MEDICAL RECORDS- YOUR RIGHTS TO YOUR MEDICAL RECORDS IN TEXAS
TEXAS MEDICAL RECORDS - YOUR
RESOURCE FOR INFORMATION
ON MEDICAL RECORDS IN TEXAS.
Copyright © 2009 Dr. JOHN
RAYMOND BAKER ,DC. ALL RIGHTS RESERVED.
FOR A PAGE WITH INFORMATION ON PROPER
REQUESTING OF CHIROPRACTIC RECORDS,
PLEASE SEE MY PAGE AT
http://www.drjohnbaker.com/chiropracticrecordsrequest.htm
NOTE- The
Texas Medical Board has no rules or definitions
with regard to the definition of what constitutes or defines a
"primary care provider" . For their official
response to my
inquiry on this matter, please download the PDF of their
return letter
HERE.
ABRIDGED VIDEO ABOUT ELECTRONIC MEDICAL RECORDS (EMR)
| Electronic Medical Records- Version 1
REASON FOR THIS PAGE
|
| EMAIL CONTACT FOR THE COPYRIGHT OWNER OF THIS PAGE Click HERE |
|
This page answers many, but not all questions about medical records in Texas. One question that comes up is who owns the medical records on a patient. The healthcare facility which compiles or generates those records owns them, but the patient about whom they are compiled, has a right to request COPIES of these records. In general, healthcare records should be maintained at the generating facility for seven (7) years. Another question that arises is "What is the right way to correct a medical record?" The accepted method is for the person making the change, to put one horizontal line through the material to be corrected, and then to put a small mark of their initials near the change to identify the person making the change. I always feel that, if space provides for it, the initials should be accompanied by the date the change was made. In general, use of materials such as "whiteout" or other expunging correcting tapes or fluids, should be avoided. Please read on. |
Video above is A MESSAGE FROM THE PAGE AUTHOR AND
SITE OWNER, DR. JOHN RAYMOND BAKER, BS,DC ,ABOUT THE
REASON FOR THE PAGE, MORE ABOUT HIPAA AND CLIA.
There is a lot of talk about how digitizing medical records and having them online will "save money".
To see how I view this notion, please CLICK HERE.
Newest update on Chiropractic records from the
Texas Board if Chiropractic Examiners.
PLEASE CHECK OUT OUR LATEST INFORMATION PAGE, THIS ONE ON PROVIDER
SEARCHES AND REQUESTING RECORDS ON PROVIDERS.click here for that page
Last update of this page was : 16 October 2008 at approximately 12:00 pm, Central Daylight Savings Time.
This site has NOT been updated since that time, and the material presented on this page was correct, as far as the author could determine, on that date. No implied nor express, implicit nor explicit representations are herein made about the validity of the material presented after that date. Laws can and do change. If question arises, please check with the Texas statutes online for the latest changes.
http://tlo2.tlc.state.tx.us/statutes/statutes.html
Texas constitution
http://tlo2.tlc.state.tx.us/txconst/toc.html
For the full Copyright Notice for
this site, please CLICK HERE.
Legal Notice - This site is not associated with the State of Texas , Texas Medical Society , or any similarly named organization , business , or other entity . It does not offer legal nor medical advice. It does offer publicly available information about the laws of Texas and other important information which is useful to the health care consumer.
NEED TO LOOK UP INFORMATION ON A DOCTOR?
http://www.docboard.org/tx/df/txsearch.htm
NEWS ITEM ON ENFORCEMENT OF MEDICAL RECORDS LAWS IN TEXAS
" In the News"
http://www.lubbockonline.com/stories/011108/loc_235668037.shtml
"
Friday, January 11, 2008
Story last updated at 1/11/2008 - 2:42 am
The Texas attorney general filed a lawsuit Thursday against a Pennsylvania-based company accused of discarding hundreds of intact medical records in a Levelland Dumpster.
Authorities found more than 4,000 pieces of patient information, including names, addresses, treatment details and bank account and Social Security numbers, in a Dumpster behind the national medical company's branch in Levelland. The branch closed in October.
That same month, Levelland police recovered information from more than 1,000 patients of Select Physical Therapy Texas Limited Partnership, also known as Health South Rehabilitation Center. But it's too early to determine if anyone's identity has been stolen as a result, authorities said at a news conference in Lubbock.
"I still don't feel secure and I don't think I ever will. I guess I was one of these folks that sat back and thought this isn't going to happen to me," said Marquita Darland, a 64-year-old whose private records were found inside the Dumpster.
The Levelland resident said she checks her accounts three to four times daily for suspicious activity.
