from anaccredited college or university, has completed clinical training in an accredited medicallaboratory science program, and has passed a national certifying examination; synonymouswith medical technologist (MT) or NCA certified clinical laboratory scientist (CLS)medical laboratory technician (MLT)/ a professional who has completed a minimum of2 years of specific training in an accredited medical laboratory technician program and haspassed a national certifying examination; synonymous with NCA certified clinicallaboratory technician (CLT)medical technologist (MT) /a term gradually being replaced but referring to the professions ofmedical laboratory scientist (MLS) or clinical laboratory scientist (CLS)medical technology/ synonymous for clinical laboratory science and medical laboratory scienceNational Accrediting Agency for Clinical Laboratory Sciences (NAACLS)/ agency thataccredits educational programs for clinical laboratory personnelNational Credentialing Agency for Laboratory Personnel (NCA)/ a credentialing agency forclinical laboratory personnel that merged with the ASCP Board of Registry (BOR) in 2009to form the ASCP Board of Certification (BOC)National Phlebotomy Association (NPA)/ professional society and credentialing agency forphlebotomists

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14Lesson 1-2●The Clinical Laboratory ProfessionalTEACHING AIDS AND RESOURCES•Career Information Fact Sheet and Interview Fact Sheet•Clinical/Medical Laboratory Science journals•Information about medical laboratory professions from professional societies•Information about educational programs in clinical/medical laboratory science•Guest speaker: laboratory professional from a local hospital or other laboratory•Transparencies or overheads of Figures 1-10 and 1-11•Transparencies or overheads of Tables 1-6 through 1-9•’s Resources CD accompanyingBasic Clinical Laboratory Techniques,6th edition, including computerized test bank and PowerPointLESSON CONTENTI.IntroductionA. Medical TechnologyB. Medical Laboratory ScienceC. Clinical Laboratory ScienceII.History of Medical TechnologyA. Early Medical Laboratories1.Late nineteenth century2.PrimitiveB. Modern Medical Laboratories1.Growth in laboratories after World War I2.Need for formal education and identification of trained personnel3.Rapid changes in technology after World War IIC. The Clinical Laboratory in the Twenty-First Century1.Emphases on wellness, geriatrics, home health care, and hospice2.State-of-art technology3.Rapid, portable testing4.ASCP Board of Certification (BOC)—change in certification categoriesIII.Role of the Laboratory ProfessionalIV.Certification Requirements for Laboratory PersonnelA. Educational Programs and Accrediting AgenciesB. Educational Requirements1.Medical Laboratory Scientist2.Medical Laboratory TechnicianC. Areas of specialization

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Lesson 1-2●The Clinical Laboratory Professional15D. Credentialing and certificationE.Licensing of Laboratory ProfessionalsV.Other Allied Health Personnel in the Clinical LaboratoryA. Phlebotomist / Phlebotomy TechnicianB. Certified Medical Assistant / Registered Medical AssistantC. Physician Office Laboratory TechnicianD. Clinical Laboratory AssistantE.Diagnostic Molecular ScientistF.Point-of-Care TechnicianG. Other Personnel Performing Testing1.Paramedics2.Nursing staffVI.Ethics and ProfessionalismA. Ethics and the Clinical Laboratory Professional1.Maintain high standards of practice2.Duty to patients, profession, colleagues, and society3.Maintain honesty, integrity, and reliability4.Maintain respect for patients, the profession, and other healthcare professionsB. Qualities Desirable in Laboratory ProfessionalsC. Patient Privacy/ConfidentialityD. Interactions Between Laboratory Personnel and PatientsE.Professional OrganizationsF.Employment OpportunitiesVII. Case StudyVIII.SummaryCase Study and AnswerRob works in the laboratory at Bay Regional Hospital. Each work day before he begins his dutiesin the laboratory, he helps collect blood from hospital patients. On one occasion, the patient onhis collection list was his friend Louis, who had been admitted to the hospital through theemergency department the night before. Rob collected blood from Louis for several laboratorytests and chatted with him briefly before returning to the laboratory.After Rob got home that evening, he received a call from Susan asking for information abouttheir mutual acquaintance Louis, who she heard was in the hospital. Susan said she had called thehospital but they would not release information about Louis and would not even confirm that hewas a patient in the hospital. Susan asked Rob if he knew if Louis was hospitalized and if so, why.1.How should Rob respond to Susan?Even though Rob, Louis, and Susan are mutual friends, Rob should not reveal medicalinformation about Louis, because the hospital was not releasing information.

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