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By GRACE CORDOVANO, DEVEN McGRAW, and AARON MIRI
The HIPAA Privacy Rule gives patients the right to copies of their medical records, with rare exceptions. When patients need a copy of their medical records, most start the process by calling their doctor’s office and asking for how to get access. The receptionist or office staff point them in the right direction, whether it’s instructing them to write down their request and sending it to the office, pointing them to contact the medical records or radiology department (if the practice is large enough), or assisting them in setting up their patient portal, if the practice is using an electronic health record (EHR). Being able to connect with a person inside the four walls of medicine is often crucial for many patients and their carepartners who may be unsure of exactly how to request their records.
But what happens to those records when a doctor closes or leaves the practice?
Independent practices close for a variety of reasons. Physicians may merge with a large practice or health system, retire, they may sell or close their practice for personal reasons, they may file for bankruptcy, or they may get sick and die. The COVID19 pandemic has had devastating financial consequences on many small, independent, and rural practices, leading to their consequent closure, acquisition, or merger.
What should patients do when their doctor’s office closes, and they need a copy of their medical records? This is especially challenging when a doctor may not have had an EHR, as is the case with many independent practices as well as more rural settings. On September 26, 2020, a tweet from Cait DesRoches, Executive Director of OpenNotes, inquired about how a family member may get access to medical records from her physican’s practice that closed, triggering a robust conversation that led to the realization that patients and families are not well informed in these circumstances.
Prevention is Worth a Pound of Cure
It can be much more difficult to get copies of records after a practice has closed. Patients should get copies of their medical records as they are generated instead of waiting until they’re needed. HIPAA Privacy Rule guidance states that individuals can get digital copies of digital information (or even digital copies of records kept on paper, as long as the practice has a scanner). Companies are developing tools and services that enable individuals and their care partners to collect, use, and store health records. Request digital (or paper, if that is preferred) copies of blood work, imaging, discharge instructions, and corresponding reports before you leave the practice.
What Happens to Medical Records When Offices Close? The Law
The Health Insurance Portability and Accountability Act (HIPAA) does not require a physician to retain medical records for any particular period of time. (HIPAA covered entities – which include physicians who bill health insurers for care – are required to keep records demonstrating compliance with HIPAA for at least six years – but those records are distinct from medical records.
) However, if the physician still has those medical records – or has placed them in storage for safekeeping – the HIPAA requirements to produce them when a patient requests still apply.
State laws typically set medical record retention requirements for physicians and may also require the physician to take particular steps (such as notifying a patient) prior to or upon closure of a practice.
An example of some of these state laws:
During the record retention period, these records are considered to be still “available” and subject to the HIPAA right of access. Consult the medical board or the state medical society in the state where the physician has practiced for further information about physician requirements in the event of closure of a practice. The Medical Board should also have information about how to file a complaint if the physician’s practice has closed without any notice or information about how to obtain records.
Irrespective of legal requirements, the American Academy of Family Physicians recommend that patients be notified by a letter that the office is closing, giving them the opportunity to obtain a copy of their medical records or have records forwarded to a physician of their choosing. The office may post an update on their website or social media page(s), if ones exist or run an ad in the local newspaper.
Patients should be notified who will be the custodian of the medical records and their contact information.
Sorry! The Office Is Closed
Unfortunately, the reality is that most individuals do not get copies of their medical records throughout their care journey. This leaves patients and carepartners in need of records facing significant uncertainty, stress, and frustration when they unexpectedly find out that their doctor’s office has closed. Here are a number of critical tips to assist patients in gathering their medical records, directly and indirectly, in the event their doctor’s office has closed.
(As noted above, state laws may allow for them to be destroyed even sooner than 10 years.)
Social media managers are often very responsive and may be an additional avenue for connecting individuals to the information they need if it is perceived that delays in response may be detrimental to their company’s reputation.
Consequently, the specific state’s county probate court may be contacted to confirm if there is a designated executor of estate that has authority over records retention processes. Alternatively, an obituary may list surviving next of kin which may also be contacted for more information on records retention.
Individuals may also file a complaint with the Office of Civil Rights (OCR) at the Department of Health and Human Services (HHS) if all efforts have been exhausted and the needed medical records have not been obtained.
A closed practice does not need to be a dead end for patient access. Proactively requesting copies of medical records throughout one’s care journey can prevent encountering such patient access barriers. Continuing to share best practices for navigating patient access barriers, from legal, regulatory, and practical standpoints, is in the best interest of all patients.