She's part of a growing class of victims: More than 25,000 Texans are impacted annually by identity theft, Attorney General Greg Abbott said.
"We are trying to send the message to businesses across the state of Texas: You have a responsibility to shred or redact information in your records that contain personal identifying information of your customers. If you fail to do so, the Texas Legislature has established very high penalties," Abbott said.
Select Physical Therapy and its parent company, Select Medical Corp., are accused of violating a Texas law passed in 2005 to guard consumers from identity thieves who comb trash for personal records. The law requires businesses to make identifying customer information unreadable prior to disposal.
Businesses who break the 2005 Identity Theft Enforcement and Protection Act can be fined up to $50,000 per violation, a fine that will be sought, along with additional civil penalties, in this lawsuit, which is the seventh filed against businesses accused of violating the act."
MY NEWS PAGE ON HIPAA RELATED MATTERS :
LATEST NEWS ON HIPAA (CURRENT)
http://www.newsinferno.com/archives/2363
" Two former Amgen employees are charging that the drug maker engaged in illegal marketing practices in an attempt to increase sales of the drug Enbrel. The former Amgen salespeople claim that they were encouraged by the company to illegally access patient records to induce insurance carriers to pay for Enbrel, an extremely pricey drug.
According to the drug s website, Enbrel is a type of protein called a tumor necrosis factor (TNF) blocker that blocks the action of a substance made by the body s immune system called TNF. People with an immune disease, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis, have too much TNF in their bodies. The Food & Drug Administration (FDA) first approved Enbrel in 2000 for treating rheumatoid arthritis, and its approved uses where expanded several times to include psoriasis and other conditions.
Elena Ferrante of Montvale, New Jersey, who was terminated by Amgen in 2005, and Mark Engelman of Laguna Niguel, California, who resigned from the company last year, is suing Amgen for lost wages and other compensation after refusing to participate in improper promotion of Enbrel. Enbrel is approved only for treating moderate to severe psoriasis, but the former employees say they were expected to engage in promotion efforts that sometimes included patients with less severe disease.
Ferrante and Niguel claim that Amgen sales reps were instructed to go into dermatologists offices and get permission to go through files to identify patients with psoriasis based on the diagnostic coding system insurers use for reimbursement. The representatives were told to then call insurers covering patients with mild psoriasis to seek approval for reimbursement of Enbrel, which costs $20,000 to $50,000 per year, depending on the severity of the sometimes-painful skin condition. When calling the insurance companies, they were instructed not to identify themselves as Amgen sales reps. Rather, they allege that they were told to say that they were calling on behalf of Dr. So-and-so.
The representatives also allege that the Amgen sales force was told to write letters on behalf of doctors, seeking advance approval so doctors could write prescriptions for Enbrel. Doctors writing prescriptions would benefit from frequent patient visits to have the drug injected..
If proved, the allegations could cause Amgen serious trouble. The Health Insurance Portability and Accountability Act (HIPAA) contains very tough sanctions for disclosing someone s health information up to 10 years in jail and a $250,000 fine if the information was transferred or used for commercial advantage. Physicians who agreed to participate in the alleged Enbrel marketing scheme could also be in trouble.
An attorney for the two former Amgen employees told the Associated Press that the New Jersey attorney general s office is investigating and has interviewed Ferrante. According to the Associated Press, that office would not confirm or deny any investigation of Amgen or Enbrel. However, last fall, the New Jersey attorney general convened a task force to investigate how the doctor-patient relationship is affected by the widespread practice of drug and medical device makers giving physicians gifts and fees for researching, consulting and speaking about their products. "
http://members.lycos.co.uk/hipaa
SPECIFIC PAGE ON REQUEST FOR CHIROPRACTIC RECORDS (CLICK HERE)
PAGE LAYOUT :
The First Section is about the HIPAA release being used to get patient records
from providers.
The Second Section is about the Texas Medical Practice Act which governs
release of records.
The Third Section talks about the fees that hospitals can charge for records.
SECTION ONE
Request of Medical Records by a lawyer on a patient...
Lots of attorneys are using a HIPAA section to request medical records on patients.
They are commonly using 45 CFR 164.508 (c). What does this section state ?
For ALL sections (which I believe providers should read) please see this
pdf.http://www.wedi.org/snip/public/articles/45CFR160&164.pdf
CLICK HERE TO OPEN A NEW WINDOW WITH SALIENT POINTS
THE HIPAA RELEASE FOR HEALTHCARE PROVIDERS
-------SNIP-------
The attorneys do not usually give you all the citations, nor do they let you know that
a healthcare providing entity, may opt NOT to provide the requested "all records" which
are frequently sought. The provider may opt to do a summary instead. Also, there are fees which the provider may charge for copying, labor, postage, etc. Also, the provider has 30 days to respond, and also, there is a provision for getting a 30 day extension if warranted.
