Patient’s Guide to HIPAA – Basic Rights: What Other Limits Are There on the Right to Seek Amendment?




You are reading the Patient’s Guide to HIPAA, FAQ 31

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FAQ 31: What Other Limits Are There on the Right to Seek Amendment?

A covered entity does not have to amend a record that it considers accurate and complete. It does not have to amend a record that is not available for inspection by you under the access provision.

More importantly, a covered entity is not required to amend a record not created by the covered entity. That means if the information in your record came from any third party – including another provider, an insurer, a relative, or anyone else – the covered entity has no obligation to amend your record or even to consider your request. We find this limitation on the right to seek an amendment to be unfair, inappropriate, and dangerous. Be aware that state law may not have the same limitation on amendment rights.

The covered entity must consider your request for amendment of third-party information if you provide a reasonable basis to believe that the originator of the information is no longer available to act on the requested amendment. Thus, if the record contains information from a previous physician who is no longer in practice, you may be able to force your current provider to consider amending information supplied by that physician. We note that it can be difficult to prove that the originator of information is unavailable, and an uncooperative covered entity can string a requester along if it doesn’t want to deal with a request for amendment honestly.

If the covered entity that is the originator of the incorrect information is available but does not act on a request for amendment, the information in the subsequent covered entity’s record may be just as wrong and could have a continuing detrimental effect on the patient. This can present a real Catch-22 for patients.

In most circumstances, a health care provider will act reasonably to verify information that may affect patient care. For example, if you tell your surgeon that you think that your blood type is A, the surgeon is not likely to cavalierly accept contrary information just because it came from a third party. Any health care provider is likely to be suitably concerned about the possibility of a medical error based on wrong information.

However, there may be real problems with third party information in some circumstances. Health insurers may not be as worried about an error, especially if the error provides an excuse to deny a claim.



Roadmap: Patient’s Guide to HIPAA: Part 2: Basic Patient Rights: Right to Request Amendment (FAQ 31 of  65)

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