Patient’s Guide to HIPAA – Basic Rights: What Records Should I Ask For? The Strategy of Asking for Records.
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FAQ 23: What Records Should I Ask For? The Strategy of Asking for Records.
A covered entity must allow you to inspect or obtain a copy of your record. Some records can be withheld. (See the next FAQ.) Just figuring out who to ask and what to ask for can be complex. Don’t assume that you need a copy of all records from all health care providers and insurers. Obtaining your health records can be surprisingly complicated, may present some hard choices, may be expensive, will require some planning, and can take time. Managing many records from many different providers may be a challenge too. This FAQ tells you about the strategy for requesting health records.
First, copying costs for paper records may be considerable. You may want to think about the costs involved before you ask. A hospital record can have hundreds or even thousands of pages. Think about whether inspecting your records will meet your needs. If you can inspect first, you might be able to narrow your request and cut the cost. Copies of electronic records may be much less expensive than copies of paper records.
Second, if you have been using the same hospital or doctor for 20 years and the reason for your request relates only to your treatment from your last visit, you might limit your request to recent records, or records dating back one visit, one month, or one year. The same idea may work if you want records from your insurer.
You may not know which records you need at first. The point is that you want to obtain records that you think are relevant, but you may not want every record from every HIPAA covered entity. Most people have had dozens of health care providers and insurers in the course of their lives. Many records will not be important or worth the time and effort to find for most people. Old records from individual practitioners may be hard to locate and obtain. However, hospitals and other long-standing institutions are more likely to have older records, although they may be in storage offsite.
If you want your records because you think you might have been a victim of an identity thief, you will find some more specific advice at the World Privacy Forum’s FAQ for medical identity theft victims. http://www.worldprivacyforum.org/2012/04/faq-medical-id-theft-victims-how-to-recover-from-medical-id-theft/
It is possible that a thief used your name to obtain services from a health care provider, clinic, pharmacy, or laboratory that you never used yourself. Don’t be surprised if the trail leads you to unexpected places.
One part of the health care world that few people recognize is the Pharmacy Benefit Manager or PBM. A PBM is a company that contracts with managed care organizations, self-insured companies, government programs, and other insurers to manage pharmacy network management, drug utilization review, and other activities. A PBM is likely to be the organization that fills your drug prescriptions by mail. A PBM may have relevant records. Your health plan hires the PBM, and you may have to seek access to PBM records through the plan. The notice of privacy practices should tell you what you need to know on this front, or it should tell you how to find out. PBM records may duplicate records that exist elsewhere, but they can be important sources of information at times. If you are seeing more than one doctor, clinic, or hospital, PBM records tend to include information from different providers.
Third, asking for a copy of your complete paper health record may provide more information than you need. It may also be especially expensive. Your health records may include results of x-rays and other diagnostic tests that may be costly to duplicate.
On the other hand, if records are electronic, it may be easy and inexpensive to obtain an electronic copy of everything or almost everything. If the covered entity has electronic records, it must give them to you in electronic form if you want them in that form. You can ask for hard copy of electronic records, but the cost might be higher. Not all electronic records can be printed on paper. You can obtain electronic records in the format you want if the covered entity can reasonably provide them in that format.
Consider how you might limit your request for access so that you limit your costs. See if you can talk to someone in the record keeper’s office when you make a request so that you can negotiate what you really need. One idea is to not ask for a hard copy of an x-ray unless you know that x-rays are essential. Even then, an electronic copy may be sufficient. If other records are especially expensive to duplicate, you may want to defer asking for those records too. Ask for a price list before requesting all records. Another idea is to ask to inspect your records first so you can decide which parts you want to have copied.
Fourth, once when you receive some records, you may be able to focus your later requests. You may find that the provider used a lab or other independent provider that will have some of your records that you may want to have or that you may want to inspect.
Finally, copying of electronic records can be very inexpensive. If you want a copy of all of your electronic records, you can ask for them. It’s a reasonable approach. Understand that the records may not arrive in a single, chronological file, however. You may receive many different files in different formats.
If you are planning to maintain your own health record archive for your lifetime, remember that computer record formats may change over time. Some formats go out of date. For example, it can be difficult or impossible today to read a file saved by a 1992 word processing program. Consider asking for records in formats likely to remain in use in the long run. Experts think that PDF may be one of those formats, but there may be others. This can be a complex issue to assess.
Roadmap: Patient’s Guide to HIPAA: Part 2: Basic Patient Rights: Right to Inspect and Copy Your Record (FAQ 23 of 65)