Please see farther down for this information.
""(b) Implementation specifications: requests for access and timely action.
(1) Individual s request for access. The covered entity must permit an individual to request access to
inspect or to obtain a copy of the protected health information about the individual that is maintained in a designated
record set. The covered entity may require individuals to make requests for access in writing, provided that it
informs individuals of such a requirement.
(2) Timely action by the covered entity.
(i) Except as provided in paragraph (b)(2)(ii) of this section, the covered entity must act on a
request for access no later than 30 days after receipt of the request as follows.
(A) If the covered entity grants the request, in whole or in part, it must inform the
individual of the acceptance of the request and provide the access requested, in accordance with
paragraph (c) of this section.
(B) If the covered entity denies the request, in whole or in part, it must provide the
individual with a written denial, in accordance with paragraph (d) of this section.
(ii) If the request for access is for protected health information that is not maintained or accessible
to the covered entity on-site, the covered entity must take an action required by paragraph (b)(2)(i) of this
section by no later than 60 days from the receipt of such a request.
(iii) If the covered entity is unable to take an action required by paragraph (b)(2)(i)(A) or (B) of
this section within the time required by paragraph (b)(2)(i) or (ii) of this section, as applicable, the covered
entity may extend the time for such actions by no more than 30 days, provided that:
(A) The covered entity, within the time limit set by paragraph (b)(2)(i) or (ii) of this
section, as applicable, provides the individual with a written statement of the reasons for the delay
and the date by which the covered entity will complete its action on the request; and
(B) The covered entity may have only one such extension of time for action on a request
for access.
(c) Implementation specifications: provision of access. If the covered entity provides an individual with access, in
whole or in part, to protected health information, the covered entity must comply with the following requirements.
(1) Providing the access requested. The covered entity must provide the access requested by individuals,
including inspection or obtaining a copy, or both, of the protected health information about them in designated
record sets. If the same protected health information that is the subject of a request for access is maintained in more
than one designated record set or at more than one location, the covered entity need only produce the protected
health information once in response to a request for access.
(2) Form of access requested.
(i) The covered entity must provide the individual with access to the protected health information
in the form or format requested by the individual, if it is readily producible in such form or format; or, if
not, in a readable hard copy form or such other form or format as agreed to by the covered entity and the
individual.
(ii) The covered entity may provide the individual with a summary of the protected health
information requested, in lieu of providing access to the protected health information or may provide an
explanation of the protected health information to which access has been provided, if:
(A) The individual agrees in advance to such a summary or explanation; and
(B) The individual agrees in advance to the fees imposed, if any, by the covered entity for
such summary or explanation.
(3) Time and manner of access. The covered entity must provide the access as requested by the individual
in a timely manner as required by paragraph (b)(2) of this section, including arranging with the individual for a
convenient time and place to inspect or obtain a copy of the protected health information, or mailing the copy of the
protected health information at the individual s request. The covered entity may discuss the scope, format, and other
aspects of the request for access with the individual as necessary to facilitate the timely provision of access.
(4) Fees. If the individual requests a copy of the protected health information or agrees to a summary or
explanation of such information, the covered entity may impose a reasonable, cost-based fee, provided that the fee
includes only the cost of:
(i) Copying, including the cost of supplies for and labor of copying, the protected health
information requested by the individual;
(ii) Postage, when the individual has requested the copy, or the summary or explanation, be
mailed; and
(iii) Preparing an explanation or summary of the protected health information, if agreed to by the
individual as required by paragraph (c)(2)(ii) of this section."
===SNIP=======
What is "reasonable" and "cost based"?
See the following: (Used pursuant to FAIR USE doctrine)
http://www.hipaadvisory.com/action/legalqa/law/Legal47.htm
"
"HIPAA and Medical Record Copy Charges"
By Steve Fox & Rebekah A.Z. Monson, Esqs., Pepper Hamilton LLP
Whether and how much to charge patients, attorneys, and healthcare providers for copies of patient medical records while complying with HIPAA and state laws has become a hot topic. Copies of medical records are routinely requested by patients changing providers, by providers in connection with providing treatment to patients, and by attorneys as part of legal disputes. The HIPAA Privacy Rule (the "Privacy Rule") requires covered entities (i.e., health plans, clearinghouses, and providers who transmit health information in electronic form in connection with a HIPAA covered transaction) to inform individuals of their right of access to inspect and obtain a copy of their protected health information ("PHI") in the individual's designated record set maintained by or for a covered entity. Generally, a designated record set consists of those records that contain health information, including billing information, about the individual.
