http://bakerchiropractic.net/tightropecopper.htm

http://bakerchiropractic.net/tightropecopper.htm

http://www.johnraymondbaker.com/healthcareinlongview.htm

http://www.johnraymondbaker.com/healthcareinlongview.htm

http://www.johnraymondbaker.com/healthcareinlongview.htm

http://www.johnraymondbaker.com/healthcareinlongview.htm

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

" State sues over tossed Levelland medical records

By Marlena Hartz | AVALANCHE-JOURNAL

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. (a) Contents of Medical Record. Each licensed physician of the board shall maintain an adequate medical record for each patient that is complete, contemporaneous and legible. For purposes of this section, an "adequate medical record" should meet the following standards: (1) The documentation of each patient encounter should include: (A) reason for the encounter and relevant history, physical examination findings and prior diagnostic test results; (B) an assessment, clinical impression, or diagnosis; (C) plan for care (including discharge plan if appropriate); and (D) the date and legible identity of the observer. (2) Past and present diagnoses should be accessible to the treating and/or consulting physician. (3) The rationale for and results of diagnostic and other ancillary services should be included in the medical record. (4) The patient's progress, including response to treatment, change in diagnosis, and patient's non-compliance should be documented. (5) Relevant risk factors should be identified. (6) The written plan for care should include when appropriate: (A) treatments and medications (prescriptions and samples) specifying amount, frequency, number of refills, and dosage; (B) any referrals and consultations; (C) patient/family education; and, (D) specific instructions for follow up. (7) Billing codes, including CPT and ICD-9-CM codes, reported on health insurance claim forms or billing statements should be supported by the documentation in the medical record. (8) Any amendment, supplementation, change, or correction in a medical record not made contemporaneously with the act or observation shall be noted by indicating the time and date of the amendment, supplementation, change, or correction, and clearly indicating that there has been an amendment, supplementation, change, or correction. (9) Records received from another physician or health care provider involved in the care or treatment of the patient shall be maintained as part of the patient's medical records. (10) The board acknowledges that the nature and amount of physician work and documentation varies by type of services, place of service and the patient's status. Paragraphs (1)-(10) of this subsection may be modified to account for these variable circumstances in providing medical care. (b) Maintenance of Medical Records. (1) A licensed physician shall maintain adequate medical records of a patient for a minimum of seven years from the anniversary date of the date of last treatment by the physician. (2) If a patient was younger than 18 years of age when last treated by the physician, the medical records of the patient shall be maintained by the physician until the patient reaches age 21 or for seven years from the date of last treatment, whichever is longer. (3) A physician may destroy medical records that relate to any civil, criminal or administrative proceeding only if the physician knows the proceeding has been finally resolved. (4) Physicians shall retain medical records for such longer length of time than that imposed herein when mandated by other federal or state statute or regulation. (5) Physicians may transfer ownership of records to another licensed physician or group of physicians only if the physician provides notice consistent with 165.5 of this chapter and the physician who assumes ownership of the records maintains the records consistent with this chapter. (6) Medical records may be owned by a physician's employer, to include group practices, professional associations, and non-profit health organizations, provided records are maintained by these entities consistent with this chapter. 165.2. Medical Record Release and Charges. (a) Release of Records Pursuant to Written Request. As required by the Medical Practice Act, 159.006, a physician shall furnish copies of medical and/or billing records requested or a summary or narrative of the records pursuant to a written release of the information as provided by the Medical Practice Act, 159.005, except if the physician determines that access to the information would be harmful to the physical, mental, or emotional health of the patient. The physician may delete confidential information about another patient or family member of the patient who has not consented to the release. If by the nature of the physician's practice, the physician transmits health information in electronic form, the physician may be subject to the Health Insurance Portability and Accountability Act (HIPAA) 45 C.F.R. Parts 160-164. Unless otherwise provided under HIPAA, physicians subject to HIPAA must permit the patient or an authorized representative access to inspect medical and/or billing records and may not provide summaries in lieu of actual copies unless the patient authorizes the summary and related charges. (b) Deadline for Release of Records. The requested copies of medical and/or billing records or a summary or narrative of the records shall be furnished by the physician