Member access to medical records
Providers must respond to requests for member access to medical records in a manner that complies with applicable state laws, federal laws, or both.
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.
Members have the right to review their health care information with their providers. You must be prepared to facilitate such requests. Your 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. You must document the access or denial of access in the member's medical record.
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, you must segregate denied and disclosable information, 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 you treated the member.
You must notify the member 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 mandated by state or federal law:
Sexuality/reproductive rights: Age 14 years or older
STD/HIV/AIDS: Age 14 years or older
Drug/alcohol Use: Age 13 years or older
Mental health: Age 13 years or older
Content on this page is from the provider manual | Disclaimer