The Privacy Rule permits covered entities to charge "reasonable, cost-based fees" for providing copies of PHI to individuals or their personal representatives. According to the Privacy Rule, fees for copies of medical records can only include the costs for: (1) copying, including the cost for supplies for and labor of copying; (2) postage if the individual has requested that the information be mailed; and (3) preparing an explanation or summary of the PHI, only if agreed to by the individual as required if the individual requested a summary or explanation instead of records. 45 CFR 164.524(c)(4).
In the Preamble to the Privacy Rule issued on December 28, 2000 (the "Preamble"), the U.S. Department of Health and Human Services ("HHS") clarified that copying fees are to be reasonable and based upon the costs of making the copies, including but not limited to labor and supply costs (examples included in the Preamble are costs of paper for hard copies and the cost of a disk for electronic copies supplied on a computer disk). Furthermore, covered entities may not charge any fees for retrieving or handling the information, or for processing the request for copies. The Privacy Rule does not provide a maximum fee, including a per-page or per-record maximum, so depending upon the length of the record, the total fees could be quite high.
In the Preamble HHS also wrote that fees for copying and postage costs provided under state law are presumed to be "reasonable", however per-page costs that include costs excluded under the Privacy Rule (e.g., processing, retrieving and handling) are not acceptable. As a result, state-mandated fees for copying charges may be preempted by HIPAA and the Privacy Rule. Many state-mandated copying fees are higher than the costs involved in copying the information and therefore these fees may be preempted by the lower "reasonable" cost standard. In connection with providing copies to individuals or their personal representatives, covered entities will need to carefully review the state-mandated fees and determine whether they meet the Privacy Rule reasonableness standard.
The aspect of the Privacy Rule requirements for medical record copying fees that is currently drawing attention is the scope of the fee limitations. The Privacy Rule copying fee requirements seem to only apply to requests made by individuals or their personal representatives and not to other requests or permissible disclosures under HIPAA. Within the context of the access rule itself (45 CFR 164.524), only individuals are addressed and by another provision (45 CFR 164.502(g)), references to individuals include their personal representatives. In general, the authority of a personal representative under the Privacy Rule to act on behalf of an individual stems from the representative's authority to make healthcare decisions for that individual. Furthermore, the Preamble clarified that the intent of HHS was to enable individuals' access to their PHI: "We do not intend to affect the fees that covered entities charge for providing protected health information to anyone other than the individual." 65 Fed. Reg 82462, 82557 (Dec. 28, 2000), see also 67 Fed. Reg. 53182, 53254 (Aug. 14, 2002). As a result, requests in the form of subpoenas or from third parties and their attorneys appear to fall outside of the HIPAA-imposed fee limitations and remain subject to applicable state laws.
The Privacy Rule standard has added another (federal) standard to the patchwork of medical records copying fees regulations that exist under various state laws governing requests by patients, subpoenas, workers compensation, insurance and medical claims, and other agency requests. However, the Privacy Rule fee restrictions only overlap with certain requests for copies -- namely those by an individual or the individual's personal representative, for the individual's PHI. Fees for other copy requests do not appear to be affected by the Privacy Rule. This is an area of the Privacy Rule that has generated confusion and has been gaining attention and may well become the subject of litigation."
===SNIP===
Also on this topic, see this :
HIPAA copy charges for medical records
"
When patients request a copy of their medical record, how much do you charge? And how do you itemize that expense? Do you have clear-cut policies about how to charge? An often overlooked element in the HIPAA Standards for Privacy of Individually Identifiable Health Information concerns how much an entity may charge patients or their designated representative for a copy of their medical record.
The HIPAA privacy standards section 164.524 (c)(4) states the following about charging patients for copies of their medical records:
Fees: If the individual requests a copy of the protected health information or agrees to a summary or explanation of such information, the covered entity may impose a reasonable, cost-based fee provided that fee includes only the cost of:
(i) Copying, including the cost of supplies for and labor of copying, the protected health information requested by the individual;
(ii) Postage, when the individual has requested the copy, of the summary or explanation, he mailed; and
(iii) Preparing an explanation or summary....
The preamble to HIPAA privacy standards section 164.524 (c)--Provision of Access further states:
We clarify this provision in the final rule. If the individual requests a copy protected health information, a covered entity may charge a reasonable, cost-based lee for the copying, including the labor and supply costs of copying. If hard copies are made, this would include the cost of paper. If electronic copies are made to a computer disk, this would include the cost of the computer disk. Covered entities may not charge any fees for retrieving or handling the information or for processing the request. If the individual requests the information to be mailed, the fee may include the cost of postage. Fees for copying and postage provided under state law, but not for other costs excluded under this rule, are presumed reasonable. If such per page costs include the cost of retrieving of handling the information, such costs are not acceptable under this rule (emphasis added).
