Medical Records

I want to obtain a copy of my medical records done as an outpatient procedure at a local hospital in 1997. I'm just not sure exactly what to ask for in my request. What I am particularly interested in is the "sedation" information. I need to ask for this pretty soon as I recently learned that not only are hospitals destroying xrays more than 6 years old they are also expunging medical records altho I'm not sure how far back they are going with that.

Due to a chronic illness I began obtaining a copy of all my medical reports since 2001. But that is all I was getting was the medical report itself. Not all the other nitty gritty that went on.

In 1999 when I was going to Mayo Clinic I requested copies of all my xrays regarding my Crohn's disease and was amazed to see they still had my barium series xrays from 1978! No more! When I returned them after the Mayo visit they were destroyed. That was when I learned that they were now destroying xrays after 6 years. But I had no idea that included medical reports back a certain number of years as well until just last week. I wanted a 1996 report and the Medical Records clerk wasn't sure if they would still have it from that far back as records were expunged after so many years but she wasn't sure how many years back.

The head of our Radiology Department did tell me that she advises any of her family members that have a chronic illness to purchase a copy of all xray films pertaining to that chronic illness. Our hospital charges $5 per film. In our state, legally, the your medical films and reports and records belong to the generating facility or doctor but you are entitled to a copy at a reasonable cost, yet a specialist from one of the country's leading teaching hospitals just this year advised me to KEEP my films I had brought with me and not return them to the generating facility.

I think that this destruction of old films and records is a result of this new HIPPA legislation that supposedly was to protect the confidentiality of our medical records but I could be wrong.

Not sure how it works in the US - but generally speaking, in England at least, documents may be destroyed after a 6 year period from the date of creation.

Which actually caused problems for me - I moved to the US in 97, but hadn't been to the doc in England for quite awhile when I lived there...a couple of years later whilst doing the whole immigration thing, I requested my medical records and was somewhat peeved to find out they'd all been destroyed. Bummer for me!


Ah well. This time around, I've kept records from virtually every doctor I've seen in the US - dentist included!

It's OUR information - and we have not only a right, but an obligation (to me, anyway) to make sure we've got our records at hand. Never quite know when we're going to need 'em!

Warm wishes,

Tess

While HIPAA only requires that records be kept for 6 years, state law on medical records supercedes that. In Massachusetts, medical records must be kept for 20 years. Some states have no such laws and in that case you would refer to the state statute on limitations for filing a medical malpractice claim (the records would have to be kept for as long as whatever this period of time is).


I don't know how to word your request other than to ask for "complete" records , including the notes of the anesthiologist (for the sedation information).

Best wishes.

Thank you, Wachusett for the information, and Tess73 for pointing out the importance of keeping a personal copy of your medical records.

Be sure to read them. You will be amazed (or perhaps amused) at the many mistakes in them. Most are trivial and unimportant, but, quite possibly something important. You have the right to ask that mistakes in your medical records be corrected or if the generating facility is unwilling to do so to write your explanation/correction to the record and to have it put on file with the record. They have to comply one way or the other, correcting the mistake or adding your explanation/correction. I'm pretty sure that is federal law, don't "think" I have it mixed up w/our state law.

I think the reports you are looking for are surgical reports. If you have the exact date of the operation that would help. Im sure you know to call the medical records department and there is a chance they might charge you. Here in Ohio , they dont charge you for the records.. they charge for the copies! At a dollar a page too. Some of those reports are 20 pages long!

While in the hospital for my upcoming TVH, I am going to ask for complete surgical records and pathology reports. Even if I do have to pay, it will be worth it to see what 'really' went on. My hospital even has it in their pamphlet (the one that tells you about the hospital) that you are able to see your medical records simply by asking the nurse, as often as you like. They do recommend having your dr present to answer any questions though. It is nice having a hosp that isnt trying to hide anything!

I didnt know anything about destroying records but I will keep that in mind for the future.

Crohnie:

What you need is the anesthesia record, usually separate from the actual surgical report. All the pertinent "little" details would be found there.

Good luck. I know that in California, we've been keeping things for 7 - 8 years, but the law keeps changing. And the problem, as you may well imagine, is the storage of years and years of records, especially now that so much information is digital. Destruction of the records isn't really related to HIPAA as it is to the costs of storage, and the fact that many x-rays, videotapes, etc. deteriorate to unreadable within a certain amount of time.

You may also be asked to pay a fee for extracting these records from storage. However, it may be waived if your physician requests them instead of you ("professional courtesy" and all that).

Did you have some incident with anesthesia back then? Perhaps reconstructing the details from memory and family reports might help you ferret out the information you're looking for. It may also be worth the while to look up the group that the anesthesiologist of record belonged to back then. Generally your chart with them would also have a copy of that information you're looking for.

Good luck with this search!



Audrey