X informed consent and non‑consent or refusal of a recommended examination or treatment, X any records of signs of violence, X any circumstances when medical confdentiality or the patient’s consent has been breached. Patients should receive explanations about diagnoses, prognoses, treatment recommendations, treatment alternatives, side‑efects of treatments and any risks of non‑treatment, so that they can give informed consent or non‑consent. The information provided to the prisoner should be documented in the patient’s fle. For invasive medical procedures or treatments with defnite unwanted side‑efects, the written consent of the patient should be sought. Only doctors, nurses and other health‑care professionals who are bound to medical confdentiality may have access to medical fles, which must be locked up and kept separate from prisoners’ individual administrative fles. Prison doctors or nurses must never allow the disclosure of patient‑related medical data to the prison administration or any other third party without the explicit consent of the patient. Exceptions to this rule are: an order from a court (in such a case the doctor should hand over the information directly to the judge) and those rare cases when the doctor must decide to breach confdentiality in order to protect a strong legal right, such as saving the health or life of another person. In both cases the doctor must inform the prisoner patient accordingly. In its country visits the CPT has constantly emphasised the need to improve the confdentiality of prisoners’ medical records.48 Several states are now installing an electronic medical record system, but this needs to have safeguards in place so that only medical staf have access to medical data on individual patients. A request from a prisoner patient to have access to his/her medical fle should be accepted by the doctor. In cases of transfer, a sealed copy of the medical record should accompany the inmate and be handed over to the health‑care team of the receiving institution. Upon release, the prisoner patient should be given a medical report. The medical information in the report will be used for future treatment by the physician in the community and can also include details from the records if required. Following a prisoner’s discharge, the 48. CPT/Inf (2004)36; (2006)24; (2007)47; (2009)25; (2009)38; (2012)19 29) CPT/Inf (2004)21; (2004)36; (2010)29; (2010)20. Prison health care and medical ethics Page 22