Providers should familiarize themselves with the HIPAA mandate and establish a clear-cut policy for medical-record copy charges.
What Can and Cannot Be Charged?
In addition to paying for copies of the medical record, patients who request a summary of their record must agree in advance to pay the cost of such a summary. Therefore, many of the activities listed in the sidebar above will occur, and providers should determine which activities can be charged and which cannot. Also, a qualified individual needs to review and summarize the record.
Alternatively, the organization could consider these options:
* Establish an appointment schedule to have a health information professional, the attending physicians, and/or another healthcare professional review and explain the contents of the record to the patient
* Define the "summary" as including certain designated documents such as transcribed or typed documents in the patient record
An hourly rate could be established for the first option, shared with the patient or patient's representative, and accepted by the patient before any effort begins. For the second option, the health information management (HIM) department could determine an average charge for these types of reports in a medical record of different stay increments, such as 1-5 days, 6-10 days, 11-20 days, 21-40 days, and more than 40 days. The charge would vary by length of stay. These are just two options; the healthcare organization's privacy committee may have considered others.
HIPAA Preempts Many State Laws
Although the preamble to the HIPAA privacy standards indicates that the per-page copy fees established by the states will be "presumed" reasonable, some experts believe that this will be a point of contention with plaintiff attorneys nationwide. Many state-mandated copy fees are higher than the costs involved in the single activity of copying and, therefore, could be preempted by the HIPAA regulations. Preemption is intended to protect patients' right to privacy and to allow patients greater access to their protected health information.
Given these criteria, the state-mandated fees could be more costly than the labor needed to make copies, possibly making patients' access to their protected health information cost-prohibitive. As a result, HIPAA may open a quagmire whereby state fees are preempted by the lower "reasonable" cost to make the copies. Note that this mandate applies only to copies requested by individuals or their designated representatives. Other requesters, such as insurers and attorneys, can continue to be charged the state-mandated fee.
Some state-mandated fees consist of a relatively substantial retrieval or handling charge ($10-$20) plus a per-page copy fee ($0.25-$1.00). Every state varies. Clearly, the HIPAA privacy standards preamble bars any covered entity from charging individuals the "retrieval or handling lee." "
FOR THOSE JUST WANTING THE MOST RECENT INFO ON COST OF GETTING MEDICAL RECORDS,
PROCESS, AND OTHER SIMPLE INFORMATION, I HAVE INCLUDED THAT AT THE TOP OF THE PAGE AS
AN UPDATE.
| Per http://www.tsbme.state.tx.us/rules/rules/165.htm
165.1.Medical Records.
165.2. Medical Record Release and Charges.
165.3. Patient Access to Diagnostic Imaging Studies in Physician's Office.
165.4. Appointment of Record Custodian of a Physician's Records.
165.5. Transfer and Disposal of Medical Records.
|
NEW SITE FOR HIPPA INFORMATION -
For the folks needing links and information on HIPAA, i.e. administrative questions, links, text of the 1996 Act, and other questions, we have a site up at :
http://members.lycos.co.uk/hipaa/ . There is the link to the federal lawsuit filed hy the Association of Physicians and Surgeons against HHS regarding privacy provisions, and much more.
We started that site because of what we perceived was an ocean of misinformation and paranoia being spread about the HIPAA provisions. Also, there is a fraud provision to the HIPAA Act, and non-healthcare providers may be prosecuted under this provision. At any rate, check it out if you get the inclination or have questions. That's http://members.lycos.co.uk/hipaa/ .
PAGE ORGANIZATION- The CLIA material is at the top (Section A), the HIPAA stuff follows that,(Section B) and then, there are general citations of Texas statutes about costs of copying (individual providers have a different set of rules to follow (Section C)and different fee guidelines than hospitals), form of a proper request, Occupations Codes, Medical Practice Act, and TSBME Rules.
Affirmative Notice- The author makes no implied nor stated guarantees concerning
the material presented on this page. The page author is not an attorney, but has made
a duly diligent effort to maintain the most recent material available with regard to the
laws of the State of Texas, as they applied to medical records. HIPAA, as a federal act,
is also covered on this page by means of links to the appropriate authorities in this matter.This page both in form and content, is copyright (c) 2000-2003 by
Dr. John R. Baker ,D.C. All Rights are Reserved.
September 28,2003- New addition to the page. It is my belief that TOO MANY physicians in Texas are afraid, reluctant, or reticent to properly manage significant pain in patients, and are ignoring the provisions of the Texas Intractable Pain Act of 1989.
