Record request

[Shikima]

I've noticed an increase in request in patient's wanting a copy of their record. I'm told that we cannot deny due to the hippo.

How have you guys managed these requests in the past? Did you allow it?
Deny? If denied, how did you justify the rejection?

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[F0nzie]

I ask if a diagnosis and med list is enough. It usually is.

If they want the entire record I typically release it. I tend keep my notes brief and inoffensive ie. I don't write detailed notes on their appearance or odor. The psychotherapy add-ons are integrated in their med visit notes so I keep the details to a minimum.

Fortunately I haven't had too many cases where I felt releasing records would be harmful to the patient.

 

[Ceke2002]

I know of one patient who requested a copy of their notes, and received a summarised report instead, which was completely full of errors. She had told her Psychiatrist that her father was a former drug user, who had since gotten clean - he recorded that her father was a drug dealer who had spent time in jail; she mentioned fights with her boyfriend at the time and said that there was only one time he had ever become violent and punched a wall in anger - he recorded that her boyfriend was giving her black eyes on a weekly basis; she also mentioned past issues with self harm but indicated it had been several years since her last episode - he recorded that she'd severely cut her arm after an argument with her mother the week before (I saw a photo of her taken during that period of time, there were absolutely no cuts or other injuries visible anywhere). Needless to say she lodged a complaint and asked for her records to be corrected.

Patient's hear stories like this and I guess it makes them wonder if their Psychiatrist is *really* listening to them as well. Unless you're a complete ignoramus, like the example Psychiatrist above (which I really, really don't think you are) I don't think you'd have anything to worry about, they probably just want to see their notes out of a sense of reassurance. I don't personally know any patients who have wanted to see their notes for any other reason (except maybe me, but that's just because I'm fascinated by the therapeutic process and want to read my notes from an academic interest point of view - I'd never actually ask to see them though).

 

[TexasPhysician]

I charge for records.

 

[Shikima]

I charge for records.

What do you charge?

 

[birchswing]

In my state you can only legally charge what is reasonable for the labor and supplies (paper) of providing records. It varies by state.

http://medicopy.net/who-we-are/blog/guide-of-state-statutes-for-copies-of-medical-records

 

[TexasPhysician]

What do you charge?

My state allows $25 for up to 20 pages and $0.50 for each additional page. I charge the max.

 

[whopper]

Most states have requirements on how much you can charge. Per the law the patient really is the owner of the record and the doc is the legally-obligated older of the record and you cannot deny them the record if they request it but you can charge fees with maximum allowable rates. I have seen some say that if the patient owes money you can refuse to provide records until they pay what they owe but I don't know if this is legal.

 

[TexasPhysician]

[QUOTE="whopper, post: 16895050, member: ] I have seen some say that if the patient owes money you can refuse to provide records until they pay what they owe but I don't know if this is legal.[/QUOTE]

Not legal in my state

 

[Monkey House]

The concept of 'Open Notes' - where patients can log onto a website and read the notes you write seems to be gaining some traction. There is a pilot at my hospital with psychiatry patients right now. Something you may be hearing more about soon?

 

[birchswing]

The concept of 'Open Notes' - where patients can log onto a website and read the notes you write seems to be gaining some traction. There is a pilot at my hospital with psychiatry patients right now. Something you may be hearing more about soon?

If you want to treat mental health the same as physical health, it makes sense. I can log on to see my diagnoses, prescriptions, test results, vitals, etc., from my physical health doctors. The doctors I see who are not psychiatrists are all part of larger groups that have official web portals. I don't know of any psychiatrists near me who are part of larger groups, otherwise I would think they would automatically be part of those same systems. I would really have no reason to request my records from any of my doctors except psychiatrists because all of my records are available online except my psychiatric ones. I personally am very comfortable with my health information being online.

As an aside, didn't electronic health records become mandatory at some point? My dentist and psychiatrist are the only two offices left that I go to that use paper records--were those fields excluded from the mandate?

 

[Doctor Bagel]

As an aside, didn't electronic health records become mandatory at some point? My dentist and psychiatrist are the only two offices left that I go to that use paper records--were those fields excluded from the mandate?

Not mandatory but strongly incentivized by payers, especially Medicare, which somehow gives you more money if you switch to EMR. Of course private practice psychiatrists don't take Medicare since their reimbursement sucks, but whatever.