Grace Cordovano, PhD, BCPA is a board-certified patient advocate specializing in the oncology space, a patient experience enhancer, and information unblocker.
Deven McGraw , JD, MPH, LLM (@healthprivacy) is the Chief Regulatory Officer at Ciitizen (and former official at OCR and ONC).
She blogs at ciitizen.com.
Aaron Miri is the Chief Information Officer for The University of Texas at Austin comprising of the Dell Medical School, UT Health Austin clinical enterprise, research, and community impact missions.
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Categories: Uncategorized
Tagged as: Aaron Miri, Deven McGraw, Grace Cordovano, Health Data, HIPAA, Medical Records
Maintaining a file of all the medical records produced under your name, known as your personal health records, can help you get faster, safer and better medical treatment in emergency situations. It also has the potential to save you money when resolving claims with your insurance company.
Copies of Your Medical Records Can Help You:
The Health Insurance Portability and Accountability Act, or HIPAA, guarantees that your medical records stay private until you give someone written permission to view or possess them. Patients typically give their health insurance company access to records to ensure it pays their claims, for example.
You can request your medical records via your health care provider’s online patient portal, ask for copies of your records in person at your doctor’s office or put the request to your provider in an email or letter. Your doctor’s office manager or an insurance company representative can identify every document in your file so that you can ask for specific documentation.
If you had a surgery that required an implant, for example, such as knee replacement surgery or hernia surgery, your operative or surgical notes contain information about the model and brand of the implant. This is important information for recalls or if you need to file a lawsuit because of a faulty device.
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Each state has laws for how long it must keep records. Most states mandate providers keep records for five to 10 years, and the median time period is seven years. For a complete list, visit HealthIT.gov.
Another option for obtaining records is to fill out a request with consumer reporting agency MIB, which was created under the Fair Credit Reporting Act. It collects and shares your medical data with insurance companies. You have a right to the data it collects about you and you can fill out a request directly on its website.
If you need to request military medical records, you’ll need to reach out to the U.
S. Department of Veterans Affairs. The VA houses all military medical records across branches of the service.
Fill out standard VA Form 180 to start the process moving. Mail the completed form to the correct records custodian listed on the form. If you have any issues, contact the VA at 800-827-1000 to find the closest VA office to you, where you will work with a patient advocate who can help you.
If you separated from the service after Jan. 1, 2014, your paperwork will likely be digitized. As long as your service treatment records, or STRs, don’t contain classified information, you should be able to get them through your Department of Defense electronic patient portal, through TRICARE Online or through Genesis, the DOD’s military health system. (TRICARE is moving its patient communications and records from its portal to the Genesis portal.)
More than 90% of health care systems, including hospitals, doctor groups, insurance companies and the VA, have Electronic Health Records systems.
EHRs provide patient portals that store medical records and streamline doctor-patient communication and prescription management.
Portals let you read, download and print stored health information. Records typically available through portals include summaries of recent doctor visits, lab results, medication lists, allergies, immunizations and discharge summaries. Many labs, including LabCorp and Quest, also have their own portals.
Patient portals, however, may not contain operation reports and physician’s notes. You may need to contact your doctor or specialist directly for more complete information.
Depending on the state, providers have anywhere from 30 to 60 days to process a request. Many facilities may provide records within five to 10 days, according to American Health Information Management Association. It should not take more than 90 days to fulfill a request.
“I called the records department, and they sent me forms to fill out via email or online,” patient Rachel Brummert told Drugwatch.
She reportedly has requested her medical records on multiple occasions. “On average it took about two weeks for my records to be copied.”
The VA and TRICARE do not have specific fulfillment timelines. Keeping copies of your records requests can be helpful in following up if needed with whichever organization or provider has your request.
Simple, small records requests are often free. Under HIPAA, providers can’t charge you for the labor of searching or retrieving records. They also can’t deny you a copy of your records if you haven’t paid for services rendered. But they can charge you a reasonable fee for the copies.
“There are statutes in every state concerning how long health care providers must retain medical records and what they are allowed to charge for copying said records,” plaintiff’s lawyer Holly Ennis told Drugwatch.
The cost for medical records ranges from $0.25 to $2 per page in most states. The rate usually gets less expensive as the page count goes up.
Sometimes patients need records from a doctor no longer in practice. Under law, the doctor must transfer his or her records to another provider.