If you are a patient, or a physician, and HAVE NOT, properly acquainted yourself with
the provisions of this act, PLEASE TAKE THE TIME, to review the intent, and the specific provisions of this law. There isNO REASON for patients to suffer from intractable pain
needlessly, and if a physician is allowing this, out of fear of the Texas State Board of Medical Examiners, you should read this law, and if the Board attempts to curtail your proper usage of pain relievers , you should have your attorney to bring up this Act, which apparently was born of just such fears of retaliation by the Board.
Click here for complete text of the TIPA.
The date is October 18th, 108
Aviso legal - Este sitio no se asocia al estado del Tejas, la sociedad m dica de Tejas, o la ninguna organizaci n semejantemente nombrada, el negocio, o la otra entidad. No ofrece consejo legal ni m dico. Ofrece p blico la informaci n disponible sobre los leyes de Tejas y la otra informaci n importante que es til al consumidor del cuidado m dico .
PAGE CONTENTS: ALTHOUGH MANY VISITORS VISIT WITH REGARD TO FINDING INFORMATION ON THEIR SPECIFIC STATE AND/OR COUNTRY'S LAWS REGARDING MEDICAL RECORDS, DUE TO THE AMOUNT OF VARIANCE BETWEEN STATES WITH REGARD TO STATUTES AND LAWS REGARDING MEDICAL RECORDS, THE PAGE AUTHOR HAS CHOSEN ONLY TO ADDRESS THE LAWS AND REQUIREMENTS UNDER TEXAS LAW(S). Due to the interest in HIPAA , we do provide links to information on HIPAA.
Definition :
Subpoena duces tecum : (suh-pea-nah dooh-chess-take-uhm or dooh-kess-take-uhm): a court order requiring a witness to bring documents in the possession or under the control of the witness to a certain place at a certain time. This subpoena must be served personally on the person subpoenaed. It is the common way to obtain potentially useful evidence, such as documents and business records, in the possession of a third party. A subpoena duces tecum must specify the documents or types of documents (e.g. "profit and loss statements of ABC Corporation for years 1987 through 1995, all correspondence in regard to the contract between ABC Corporation and Merritt") or it will be subject to an objection that the request is "too broad and burdensome." To obtain documents from the opposing party, a "Request for Production of Documents" is more commonly used. Failure to respond to a subpoena duces tecum may subject the party served with the subpoena to punishment for contempt of court for disobeying a court order.
A sample used for taxes is found at :http://www.window.state.tx.us/taxinfo/taxforms/50-219.pdf
and here is a witness subpoena duces tecum : Witness Subpoena Subpoena Duces Tecum
Another sample subpoena duces tecum in Texas :http://sago.tamu.edu/legal/Forms/student2.doc
One used in probate court in Texas :http://www.cclerk.hctx.net/DLFORMS/i0277.pdf
SECTION A
In Texas, in HIPAA, and just about in every jurisdiction in the United States, if there is one party who is , authorized to view medical records, it is the person about whom these records were created, i.e. "the patient". In Texas, the patient has the right to request release of medical records from physicians, other health care professionals, hospitals, and other persons maintaining medical records of a provider status. The Rules of the Texas Board of Medical Examiners, the Occupations Codes, the Health and Safety Codes, the Medical Practice Act, and the Chiropractic Act, ALL spell out the patient as being an authorized person. Thus, it seems that Clinical Pathology Laboratories, Inc. is
operating in a very bizarre fashion with regard to its billing procedures, but they
are intentionally trying to misinterpret CLIA. For those wanting more information
on the provisions of CLIA, please follow the following link :
http://www.vh.org/adult/provider/pathology/CLIA/LabGuideIndex.html (interpretive guidelines)
http://www.vh.org/adult/provider/pathology/CLIA/SearchCLIA.html (search page)
You may also contact the people involved in the government with CLIA at the following link :
HIPAA- regarding release of private, individually identifiable,protected health information :
http://www.hhs.gov/news/facts/privacy.html
"Limits on Use of Personal Medical Information. The privacy rule sets limits on how health plans and covered providers may use individually identifiable health information. To promote the best quality care for patients, the rule does not restrict the ability of doctors, nurses and other providers to share information needed to treat their patients. In other situations, though, personal health information generally may not be used for purposes not related to health care, and covered entities may use or share only the minimum amount of protected information needed for a particular purpose. In addition, patients would have to sign a specific authorization before a covered entity could release their medical information to a life insurer, a bank, a marketing firm or another outside business for purposes not related to their health care."
(Emphasis added by page author. Please see the misrepresentation made by a hospital in Texas, and the fact that they are NOT following the HIPAA guidelines.)
