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#547422 - 08/22/07 05:53 PM
Re: Doc refusing to give me Progress Notes
[Re: Neocris]
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thundr69
Enthusiast
Registered: 03/14/06
Posts: 244
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I know why they don't want to give the notes, they are afraid we may sue them over something. You should have heard the [censored] this guy was telling me. Records shouldn't be all over the place -um, no, just in my house. I won't understand what's in them. He doesn't want calls at 6am with questions about what's in there, he doesn't want me treating myself. It was unreal!! At that point I just told him that he was being absolutely absurd and that I was now really curious to see what was in there and was now really uncomfortable with their practice. I told him that I didn't feel the need to even have a reason why since I had a right to them. I even reminded him that the good 50 pages of records that he now had in his file were copies of records from my previous doc that I had hand delivered to them. Explained to him that many people do this. He said it is not wide spread. At some point he said again records shouldn't be all over the place and what if everybody wanted a copy of them, I pointed out that he said hardly no one did. It was really unreal, we must have had a 20 minute conversation about it with him giving me all those ridiculous reasons. The records aren't really mine he said, they are shared because the doc's notes are hers. Ridiculous. I even told him that I was not unhappy with my care there (to try to ease his mine about any lawsuits or anything, I'm Sure that's the reason) He said he was really trying to make me understand all this because he didn't want me to leave the practice because of this(He has been treating my father and law for years). I said well, I really do not know because I know that it is my right to have my records and the fact that you are denying them seems strange since I have not had this problem with other docs (which isn't exactly true but previous doc did give me everything,I think she was reluctant because she knew I was leaving her practice).
I said it is my right to them so much that I felt like I was in jail or in court or something. I am SICK of going through all this just to get some PAIN RELIEF!! Sorry for the long post but wanted to let you know what he was saying and what a bloody ordeal it was. My seven year old was with me and when we left she said mommy, what are they afraid of!
_________________________
The only courage that matters is the kind that gets you from one moment to the next.
Mignon McLaughlin
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#547454 - 08/22/07 06:36 PM
Re: Doc refusing to give me Progress Notes
[Re: thundr69]
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smiles2
Board Addict
Registered: 06/10/07
Posts: 331
Loc: home
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Tell them to release your records to you,or you will send your lawyer in to get them.TOTAL hippa violation!!!!I'm so sorry your going through this 
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#547474 - 08/22/07 07:08 PM
Re: Doc refusing to give me Progress Notes
[Re: TomSmallie]
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thundr69
Enthusiast
Registered: 03/14/06
Posts: 244
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OK, just looked up NYS law to see what the rights are. They say the physician must give the notes but can exclude some. See below. I am copying and pasting and I hope it isn't against board Rules. Two things are confusing me, the part that says not all notes are to be considered personal observations and does whatever HIPPA says supercede it? Meaning, does HIPPA have an exclusion on notes? I know that usually, federal law will supercede state but not sure. It seems to me that doing battle about the NATURE of the notes is going to be a ROYAL PAIN I tried to find the part that clarifies the note thing for the physician but had trouble finding it.
If anyone actual takes the time to read this, I can't thank you enough, 
The law permits access by "qualified persons." "Qualified persons" include the patient or an incapacitated adult patient's legal guardian....
Section 18 requires that within 10 days of a written request for access to records, the provider must give the qualified person the opportunity to inspect the records. Providers must also provide copies of records if copies are requested. Providers are permitted to charge reasonable fees to recover costs for inspections and copying. However, a qualified person cannot be denied access to information solely because of inability to pay.
The law also states that access to the following records or parts of records may be denied:
* personal notes and observations maintained by the practitioner;
There are more exclusions but they don't apply to me
Now later is says this:
Personal Notes and Observations
Section 18 of the Public Health Law permits providers to deny access to personal notes and observations. The Law defines personal notes and observations as "a practitioner's speculations, impressions (other than tentative or actual diagnosis) and reminders, provided such data is maintained by a provider."
It has been suggested that handwritten portions of health care records may all be considered "personal notes and observations" and may be withheld from qualified persons, but this interpretation is overbroad. Consequently, Subpart 50-3 of the Department of Health's Rules and Regulations states "Handwritten notes and observations shall not be presumed to be personal notes and observations."
Then later is says this about HIPPA
Relationship Between Section 18 and Federal Regulations
In some instances where a patient or a patient's personal representative has no right to access health information under State law, a right of access may nevertheless exist under federal law. Health care providers that are required to comply with the federal law known as the Health Insurance Portability and Accountability Act (HIPAA) generally must provide patients with access to all medical records and billing records. Many of the exceptions that exist in Statelaw do not exist in the federal law; the federal law does, however, have an exception for psychotherapy notes.
Any qualified person who may access records on behalf of a patient under State law is a personal representative with a right of access under federal law. Parents have a right of access to their children's medical records under federal law to the same extent that they have that right under State law.