within 15 business days after the date of receipt of the request and reasonable fees for furnishing the information. (c) Denial of Requests for Records. If the physician denies the request for copies of medical and/or billing records or a summary or narrative of the records, either in whole or in part, the physician shall furnish the patient a written statement, signed and dated, within 15 business days of receipt of the request stating the reason for the denial and how the patient can file a complaint with the federal Department of Health and Human Services (if the physician is subject to HIPAA) and the Texas State Board of Medical Examiners. A copy of the statement denying the request shall be placed in the patient's medical and/or billing records as appropriate. (d) Contents of Records. For purposes of this section, "medical records" shall include those records as defined in 165.1(a) of this title (relating to Medical Records) and shall include copies of medical records of other health care practitioners contained in the records of the physician to whom a request for release of records has been made. (e) Allowable Charges. (1) The physician responding to a request for such information shall be entitled to receive a reasonable, cost-based fee for providing the requested information. A reasonable fee shall be a charge of no more than $25 for the first twenty pages and $.50 per page for every copy thereafter. If an affidavit is requested, certifying that the information is a true and correct copy of the records, a reasonable fee of up to $15 may be charged for executing the affidavit. A physician may charge separate fees for medical and billing records requested. The fee may not include costs associated with searching for and retrieving the requested information. (2) A reasonable fee, shall include only the cost of: (a) copying, including the labor and cost of supplies for copying; (b) postage, when the individual has requested the copy or summary be mailed; and (c) preparing a summary of the records when appropriate. (f) Emergency Requests. The physician providing copies of requested medical and/or billing records or a summary or a narrative of such records shall be entitled to payment of a reasonable fee prior to release of the information unless the information is requested by a licensed Texas health care provider or a physician licensed by any state, territory, or insular possession of the United States or any State or province of Canada if requested for purposes of emergency or acute medical care. (g) Non-emergent Requests. In the event the physician receives a proper request for copies of medical and/or billing records or a summary or narrative of the records for purposes other than for emergency or acute medical care, the physician may retain the requested information until payment is received. If payment is not routed with such a request, within ten calendar days from receiving a request for the release of such records, the physician shall notify the requesting party in writing of the need for payment and may withhold the information until payment of a reasonable fee is received. A copy of the letter regarding the need for payment shall be made part of the patient's medical and/or billing record as appropriate. (h) Improper Withholding for Past Due Accounts. Medical and/or billing records requested pursuant to a proper request for release may not be withheld from the patient, the patient's authorized agent, or the patient's designated recipient for such records based on a past due account for medical care or treatment previously rendered to the patient. (i) Subpoena Not Required. A subpoena shall not be required for the release of medical and/or billing records requested pursuant to a proper release for records under this section and the Medical Practice Act, 159.006, made by a patient or by the patient's guardian or other representative duly authorized to obtain such records. (j) Billing Record Requests. In response to a proper request for release of medical records, a physician shall not be required to provide copies of billing records pertaining to medical treatment of a patient unless specifically requested pursuant to the request for release of medical records. (k) Prohibited Fees for Records Released Related to Disability Claims. The allowable charges as set forth in this chapter shall be maximum amounts, and this chapter shall be construed and applied so as to be consistent with lower fees or the prohibition or absence of such fees as required by state statute or prevailing federal law. In particular, under 161.202 of the Texas Health and Safety Code, a physician may not charge a fee for a medical or mental health record requested by a patient, former patient or authorized representative of the patient if the request is related to a benefits or assistance claim based on the patient's disability. (l) Applicable Federal Law. Whenever federal law or applicable federal regulations affecting the release of patient information are inconsistent with provisions of this section, the provisions of federal law or federal regulations shall be controlling, unless the state law is more restrictive/stringent. Physicians are responsible for ensuring that they are in compliance with federal law and regulations including the Health Insurance Portability and Accountability Act (HIPAA) 45 C.F.R. Parts 160-164. 