Getting Your Medical Records: Information on Rights, Procedures, and Denials

Your right to obtain medical records, and tips on how to get them.

You may need to get copies of your medical records for a number of reasons. If you're involved in a personal injury lawsuit, medical records may be a key element in the case. For example, if you file a legal claim after a car accident, you may need to prove that the accident and not a previous medical condition caused your injuries. Or the extent of your injuries may be in dispute. In medical malpractice claims, medical records form the crux of the case. And sometimes patients just need their medical records to provide to a specialist or a new doctor. Read on to learn about your right to obtain your medical records, and how to go about getting them.

Your Right to Medical Records

The federal Health Information Portability and Accountability Act (HIPAA) gives patients the right to obtain a copy of their medical records from any medical provider, with a few exceptions.

Who May Get Records?

According to HIPAA, you may request:

Your own medical records.

Someone else's records if you are a designated representative. You may request someone else's medical records if they give you permission, in writing, to act as their representative in accessing records. For example, if your elderly parents designate you as their representative, medical providers must provide you with your parents' medical records if you make a request to obtain them.

Someone else's records if you are their legal guardian. Likewise, if you are appointed as the legal guardian of another adult, you have the legal right to get that person's medical records

Your children's medical records, with some exceptions. For the most part, parents and legal guardians can obtain their children's medical records. There are a few exceptions to this rule. A parent may not get a child's records if:

• the child has consented to medical care and parental consent is not required under state law
• the child gets medical care at the direction of a court, or
• the parent agrees that the minor and the medical provider have a confidential relationship.

Records of deceased persons in certain circumstances. If you are the personal representative of an estate either designated by a will or appointed by a court to settle a deceased person's affairs HIPAA gives you access to the deceased's medical records. In addition, if you are related to a deceased person and certain information in that person's medical file relates to your own health, HIPAA lets you access that information.

What Records Can You Get?

HIPAA gives patients the right to get copies of all of their medical records. Patients also have the right to view usually at the medical provider's offices their original medical records.

HIPAA does allow health care providers to withhold certain types of medical records, including:

• psychotherapy notes
• information the provider is gathering and compiling for lawsuits, and
• medical information that the provider believes could reasonably endanger your life, your physical safety, or the safety of another person.

Usually, if the provider denies your request for medical records, it must provide you with a denial letter. In some cases, you may be able to appeal the denial.

When Will You Get the Requested Medical Records?

HIPAA requires medical providers to provide copies of medical records within 30 days of your request. If it will take more than 30 days to meet your request, the medical provider must give you a reason for the delay.

Some states require a quicker turnaround. For example, in California, providers must allow patients to see their records within five days of the request and must provide copies of those records within fifteen days. For a list of state laws governing access to medical records, visit the Center on Medical Records Rights and Privacy at Georgetown University's Health Policy Institute online at http://hpi.georgetown.edu/privacy/records.html.

Although states and medical providers vary on the procedure you need to follow in requesting medical records, it's usually safest to do the following:

• Contact the medical provider and find out where the request should be sent. Some providers use third-party services to maintain and copy patients' medical records. Other providers have specific offices or personnel dedicated to medical record requests. The process will be quicker if you send your request to the right location right off the bat.
• Make the request in writing.
• Include your name, address, telephone number, email address, date of birth, and medical record number, if you know it (this is not the same as your invoice number). Some providers will request your social security number.
• Fill out a release form. This step is required by most medical providers. Ask the provider to send the form to you, or see if it's available online. You can also offer to stop by the office to pick up a copy of the form.
• Specify whether you want to view the originals, get copies, or both.

Specify Which Records You Want

When it comes to identifying which medical records you want, you can be general or specific. Sometimes, patients want their entire medical file. But if you’ve seen the doctor over a long period of time and don't want to pay for copies of every immunization and preventative visit for the last 20 years, it might make sense to specify which part of the record you want.

You can narrow your request by specifying records that cover treatment over a certain time period or for a certain medical condition. You can also specify whether you want MRI films and reports, X-ray films and reports, prescriptions, lab tests and evaluations, billing records and receipts, pathology reports, admitting records, emergency room records, anesthesiologist records, treatment notes, vaccination records, and anything else you think you may need.

Request Records From Third-Party Providers

Once you get your medical records, you may notice they include reports from third-party providers, like specialists or radiologists. The documents from the third-party provider are what your doctor received, but they may not constitute all the medical records that the third-party provider's office has on you. If you need more information from the third-party provider, make a separate medical record request to that provider.

Pay for the Records

HIPAA allows providers to charge for "reasonable costs" in copying your medical records. State laws often put limits on these charges, although many providers charge less than the limit (or nothing at all in some cases). Ask the medical provider how much the charges will be.

Many medical providers require payment before turning over the records. But that doesn't necessarily mean you'll be required to pay any outstanding medical bills before you can get copies of your records.

What to Do if You Are Denied Records or the Records Are Not Complete

Sometimes, something appears to be missing from your medical records. Most often, this is due to a mistake or honest oversight, and getting the right information merely requires a follow-up written inquiry.

But some health care advocates claim that certain hospitals and medical providers make it difficult for patients to get medical records when a medical malpractice lawsuit is involved. If you believe that a hospital or other provider has failed to turn over medical information that may be key to a malpractice claim, you have several courses of action to consider:

• Contact the Office of Civil Rights at the Department of Human and Health Services at 200 Independence Avenue, S.W., Washington, D.C. 20201, (866) 627-7748. Visit them online at www.hhs.gov/ocr/privacy/.
• File a complaint with your state's medical board. But if you plan to file a lawsuit, remember to be conscious of the time this might take and how that could affect your case. One study found that medical boards took, on average, 2.6 years to investigate complaints.
• Contact a personal injury lawyer.

If a provider refuses to give you with a copy of your medical records and if the provider doesn’t give you an explanation or if you don't agree with the decision to withhold records you can also pursue the options listed above to challenge the denial of your request.

Once you have your medical records, you may be ready to visit a personal injury attorney. For help on choosing a good personal injury attorney, read Nolo's article Finding a Personal Injury Lawyer. You can go to Nolo's Lawyer Directory for a list of personal injury attorneys in your area (click on the "Types of Cases" and "Work History" tabs to learn about a particular lawyer's experience, if any, with your particular legal issue).