If a right of access exists under federal law, the procedure for exercising that right of access should be written in the provider's Notice of Privacy Practices. The provider should have a reviewing official to make final determinations. New York does not enforce HIPAA. HIPAA is enforced by the Office for Civil Rights in the United States Department of Health & Human Services.
[color:#993399][/color]
_________________________
The only courage that matters is the kind that gets you from one moment to the next.
Mignon McLaughlin
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#547614 - 08/23/07 01:29 AM
Re: Doc refusing to give me Progress Notes
[Re: thundr69]
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patient2all
GRAND Pooh-Bah
Registered: 05/16/02
Posts: 3473
Loc: usa
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They say the physician must give the notes but can exclude some.
I read it all 
I just want to clarify that the notes that can be excluded apply to only very rare circumstances which I highly doubt apply in this case:
1) Psychiatric assessments where there is a compelling reason to believe release could cause the patient to harm themselves or others based on their content
2) Notes that pertain to an ongoing lawsuit
That's about it. Surely the original poster's issues fall into the more ordinary realm of medical care and neither of those circumstances apply.
------
In fact, when I got my hospital chart since my disease was so baffling and rare they had sent in several psyhciatrists to interview me. Conclusion: schizophrenia
I made the head of the psychiatric dept at the hospital add a notation at the bottom stating "patient claims he is merely eccentric, not schizophrenic". More accrurate, but like that means a lot
-----
Now in several posts, I've included links to formal HIPAA requests and penalties for violation but I sense you're not wanting to make a stink like that. So kill them with kindness:
Some ideas:
This formal request is for a personal copy of my Medical Records and History covering the treatment period as noted above.
I'm interested in receiving all my medical records covering your considerable attention to my medical ailments including but not limited to, progress notes, laboratory notes and diagnostic results.
Sadly, we live in times where threats of terrorism and natural disaster always a possibility.
Much has been written in the media and also suggested by various health organizations that it is advisable for individuals and families keep a copy of all medical treatment close at hand in the event of a sudden relocation.
Given the unique nature of the events that precipitated my illness, I'm interested in learning more about it. I'm an excellent researcher and would be interested in locating more resources on the Internet. Having my chart would aid that research.
Don't worry, I'm not suing anyone! Again, I was most impressed with the diligence of care and the dogged efforts of all your staff in getting to the bottom of my rare ailment and making me feel comfortable during a terrifying health crisis.
-----
Pick from it what you choose. My PCP also refused to turn over any progress notes on the grounds that they were just chicken-scratch no one else could read.
Finally I figured out his day off and went in then. He was right, his notes were sloppy garbage. While I have to be seen every 2 months, there were clearly times when he did not make any notation at all of my visits.
----
And remember, there is no need to talk to the doctor about your need for the records. He ain't going to make the copies. Deal with the front desk.
Good luck,
patient2all
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#547768 - 08/23/07 09:41 AM
Re: Doc refusing to give me Progress Notes
[Re: patient2all]
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thundr69
Enthusiast
Registered: 03/14/06
Posts: 244
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A year on this board and I still can't figure out how to quote properly! LOL But Loved your line about being eccentric! I actually probably know more people with schizophrenia than the average person due to the nature of my work and I assure everyone, eccentric describes a lot of them way better than some of the other things I've heard, :).
Anyway, 1) I did initially just deal with the front desk and when I said I wanted the progress notes too, they immediately said, oh no, I need to speak to the Doc about that. So I spoke to the doc and after no luck she said speak to the other doc, who is in charge of the practice and he still said no.
2)my state law said they can exclude progress notes in addition to the other things you mentioned. I just left all those other things out for brevity sake. The confusing thing for me is:
"Public Health Law permits providers to deny access to personal notes and observations. The Law defines personal notes and observations as "a practitioner's speculations, impressions (other than tentative or actual diagnosis) and reminders, provided such data is maintained by a provider."
And then:
It has been suggested that handwritten portions of health care records may all be considered "personal notes and observations" and may be withheld from qualified persons, but this interpretation is overbroad. Consequently, Subpart 50-3 of the Department of Health's Rules and Regulations states "Handwritten notes and observations shall not be presumed to be personal notes and observations."
This would have applied in your situation because in HIPAA, you have the right to amend the record and how would you do that if the Notes part of it is excluded? So I am thinking maybe Hipaa would over ride that part.
This says to me that I can debate with the doctor over at least some portions of the progress notes. I think that I will write a letter with some of the phrasing you suggest and do what the other poster said and send it by registered letter. I think I will also include a copy of HIPAA with it. I just need to find a website where i can print out a reasonable copy of it. Still I wonder if HIPPA supercedes the state law that allows the exclusion of the progress notes since in my cursory view of that section of HIPAA it makes no mention of that exclusion. I did gather that Hipaa will not supercede a more stringent law but I am thinking that this may refer to the protection portion rather than the portion that refers to me. So much trouble for what should be so simple
_________________________
The only courage that matters is the kind that gets you from one moment to the next.