165.3. Patient Access to Diagnostic Imaging Studies in Physician's Office. (a) Purpose. This section is promulgated to ensure that patients have reasonable access to films and other static diagnostic imaging studies maintained in the physician's office and that the practice of medicine by individual licensees and the delivery of health care to the public shall not be unduly hindered or interrupted by allowing for such access. (b) Request and release. (1) Upon receiving a written request and release of information as provided for in the Medical Practice Act, 159.005, as required for the release of medical records, a physician in possession or control of films or other static diagnostic imaging studies of a patient shall allow access to the films or other diagnostic imaging studies through one or more of the following means: (A) providing copies of the films or other static diagnostic imaging studies to the patient or recipient as designated in the request; or, (B) releasing the original films or other static diagnostic imaging studies to the patient or recipient as designated in the request. (2) Release and transfer of original films or other static diagnostic imaging studies may be evidenced by a signed and dated receipt from a recipient of the original films or other diagnostic imaging studies, or from their authorized representative, acknowledging receipt of and responsibility for the original studies. (c) Exceptions. As provided for under the Medical Practice Act, 159.005, a physician is not required to release films or other static diagnostic imaging studies directly to a patient if the physician determines that access to the films or static diagnostic imaging studies would be harmful to the physical, mental, or emotional health of the patient. If a physician makes a determination that access would be harmful to the physical, mental, or emotional health of the patient, the physician shall, within the time allowed after receipt of a proper request, provide access to the requested films or static diagnostic imaging studies to an authorized representative of the patient as provided for in subsection (b) of this section. (d) Time for release and denial. The requested copies or access to films or other static diagnostic imaging studies shall be provided by the physician within 15 business days after the date of receipt of the request. If the physician denies the request, in whole or in part, the physician shall furnish the patient a written statement, signed and dated, within 15 business days of receipt of the request stating the reason for the denial and how the patient can file a complaint with federal Department of Health and Human Services and the Texas State Board of Medical Examiners. A copy of the statement denying the request shall be placed in the patient's medical records. (e) Fees. The physician responding to a request for copies of films or other static diagnostic imaging studies shall be entitled to a reasonable fee for providing the copies. A reasonable fee shall be no more than $8 per copy. In addition, a reasonable fee may include actual costs for mailing, shipping, or delivery. (f) Emergency Request. The physician providing copies of requested films or other static diagnostic imaging studies shall be entitled to a reasonable fee prior to release of the copies unless the copies are requested by a licensed Texas health care provider or a physician licensed by any state, territory, or insular possession of the United States or any state or province of Canada if requested for purposes of emergency or acute medical care. (g) Non-emergent Requests. In the event that the physician receives a proper request for copies of films or other static diagnostic imaging studies for purposes other than for emergency or acute medical care, the physician may retain the requested information until payment is received. If payment is not routed with such a request, within ten calendar days from receiving a request for copies of films or other static diagnostic imaging studies, the physician shall notify the requesting party in writing of the need for payment and may withhold the copies until payment of a reasonable fee is received. A copy of the letter regarding the need for payment shall be made part of the patient's medical record. (h) Improper Withholding for Past Due Accounts. Access to or copies of films or other static diagnostic imaging studies requested pursuant to a proper request for release may not be withheld from the patient, the patient's authorized agent, or the patient's designated recipient for such copies based on a past due account for medical care or treatment previously rendered to the patient. (i) Subpoena. A subpoena shall not be required for access to or the release of originals or copies of static diagnostic imaging studies requested pursuant to the provisions of this section. (j) Maximum charges. The allowable charges set forth in this section shall be maximum amounts, and this section shall be construed and applied so as to be consistent with lower fees or the prohibition or absence of such fees as required by prevailing state or federal law. 165.4. Appointment of Record Custodian of a Physician's Records. (a) The board may appoint a temporary or permanent custodian for medical records abandoned by a physician when a person or entity applies with the board to be appointed record custodian. (b) The records will be considered abandoned if they are without custodial care for a minimum of two weeks without alternative arrangements being made by the physician, the physician's legal