About reading records, patients at the VA can already log in and read all their records, which can be especially tricky there as a good deal of the patients are in the process of filing for disability and hoping your documentation helps that.

 

[sunlioness]

Most states have requirements on how much you can charge. Per the law the patient really is the owner of the record and the doc is the legally-obligated older of the record and you cannot deny them the record if they request it but you can charge fees with maximum allowable rates. I have seen some say that if the patient owes money you can refuse to provide records until they pay what they owe but I don't know if this is legal.

I had a psychiatrist deny me a record request because the patient owed her money. He was claiming he was on all kinds of benzos and I wasn't going to prescribe without verifying. She wouldn't even send me a med list until the patient paid up. I eventually called the pharmacy. That doc was shady as heck anyway.

In IL, I just woulda looked it up online. I'm going to miss doing that. Unless PA has a database now too? That would be nice.


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[PikminOC]

One of my patients signed the form to let their hubby into the appt.
Later, the hubby cancelled follow ups. I spoke to the patient and she confirmed this (but I felt she was being coerced by her demanding husband).
Hubby asked for the records and there was a signature on the request form. I asked for her to come in and sign the consent in person.
Hubby got mad, said I was accusing him of forging her signature, and said he was reporting me to the med board. She didn't come into the office to sign the form.
What do you all think?

 

[Shikima]

One of my patients signed the form to let their hubby into the appt.
Later, the hubby cancelled follow ups. I spoke to the patient and she confirmed this (but I felt she was being coerced by her demanding husband).
Hubby asked for the records and there was a signature on the request form. I asked for her to come in and sign the consent in person.
Hubby got mad, said I was accusing him of forging her signature, and said he was reporting me to the med board. She didn't come into the office to sign the form.
What do you all think?

You called it correctly.

I heard you can refuse on the grounds that releasing the records would be detrimental to the patient's health care.

 

[PikminOC]

You called it correctly.

I heard you can refuse on the grounds that releasing the records would be detrimental to the patient's health care.

That's not why I'm not releasing. She is no longer a patient. I just want to make sure she is the one requesting the record. Hubby said he wants the records and wants to pick them up...

 

[smalltownpsych]

I wouldn't release the records to him. I don't see what his complaint would be. She would have to be the one complaining and your thinking on this sounds reasonable in that you are protecting your patient's interests. He sounds like a bully to me.

 

[PikminOC]

I wouldn't release the records to him. I don't see what his complaint would be. She would have to be the one complaining and your thinking on this sounds reasonable in that you are protecting your patient's interests. He sounds like a bully to me.

Thank you. That's the way I felt so I know she is feeling that way too.

 

[Ceke2002]

One of my patients signed the form to let their hubby into the appt.
Later, the hubby cancelled follow ups. I spoke to the patient and she confirmed this (but I felt she was being coerced by her demanding husband).
Hubby asked for the records and there was a signature on the request form. I asked for her to come in and sign the consent in person.
Hubby got mad, said I was accusing him of forging her signature, and said he was reporting me to the med board. She didn't come into the office to sign the form.
What do you all think?

I wouldn't release the records to him. I don't see what his complaint would be. She would have to be the one complaining and your thinking on this sounds reasonable in that you are protecting your patient's interests. He sounds like a bully to me.

Thank you. That's the way I felt so I know she is feeling that way too.

I think you made the absolute right call requiring the patient to come in and sign the consent in person, and I agree with smalltownpsych's assessment of the situation, that the husband sounds like a bully. I'd even go so far as to say the husband more than likely *did* forge his wife's signature, hence the defensive reaction when you required her to come in and sign the form herself. We had a similar situation happen in our family, except in this case the Doctor in question (a GP) did write up and sign off on a falsified report, knowing the patient's signature on the report would either be coerced or forged.

 

[PikminOC]

I think you made the absolute right call requiring the patient to come in and sign the consent in person, and I agree with smalltownpsych's assessment of the situation, that the husband sounds like a bully. I'd even go so far as to say the husband more than likely *did* forge his wife's signature, hence the defensive reaction when you required her to come in and sign the form herself. We had a similar situation happen in our family, except in this case the Doctor in question (a GP) did write up and sign off on a falsified report, knowing the patient's signature on the report would either be coerced or forged.

Thanks ceke!
So far she hasn't come to the office to sign for it..

 

[psyxh]

In IL, I just woulda looked it up online. I'm going to miss doing that. Unless PA has a database now too? That would be nice.

