Patient Access to the Medical Record Policy

    Patients have the right to inspect and receive copies of their medical records. There is a charge of 50 cents per page with a $2.00 minimum to cover the costs of meeting this request. You also  may request and receive  medical records in an  electronic format  if this method is available.  There is a charge for this service.

     Physicians may disclose a decedentís information to family members and others who were involved in the care or payment for care of the decedent, unless inconsistent with any prior expressed preference of the individual.

    Under federal regulations there are certain instances where this practice has the right to deny a patientís request to inspect and copy their medical record. This denial will be given to the patient in writing and will explain why the request has been denied.

There are several circumstances when the denial may not be appealed (unreviewable denial).

bulletPsychotherapy notes.
bulletInformation compiled in reasonable anticipation of or for use in a civil, criminal, or administrative action proceeding.
bulletProtected health information (PHI) maintained by a practice subject to Clinical Laboratory Improvements Amendments (CLIA) (to the extent access to an individual would be prohibited by law).
bulletCorrectional facility can deny part or total access.
bulletIn research situations.
bulletIf the information was obtained from someone other than a health care provider and if access would compromise an individual providing information under a promise of confidentiality.

    The patient can appeal the denial and has the right to request review by another licensed health professional designated by the practice and who was not a part of the original decision to deny access (reviewable denial).

bulletIf a licensed health care professional determines that the requested access would endanger the life or physical safety of the individual or another person.
bulletIf the record makes reference to another person and the licensed health professional believes the access could cause substantial harm to that person.
bulletRequest has been made by patientís personal representative and the licensed professional believes it could cause harm to that individual or another person.

    Patients should make this request on the form below, which is then submitted to Dr. Elliott for action.


Patient Access to the Medical Record Request Form

I, __________________________________, request Brett Elliott, M.D. P.A. to make copies of my medical records for my personal inspection. I understand that these records contain protected health information (PHI). I agree to be responsible for the cost of copying these records, including copying fees, labor, supplies, and postage (if applicable). The charge for this will be 50 cents per page and I will be charged a minimum of $2.00. I agree to pay for this prior to the service being rendered.


Patient Signature: ________________________________________________Date of request: _______________



This page was last updated on  07/26/2013