guardian, or by the executor of the physician's estate. (c) The record custodian appointed by the board shall take custody of and maintain the confidentiality of the physician's records, to include available medical records and billing records, according to the provisions of board rules and state statutes. (d) The appointed record custodian shall provide the records, or copies of the records, to the patient or to the patient's designee according to board rules and state statutes. In addition to the reasonable copying fee defined in board rules, the appointed record custodian may charge an additional fee of $25.00 per patient record. (e) The appointed record custodian shall retain care of the records for no less than 90 days and shall publish appropriate notice of pending destruction of the records for no less than 30 days prior to destruction of the records. (f) Destruction of medical records shall be done in a manner that ensures continued confidentiality. (g) The board may publish a Request for Bids for one entity to function as the appointed record custodian for all areas of the state. If a sole statewide contractor is not selected, the board may publish a Request for Bids for entities to function as regional appointed record custodian or a custodian may be appointed on a case by case basis. 165.5. Transfer and Disposal of Medical Records. (a) Required Notification of Discontinuance of Practice. When a physician retires, terminates employment or otherwise leaves a medical practice, he or she is responsible for: (1) ensuring that patients receive reasonable notification and are given the opportunity to obtain copies of their records or arrange for the transfer of their medical records to another physician; and (2) notifying the board when they are terminating practice, retiring, or relocating, and no longer available to patients, specifying who has custodianship of the records, and how the medical records may be obtained. (3) Employers of the departing physician as described in 165.1(b)(6) of this chapter are not required to provide notification, however, the departing physician remains responsible for providing notification consistent with this section. (b) Method of Notification. (1) When a physician retires, terminates employment, or otherwise leaves a medical practice, he or she shall provide notice to patients of when the physician intends to terminate the practice, retire or relocate, and will no longer be available to patients, and offer patients the opportunity to obtain a copy of their medical records. (2) Notification shall be accomplished by: (A) publishing notice in the newspaper of greatest general circulation in each county in which the physician practices or practiced and in a local newspaper that serves the immediate practice area; (B) placing written notice in the physician's office; and (C) sending letters to patients seen in the last two years notifying them of discontinuance of practice. (3) A copy of the notice shall be submitted to the Board within 30 days from the date of termination, sale, or relocation of the practice. (4) Notices placed in the physician's office shall be placed in a conspicuous location in or on the facade of the physician's office, a sign, announcing the termination, sale, or relocation of the practice. The sign shall be placed at least thirty days prior to the termination, sale or relocation of practice and shall remain until the date of termination, sale or relocation. (c) Prohibition Against Interference. (1) Other licensed physicians remaining in the practice may not prevent the departing physician from posting notice and the sign. (2) A physician or physician group should not withhold information from a departing physician that is necessary for notification of patients. (d) Voluntary Surrender or Revocation of Physician's License. (1) Physicians who have voluntarily surrendered their licenses in lieu of disciplinary action or have had their licenses revoked by the board must notify their patients, consistent with subsection (b), within 30 days of the effective date of the voluntary surrender or revocation. (2) Physicians who have voluntarily surrendered their licenses in lieu of disciplinary action or have had their licenses revoked by the board must obtain a custodian for their records to be approved by the board within 30 days of the effective date of the voluntary surrender or revocation. (e) Criminal Violation. A person who violates any provision of this chapter is subject to criminal penalties pursuant to 165.151 of the Act. ==================================================================== Texas Health and Safety Texas Texas Health & Safety Code 241.154: Hospitals: A basic retrieval or processing fee not to exceed $30.00 for first 10 pages of records; then, $1.00 per page for pages 11-60 $.50 per page for pages 61-400 $.25 per page for any remaining pages Plus actual cost of mailing or shipping In addition, a reasonable fee not to exceed $10.00 for execution of an affidavit or certification of records. Microform or electronic medium copy processing fee can be up to $45.00. 22 Texas Administrative Code 165.2(e) Doctors: No more than $25.00 for the first 20 pages; then, $.50 per page for every copy thereafter In addition, actual cost of mailing or shipping Also, a reasonable fee not to exceed $15.00 for executing affidavit. 