Unfortunately, PA is way behind on their prescription monitoring database rollout.

 

[sunlioness]

Unfortunately, PA is way behind on their prescription monitoring database rollout.

Bummer. I'm going to miss that. That and wine in the grocery store and 70mph speed limits.


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[WingedOx]

In IL, I just woulda looked it up online. I'm going to miss doing that. Unless PA has a database now too? That would be nice

IL-PMP is wonderful... therefore I fully expect it to get cut out of the state budget.

 

[WingedOx]

One of my patients signed the form to let their hubby into the appt.
Later, the hubby cancelled follow ups. I spoke to the patient and she confirmed this (but I felt she was being coerced by her demanding husband).
Hubby asked for the records and there was a signature on the request form. I asked for her to come in and sign the consent in person.
Hubby got mad, said I was accusing him of forging her signature, and said he was reporting me to the med board. She didn't come into the office to sign the form.
What do you all think?

can't argue with you there.

I usually deferred people to Medical Records department at my old place. PP is a different animal though.

 

[whopper]

I have seen a few cases where the physician refused to give records. One case the psychiatrist was an alcoholic and his practice went belly-up. When patients asked for their records because they had new doctors (I was one of them) we asked for the old records. Whenever one of us called he answered and flatly told us he had no way to give them because he had no working staff.

Another case was one where a psychiatrist that had a local shady rep put a pt on lithium without any labs and she had a significant renal reaction that required she go to the hospital. I reviewed her hospital records and she wanted me to be her new psychiatrist. The former one completely screwed up. Never warned her about lithium side effects, never got labs, the patient was feeling sick and called the former doctor, and that doctor just told her to keep taking her lithium.

I told the patient she should consider getting a lawyer about what happened because what the former doctor did was egregiously terrible. The patient ended up missing several weeks of work over this and IMHO was at least entitled to lost pay for damages including that her kidneys went from no renal disease to about stage 2 or 3 function over the incident. Her former doctor refused to give the records. Even when the lawyer sent a certified letter the former doctor refused to open it and sent the letter back.

In each case (and several more) despite that the doctors were legally obligated to give the records they never complied and nothing happened to them.
In cases like this the police will not intervene. They like to keep to things like preventing violence. When things get complicated in a legal sense they tell you to just get a lawyer. It got to the point where all of these patients (Except one) just gave up because who wants to spend several thousands of dollars in legal fees?

In one particular case I did see one patient's husband doggedly try to get the records and got a lawyer that was very aggressive to get the records and they still couldn't get them. He was trying to get them from a psychiatrist that previously treated his wife that he was suing. Now in that case the husband was obsessed with suing everyone. Every time I saw his wife I could tell he was trying to find some angle to sue me from the first time I met her. He insisted on sitting in her interview despite that I could tell from her body language she didn't want him there. When I requested he leave for her sake they asked for a moment alone and when I came back she told me he could stay and I sensed he put her under some type of duress to make her say that. Later on she told me he did. He was the bread-winner and he was wealthy. She told me if he wasn't allowed to stay he wouldn't pay for any of her medical bills.

I was shocked an appalled to see this lack of accessibility occur. If the law says the doc's supposed to provide the records why did it become virtually impossible for patients to get the doc to follow the law?

I've never seen the police intervene on anything unless there was a sense of acute danger such as a domestic dispute, assault, a homeless guy that's malodorous walking into a store, the only exception is if there's a warrant out for an arrest or some type of court order. Then they'll respond.

 

[Merovinge]

I'm sure you know way more about this than I do Whopper, but we've just finished having JD's give a didactic series and I believe any record request like you are referring to will require a subpoena if its not a mutual release. If the subpoena is defied, then the judge can hold you in contempt and have the court deputy bring you in/jail you/fine you. From what the JD's say, this happens not irregularly in IL

 

[Doctor Bagel]

I have seen a few cases where the physician refused to give records. One case the psychiatrist was an alcoholic and his practice went belly-up. When patients asked for their records because they had new doctors (I was one of them) we asked for the old records. Whenever one of us called he answered and flatly told us he had no way to give them because he had no working staff.

I'm wondering if the records even existed. I can see an impaired doc falling really behind on his/her documentation.

 

[michaelrack]

When things get complicated in a legal sense they tell you to just get a lawyer. It got to the point where all of these patients (Except one) just gave up because who wants to spend several thousands of dollars in legal fees?