If the doctor left a practice that is still operating, the records will remain with the practice. If another doctor bought the practice, the new practice would maintain the records.
If the provider didn’t leave any details before leaving the practice, a patient may be able to put together records from hospitals, labs and specialists they saw. The insurance company may also be able to help.
You have a right to request and obtain your medical records. But sometimes a third party must request them. Third parties can include a parent, grandparent or adult child, legal guardians, patient advocates, attorneys and caregivers. All must have written permission from the patient to get the records.
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“An attorney would still need a signed medical authorization release to obtain a client’s medical records from any health care provider,” Ennis explained.
“Often, many health care providers respond more quickly to an attorney than to a patient.”
Requesting another person’s medical records has its own requirements. There are different forms to fill out, and the requestor must have the proper legal documents to show the medical records department.
If someone is no longer capable of making decisions or is incapacitated, their representatives must have a power of attorney for health care and finances — a specific document that grants a third party the legal ability to access medical records.
Requesting medical records about someone who is deceased requires the requester to be an executor of the deceased patient’s estate or to have permission from the executor for the access. If no executor exists, another person can petition to become the executor through a probate court. The petitioner must have documentation of their relationship to the deceased.
There are rare exceptions when a provider can deny access to a medical record.
The two most cited examples of denial are because of mental health or ongoing litigation.
Examples of Records Providers May Deny
Most state laws, which often mirror one another, protect providers if they claim that releasing the record will do you harm or harm someone else. One example would be notes from a psychotherapist. However, judges rarely uphold a denial strictly because a patient could be upset or angry about the contents of the record.
Any denials must be spelled out in plain language, explaining the reason for the denial in a letter, email or fax.
If a provider denies a medical records request, review your request and make sure you gave the provider all the information required and that all authorizations have signatures. Sometimes merely calling the provider’s medical records department resolves any issues.
Essential information to include:
“Patients are absolutely entitled to obtain their medical records.
Usually, the provider has 30 days to respond,” Ennis said. “Patients need to look up the state law in their state so they are ready to demand their records under legal authority if the health care provider is noncompliant.”
George Washington University publishes the laws in each state on its website. You can also file a complaint with the Office for Civil Rights if you feel a provider violated your rights. You must file any complaint within 180 days of a violation.
It is possible to correct an error or an omission in your medical records. Most times, you can fix the error with a direct message to a nurse or administrator through the patient portal.
Sometimes you will have to call the provider directly. And other times you may need to write a formal letter to the doctor’s office or insurance company requesting a correction.
Follow up to ensure any requested corrections get made.
Please seek the advice of a medical professional before making health care decisions.
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Visit honey. center
3. Getting Personal medical book
When a driver is hired by an organization, an employee of the personnel department is obliged to accept from him a standard package of documents established by Article 65 of the Labor Code of the Russian Federation. Such documents include a passport, a work book, an insurance certificate of state pension insurance, a document on education, etc. Also, in accordance with Article 328 of the Labor Code of the Russian Federation, an employee whose activities will be directly related to the movement of the vehicle is hired only after he has passed the mandatory preliminary medical examination. However, this is not the only medical document according to the Labor Code of the Russian Federation that a driver may need for employment.
According to Article 213 of the Labor Code, if a person gets a job in a food industry, catering and trade organization, medical and children's institutions, water supply facilities and some other employers, he must undergo a medical examination to issue a personal medical book (LMK).
This document must be obtained in order to protect public health, prevent the occurrence and spread of diseases. We add that the requirements of the Labor Code of the Russian Federation are supplemented by the Letter of the Ministry of Health of the Russian Federation of 08/07/2000 No. №1100/2196-0-117. On the basis of this document, those involved in the production, storage, transportation and sale of food products and drinking water will also have to issue a sanitary book; communal and consumer services to the population, as well as persons working in transport enterprises and engaged in the transportation of people. Summarizing, we can say that a health book (medical book) is equally necessary for a refrigerator driver transporting food; forwarding driver of the laboratory performing the transportation of medical tests; driver-courier for the delivery of bottled drinking water; taxi driver or driver of city, intercity and international buses. About what kind of examination these workers need to pass and what is its price, read on.
The profession of a driver is not a criterion that affects the scope of the survey. The list of specialist doctors, laboratory and functional studies, which is required by the driver's health book, is determined by the area of \u200b\u200bhis activity. In accordance with it and on the basis of the Order of the Ministry of Health and Social Development of 12.04.2011. No. 302n, each driver will find out in a medical institution the scope of the upcoming examination. This means that a forwarding driver from one field of activity and his colleague, but from another field of activity, will issue a medical book in different ways - they will need to take slightly different tests and go through different doctors.