22 Texas Administrative Code 165.3 Doctors: Maximum charge for x-rays and diagnostic imaging studies $8.00 per copy ===================================== From http://www.hcms.org/commheal/medrecpt.html The Harris County Medical Society has prepared the following guidelines on medical records. It is hoped that this guide will be helpful in answering the questions asked most often by patients. The information has been taken from several sources to provide a simple and condensed reference. There are quotations from The Medical Practice Act of Texas (1994) which is the law governing the practice of medicine in our state. 1. What is included in a patient's medical records? The Medical Practice Act of Texas states, "Medical Records means any records pertaining to the history, diagnosis, treatment, or prognosis of the patient." 2. Who owns the medical records? The American Medical Association's Code of Medical Ethics Current Opinion states, "Notes made in treating a patient are primarily for the physician's own use and constitute his/her property. However, a physician shall furnish (1) copies of medical records (2) a summary or (3) a narrative report of the medical records, pursuant to a written consent for release of the information." 3. Does the patient have to sign the written consent for release before the physician releases or forwards the medical records? The Medical Practice Act of Texas states, "Consent for the release of confidential information must be in writing and signed by the patient, or a parent or legal guardian if the patient is a minor, or a legal guardian if the patient has been adjudicated incompetent to manage his/her personal affairs, or an attorney ad litem appointed for the patient, or a personal representative if the patient is deceased." 4. What is a "consent for release" of medical records? The Texas Medical Association's Board of Councilors Current Opinions states, "Patient authorizations for release of confidential information should be in writing, signed by the patient or someone legally authorized to act on his behalf, and should specify the following: (1) the records which are to be covered by the release, (2) the reasons or purposes for the release and (3) the person to whom records are to be released." This is also stated in the Medical Practice Act of Texas. 5. May a fee be charged for the time and expense involved in forwarding this information? The Medical Practice Act of Texas states, "The information shall be furnished by the physician within 30 days after the date of receipt of the request and reasonable fees for furnishing the information shall be paid by the patient or someone on his behalf." A reasonable fee has been defined by the Texas State Board of Medical Examiners and are limited to no more than $25 for the first twenty pages and 154 per page for every copy thereafter. Other costs allowed include the actual costs for mailing and shipping. Please note that hospital medical records are under the jurisdiction of the Hospital Licensing Law and controlled by a separate fee schedule. 6. What happens to a patient's records when the physician retires or relocates? The American Medical Association's Code of Ethics Current Opinion states, "When a physician retires or dies, patients should be notified and urged to find a new physician and should be informed that upon authorization records will be sent to the new physician." 7. If a patient has a new physician, it is appropriate to ask a former physician for his/her medical records? The American Medical Association's Code of Medical Ethics Current Opinion states, "A physician who formerly treated a patient should not refuse, for any reason, to make his/her records of that patient promptly available on request to another physician presently treating the patient. Proper authorization for the use of records must be granted by the patient." 8. What if a patient has an outstanding bill and needs his/her medical records? The Texas Medical Association's Board of Councilors Current Opinions states, "It is unethical for a physician to refuse or to delay improperly in responding to a valid request for transfer of a former patient's medical records because of an unpaid bill." 9. Under what circumstances would a physician deny a patient his/her medical records? The Medical Practice Act of Texas states, "A physician shall furnish copies of medical records requested, or a summary or narrative of the records, pursuant to a written consent for release of the information, except if the physician determines that access to the information would be harmful to the physical, mental, or emotional health of the patient." =================================================== 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 11, 2004: 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: $37.09 11-60 pages: $1.24 per page 61-400 pages: $0.62 per page More than 400 pages: $0.32 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: $55.64 Subsequent pages: $1.24 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 $12.36 for a set. ----------------------------------------------------- ###

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 :

clia@cdrh.fda.gov

SECTION B

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.

SECTION C

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:

1. 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
2. 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

"

What about hospital records?

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)."
  
  
  
  
  

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