Firstly, some HIPAA resource links:
http://www.hipaadvisory.com/regs/
MEDICAL PRIVACY
http://www.hhs.gov/ocr/hipaa/finalreg.html
MORE RELEASE INFO
http://www.spcbtx.org/forms/Consumer/medrelease.pdf
For the text of HIPAA...click here (opens in new page)
HIPAA - HIPAA seems to be the buzzword nowadays. One link for more information is:
http://telehealth.hrsa.gov/pubs/hipaa.htm
Another good link (updated on April 14, 2003) is http://www.hhs.gov/ocr/hipaa/
From this site, we have these links:
" Protecting the Privacy of Patients' Health Information
4-page general Fact Sheet describing patients' rights and the responsibilities of
health plans, doctors and other covered entities - April 14, 2003
View Health Information Privacy Frequently Asked Questions (FAQs)
What's New - Updated April 15, 2003 with the Interim final rule: Civil Money Penalties:
Procedures for Investigations, Imposition of Penalties, and Hearings.
Unofficial Version - The Office of the Federal Register publishes the official version of all federal regulations
Privacy Guidance about Authorizations for Research and Institutional Review Boards "
Privacy issues covered in HIPAA
http://telehealth.hrsa.gov/pubs/privac.htm
A new and useful website available from Public Citizen is :
http://www.questionabledoctors.org
New -Texas State Board of Medical Examiners Rule 173.1, mandates the establishment of physician profiles with a wealth of information. The search page is located at http://204.65.101.19/ProfileOnLine/Phys_SearchPage.asp
If you look up your doctor, you
will probably not find him or her there.
State of Texas Request for Records
In Texas, there are three essentials on a written, signed, request for records, for the patient requesting copies of their own records.
The written request must contain the following essential elements :
(A) the information or medical records to be covered by the release;
(B) the reasons or purposes for the release; and
(C) the person to whom the information is to be released,
Thus, to construct a good request for records in Texas, you should include the following,
even if it is a request for your own records.
1) The "three questions" cited above need to be answer.
2) It must be in writing.
3) The name, address, date of birth, and social security number of the patient
should be on the form.
4) Some places are sticklers about an idiotic inclusions of the following phrase
"I understand I have the write to revoke this authorization at any time."
And, just to make the HIPAA idiots happy, you should request all
"protected health information and records", as well as all "individually identifiable
health information and records for the patient named and identified."
I say that is rather retarded because, if the patient is doing the authorization, and
directs that copies of the records be delivered to the patient, it is nonsensical to
say that you would revoke delivery of copies of records to yourself, unless you
are a sufferer of multiple personality disorder and the right hand doesn't know
what the left hand is doing.
With regard to such matters as copying of medical records, fees for copying records, etc. , please refer to the TSBME Rule
165 -
ESPANOL -PARA UN PAGINA DE TEXAS STATE BOARD OF MEDICAL EXAMINERS DE RULE 165,aqui
CHIROPRACTIC- The Chiropractic Board on its website gives guidelines on a doctor's responsibility regarding medical records.
Please view these at : http://www.tbce.state.tx.us/enforce.html
They site the following :
"What is a "reasonable" charge for chiropractic records?
22TAC 80.3 (e), (4)A reasonable fee for paper copies is
not to exceed: (a)$30 for retrieval of records and processing
the request, including copies for the first 10 pages;
(b)$1.00 per page for pages 11-60; (c)$.50 per page for
pages 61-400; and (d)$.25 per page for pages over 400;
(5)A reasonable fee for copies of films or other static
diagnostic imaging studies shall be a charge not to exceed
$45 for retrieval and processing ,including copies for the
first 10 pages, and $1.00 for each additional page over 10.
(6)Reasonable fees may also include actual costs for mailing,
shipping or delivery."
Also, from the Chiro Board:
"How long must I retain the records of my patients?
22TAC 80.5: an adequate record for each patient
shall be maintained for a minimum of seven years from
the anniversary date of the last treatment."
UPDATE- 3-28-2002
A serious danger to your freedoms and privacy is looming. Bush is trying to decrease the confidentiality of your medical
records (what do you expect from someone, who while governor of Texas said "There ought to be limits to freedom."
In the Washington Post, there is an article on this:
http://www.washingtonpost.com/ac2/wp-dyn/A158-2002Mar21?language=printer
The Bush administration yesterday proposed changing some of the federal rules designed to protect the confidentiality of Americans' medical records, including the ability of patients to decide in advance who should be able to use their personal health information.