Mignon McLaughlin
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#547792 - 08/23/07 10:18 AM
Re: Doc refusing to give me Progress Notes
[Re: thundr69]
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Amberray
Member
Registered: 02/28/07
Posts: 189
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A year on this board and I still can't figure out how to quote properly! LOL But Loved your line about being eccentric! I actually probably know more people with schizophrenia than the average person due to the nature of my work and I assure everyone, eccentric describes a lot of them way better than some of the other things I've heard, :). Anyway, 1) I did initially just deal with the front desk and when I said I wanted the progress notes too, they immediately said, oh no, I need to speak to the Doc about that. So I spoke to the doc and after no luck she said speak to the other doc, who is in charge of the practice and he still said no. 2)my state law said they can exclude progress notes in addition to the other things you mentioned. I just left all those other things out for brevity sake. The confusing thing for me is: "Public Health Law permits providers to deny access to personal notes and observations. The Law defines personal notes and observations as "a practitioner's speculations, impressions (other than tentative or actual diagnosis) and reminders, provided such data is maintained by a provider." And then: It has been suggested that handwritten portions of health care records may all be considered "personal notes and observations" and may be withheld from qualified persons, but this interpretation is overbroad. Consequently, Subpart 50-3 of the Department of Health's Rules and Regulations states "Handwritten notes and observations shall not be presumed to be personal notes and observations." This would have applied in your situation because in HIPAA, you have the right to amend the record and how would you do that if the Notes part of it is excluded? So I am thinking maybe Hipaa would over ride that part. This says to me that I can debate with the doctor over at least some portions of the progress notes. I think that I will write a letter with some of the phrasing you suggest and do what the other poster said and send it by registered letter. I think I will also include a copy of HIPAA with it. I just need to find a website where i can print out a reasonable copy of it. Still I wonder if HIPPA supercedes the state law that allows the exclusion of the progress notes since in my cursory view of that section of HIPAA it makes no mention of that exclusion. I did gather that Hipaa will not supercede a more stringent law but I am thinking that this may refer to the protection portion rather than the portion that refers to me. So much trouble for what should be so simple
Oh great!! I didn't know that. I was under the impression that the patient "owns" their chart legally and that we should be able to have copies of any documentation that we request?? Of course we have to pay like $1.00/page but regardless be able to have our information. When I went to my chiropractor, I brought my medical records with me and luckily my doctor's office was compliant about giving them to me.
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#547816 - 08/23/07 10:51 AM
Re: Doc refusing to give me Progress Notes
[Re: patient2all]
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IEQ
Journeyman
Registered: 01/24/05
Posts: 61
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Perhaps you should get all the information on who to call or where to send mail in order to file a complaint against the doc. Then politely explain to the frontdesk personnel that if they will not provide the copies immediately (like while you are standing there) then your only recourse is to file the complaint. Of course, they will have to speak to the doc first but don't give up. Regardless of whether or not the doc CAN exclude certain information, NO doc wants to deal with govt agencies so it would be much easier for him/her to simply give you the records. Now realize, you had better have a new physician lined up because I would expect the doc to term your care (right or wrong, I think it will happen). You do not have to spend money on lawyers when the govt is there to actually help you...for once. Although, it is hopefully the threat that gets the results versus actually having to file complaints.
http://www.hhs.gov/ocr/hipaa/
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#548238 - 08/23/07 06:38 PM
Re: Doc refusing to give me Progress Notes
[Re: thundr69]
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Survivor
Member
Registered: 02/14/05
Posts: 167
Loc: ...a foot in each realm...
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Actually, if the clinic or hospital you are trying to get medical records from has a 'Medical Records' department (and unless they're a really small clinic, they will have one) that's probably the best place to go, because that's their job, and they will know all about HIPAA regs. But as someone posted up above somewhere, it's best to send the request in written form, as a formal business letter, specifying a date range, specify exactly what kinds of records you want (x-ray results, lab results, progress reports by all physicians, prescriptions ordered, etc.), and include the language 'pursuant to HIPAA requirements'. Then include your address, DOB, and/or clinic number, and be sure to keep a copy for your records. This should sail right through, as this department's main responsibility other than filing the records is providing copies to the billing office, the insurance companies, and the patient. That's what they do.
Good luck!
_________________________
Survivor =^..^=
"Get busy living or get busy dying." - Morgan Freeman in "The Shawshank Redemption"
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#548247 - 08/23/07 06:51 PM
Re: Doc refusing to give me Progress Notes
[Re: Survivor]
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boltin1
Banned
Pooh-Bah
Registered: 06/03/07
Posts: 1243
Loc: Northeast
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OKAY you got TONS of advice now and even SAMPLE letters, so lets get ON THE BALL and do it!!
Send the letter using registered mail too, someone has to sign for it. