Member access to medical records
Members have the right to review their health care information with their providers. Providers must respond to requests for member access to medical records in a manner that complies with applicable state and federal laws. The procedures for members' access and review of their medical records and associated information must be designed to ensure the integrity of the record throughout the access and review. Providers must document the access or denial of access in the member's medical record.
Upon written request, members have the right to inspect and receive a paper or electronic copy of their health care records and associated information maintained in their providers' information systems, subject to exceptions recognized by law. Providers must promptly respond no later than 15 working days after receiving the request shall:
- Make the requested Protected Health Information available for examination during regular business hours and provide a copy, if requested.
- Inform the individual if the information does not exist or cannot be found.
- Deny the request in whole or in part and inform the individual.
Denial of access
You must inform the member of any delay or denial of the request under an exception recognized by law. You may deny access only when the disclosure:
- Would be injurious to the member's health.
- Would allow the member to identify any individual who appropriately provided information in confidence.
- May reasonably be expected to cause danger to the life or safety of any individual.
- Involves information compiled and to be used solely for litigation, quality assurance, peer reviews, or other administrative purposes.
- Pertains to information prohibited from access by law.
- To the extent possible, denied and disclosable information must be segregated, and you may deny access to the relevant portion only.
If you deny access because disclosure would be injurious to the member or could endanger the life or safety of others, the member may select another provider to review the information in question. This provider must be licensed, certified, registered, or otherwise authorized by state law to treat the member for the same condition as the original provider who treated the member.
The member must be notified of the right to select another provider to review the records, but the member is responsible for paying the second provider.
Parents have the right to access and authorize access to their minor children's records with the following exceptions where a minor can consent to their own care as mandated by state or federal law:
- Sexual and reproductive health care, including contraception and abortion services: Minors of any age.
- STI/HIV/AIDS testing, prevention, and treatment: Age 14 years or older.
- Substance use disorder treatment: Age 13 years or older.
- Mental health treatment: Age 13 years or older.
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