If a woman works as a vehicle driver, then this increases the scope of the survey.
The driver's license is valid for 12 months. After this period, an employee of the taxi service or the transport department of any other organization will need to undergo the examination again in the amount prescribed by law in order to be able to continue working as a driver.
When the necessary document needs to be issued quickly, each of us will consider all possible options for resolving the issue. In this regard, we hasten to warn you. Offers to buy a personal medical book with delivery to the door of the house in 1 day should be rejected. The procedure for issuing and renewing a medical book does not involve the purchase and sale of a finished document in absentia.
Be careful, acquiring LMC in this way is illegal and punishable by law for all parties to the transaction.
Where to make for the first time and extend the medical book for the driver urgently? To undergo an examination and enter its results in the LMC, you should personally contact medical institutions with state permission for this type of activity. Medical Center "OMED" values its reputation and conducts licensed activities. With us you can get an examination for LMK quickly and inexpensively.
Come to us at the address in St. Petersburg: st. Bukharestskaya, 74 (metro station "Mezhdunarodnaya", Frunzensky district).
To the question: “How to get a medical book for work?” you can either answer briefly, or consider several options for solving it.
If you are in a hurry to get the answer , then you need the fastest solution - issuing a medical book in a commercial medical center that has the necessary valid licenses for medical services and meets the requirements of the law for medical centers. This will give you a guarantee that the issued medical book will not cause any trouble for you or your employer.
Such a medical center is MedProf, which has sites in St. Petersburg and Moscow. You can read more about the medical book registration service at MedProf on its page.
If you are someone who carefully collects information , considers different options for solving your pressing issue, weighs all the pros and cons, and then makes a deliberate choice, then we are ready to help you with this and provide the necessary information about how to apply for a medical book to get the job of your dreams.
You can do it yourself or through a commercial organization, as we mentioned earlier.
Making a health book or the so-called health minimum is a multi-stage process:
First, you need to pass a medical examination , in which you need to visit several medical specialists and pass tests.
listen to a short theoretical course.
Thirdly, pass certification on the basis of the completed course.
Fourthly, draw up a form of personal medical book , make notes on the certification passed, the conclusions of all medical specialists and the results of the tests. Of course, you can't bring all this in yourself :)
Fifthly, register a medical book with Rospotrebnadzor.
Now that you understand the whole process of obtaining a medical book, you can consider it in the context of different options for solving this issue.
Difficulties and joys.
Let's say you have a great sense of adventure. In this case, you should do the independent registration of a medical book.
First you need to contact the Center for Hygiene and Epidemiology in order to officially purchase a form of a personal medical book.
After you have a form or just a medical book (sanitary book) in your hands, you need to undergo a medical examination in accordance with the requirements for its volume.
The following will help you to visit doctors, get the results of laboratory tests and functional diagnostics:
Yes, get ready, the program will be extensive and incredibly exciting :)
Epidemiology, in order to register a medical book with Rospotrebnadzor.
It will take 1-3 working days, after which you can pick it up and solemnly hand it over to your future employer.
Theoretically, everything is very easy, but in practice there are different nuances.
1. The whole process is completely under your control. The better you understand the issue, the less the risk of making a mistake - to go through an incomplete examination, skip an error when processing documents, not notice that somewhere they forgot to put the necessary stamp, etc.
2. The final cost of the medical book will be known only after receiving it. It is very likely that in the end the savings will not work or the savings will be negligible.
3. In public clinics, very often the staff of doctors is not 100% staffed. In practice, this may mean the following:
4.
You will need to additionally look for a photo studio in order to take the correct photo for the medical book.
5. Not all public clinics do fluorography, so there is a chance that you will have to go to the nearest fluorography station.
6. CHI covers tests and functional studies for health reasons, that is, you still have to incur financial costs to apply for a medical book.
But all this, of course, can be endured if you are an avid fan of standing in lines, listening to the latest news from the members of the “over 65” club, watching and maybe even participating in the RUDE creative impulse of all those gathered here :)
Registration of a medical book in MedProf is an outrageously simple way to get a medical book registered with Rospotrebnadzor in the shortest possible time for a legal document. Without the need for your own immersion in the topic of the issue and its personal control.