.

It would be a lot cheaper just to make a complaint to the state medical board

 

[PikminOC]

I have seen a few cases where the physician refused to give records. One case the psychiatrist was an alcoholic and his practice went belly-up. When patients asked for their records because they had new doctors (I was one of them) we asked for the old records. Whenever one of us called he answered and flatly told us he had no way to give them because he had no working staff.

Another case was one where a psychiatrist that had a local shady rep put a pt on lithium without any labs and she had a significant renal reaction that required she go to the hospital. I reviewed her hospital records and she wanted me to be her new psychiatrist. The former one completely screwed up. Never warned her about lithium side effects, never got labs, the patient was feeling sick and called the former doctor, and that doctor just told her to keep taking her lithium.

I told the patient she should consider getting a lawyer about what happened because what the former doctor did was egregiously terrible. The patient ended up missing several weeks of work over this and IMHO was at least entitled to lost pay for damages including that her kidneys went from no renal disease to about stage 2 or 3 function over the incident. Her former doctor refused to give the records. Even when the lawyer sent a certified letter the former doctor refused to open it and sent the letter back.

In each case (and several more) despite that the doctors were legally obligated to give the records they never complied and nothing happened to them.
In cases like this the police will not intervene. They like to keep to things like preventing violence. When things get complicated in a legal sense they tell you to just get a lawyer. It got to the point where all of these patients (Except one) just gave up because who wants to spend several thousands of dollars in legal fees?

In one particular case I did see one patient's husband doggedly try to get the records and got a lawyer that was very aggressive to get the records and they still couldn't get them. He was trying to get them from a psychiatrist that previously treated his wife that he was suing. Now in that case the husband was obsessed with suing everyone. Every time I saw his wife I could tell he was trying to find some angle to sue me from the first time I met her. He insisted on sitting in her interview despite that I could tell from her body language she didn't want him there. When I requested he leave for her sake they asked for a moment alone and when I came back she told me he could stay and I sensed he put her under some type of duress to make her say that. Later on she told me he did. He was the bread-winner and he was wealthy. She told me if he wasn't allowed to stay he wouldn't pay for any of her medical bills.

I was shocked an appalled to see this lack of accessibility occur. If the law says the doc's supposed to provide the records why did it become virtually impossible for patients to get the doc to follow the law?

I've never seen the police intervene on anything unless there was a sense of acute danger such as a domestic dispute, assault, a homeless guy that's malodorous walking into a store, the only exception is if there's a warrant out for an arrest or some type of court order. Then they'll respond.

In the case I posted, do you think what I did was ok in asking the wife to come in and sign for the records herself?

 

[PikminOC]

It would be a lot cheaper just to make a complaint to the state medical board

So they get the records that way?

 

[PikminOC]

Whopper in the case of the man getting records for the wife that is inappropriate. Those are the wife's records. Psych records are very personal.

 

[michaelrack]

So they get the records that way?

If the state medical board called me and asked why I wasn't giving records to a patient, I would either say 1) yes I will in the next 24 hours, or 2) I would love to but I don't have the records (and I would tell the medical board which sleep lab/institution had the records) or 3) describe the situation why I didn't want to give the records and ask the board's advice

I think most docs would act similarly

 

[PikminOC]

If the state medical board called me and asked why I wasn't giving records to a patient, I would either say 1) yes I will in the next 24 hours, or 2) I would love to but I don't have the records (and I would tell the medical board which sleep lab/institution had the records) or 3) describe the situation why I didn't want to give the records and ask the board's advice

I think most docs would act similarly

Thank you very much.
I did ask for his wife to come in and sign. He wouldn't do it.
I think we are in our rights to ask for that if there is a suspicion.

 

[michaelrack]

Thank you very much.
I did ask for his wife to come in and sign. He wouldn't do it.
I think we are in our rights to ask for that if there is a suspicion.

Agree

 

[PikminOC]

If the state medical board called me and asked why I wasn't giving records to a patient, I would either say 1) yes I will in the next 24 hours, or 2) I would love to but I don't have the records (and I would tell the medical board which sleep lab/institution had the records) or 3) describe the situation why I didn't want to give the records and ask the board's advice

I think most docs would act similarly

You would talk to the board? I heard that its better not to talk to them and have your lawyer handle it.