The proposal would alter a federal safeguard, adopted by the Clinton administration, that compels patients to give written permission before their records may be disclosed to doctors, hospitals, pharmacies and insurance companies. The new version would erase that requirement and, instead, say that patients must at some point be notified of their privacy rights by those who use their records.
In other changes that would loosen privacy rules, the administration wants to enable more parents to find out what medical services their teenagers seek and make it easier for researchers to gain access to patients' records. In addition, business associates of various health care providers would be given more time before they have to follow the confidentiality rules."
For a laugh, and to show the craziness of the situation, check out this link :
http://www.seniors.gov/articles/0401/patient-privacy-rule.htm
And then, look at this site:
http://www.haciendapub.com/faria1.html
Regarding copying fees for medical records, there is a standard for physicians established
by the Texas State Board of Medical Examiners and sets definite limits for costs, plus a
time period of 15 business days within which records must be provided (if they have already
been paid for). This is promulgated and provided for under the Occupations Code (i.e.
that the TSBME set the "reasonable fee" standard). If you encounter doctors who are breaking
these laws and either overcharging or not getting your records to you within this time frame, you should
contact the Texas State Board of Medical Examiners and advise them of the violations by this doctor.
Their website is located at : http://www.tsbme.state.tx.us. Their complaint page is located at:
http://www.tsbme.state.tx.us/complain/complain.htm
Hospitals have different rules. From
http://www.texashealth.org/main.asp-enorgid--level-2-id-B6CA869F36DC4881BD35AAD7A7A271D0
" Fees
The Texas Legislature sets the fees our hospital charges for copies of medical records. This is found in S241.154(e) of the Health and Safety Code. These charges are reviewed and updated annually based on the price index as published by the Bureau of Labor Statistics of the United States Department of Labor. The following fees are effective as of September 2, 2005:
Medical Records in Paper Form
Each hospital charges the following fees for the copying of health care information. Additionally, the hospital charges the actual cost of mailing, shipping or otherwise delivering the provided copies.
1-10 pages: $38.31 11-60 pages: $1.28 per page 61-400 pages: $0.64 per page More than 400 pages: $0.33 per page
Records Stored on Other Medium
If the requested records are stored on any microform or other electronic medium, the hospital charges the following fees. Additionally, the hospital charges the actual cost of mailing, shipping or otherwise delivering the provided copies.
1-10 pages: $57.48 Subsequent pages: $1.28 per page
Exceptions
Local, state or federal agencies requesting health care information may be entitled by statute to a different fee. The agency should inform the hospital of this fact, or information can be obtained from the Legal Department.
Other Charges
The hospital may charge a reasonable fee for:
- Execution of an affidavit or certification of a document, not to exceed the charge authorized by Section 22.004, Civil Practice and Remedies Code; and
- Written responses to a written set of questions, not to exceed $12.77 for a set. "
====SNIP-
Also, from another source on hospital records :
http://www.tmb.state.tx.us/consumers/faq/mrec.php
"
Requests for records created and kept by a hospital should be directed to the hospital rather than to the physician. Fees by hospitals differ from those records provided by physicians.
Samples of Record Requests
The following are samples of record requests which contain the required three elements mentioned above:
- Sample #1
Dear Dr.___. Please send a complete copy of my medical records to my new physician, Dr.___, (provide complete address, including zip code), so that he/she can review my medical history. (Patient signature, followed by complete name, legibly printed or typed).
- Sample #2
Dear Dr.___. Please send a copy of the immunization records of my child, (child's full name), to the following school, (give complete name and address of school, and name of person at school who is to receive the report), for their records. (Signature of parent or legal guardian, followed by complete name, legibly printed or typed).
- Sample #3
Dear Dr. ___. Please send a complete copy of my medical records to me for my personal files. (Patient signature, followed by complete name, legibly printed or typed).
- Sample #4
Dear Dr. ___. Please send a complete copy of my medical records, excluding any reference to HIV testing, to my employer, (give complete name and address of employer), for their files. (Patient signature, followed by complete name, legibly printed or typed.
- Sample #5.
Dear Dr. ___. Please send copies of the EKG and the results of the lab studies performed in your office last month to Dr. ___ (complete address). I need this information for ongoing medical care. (Patient signature, followed by complete name, legibly printed or typed)."
Keywordsfor this page= rights , medical records , retrieval services , document retrieval service ,request , release , authorization ,subpoena , duces , tecum ,HIPAA, privacy, Medical Practice Act ,patient chart ,file ,chart, lawyers , attorneys , laboratory , health records , document services .chiropractic, medical records , Medical Practice Act ,patient records , release of records , 165.2 , Texas
Labels: medical records, rights
posted by Dr. John Baker,DC at
8:10 PM
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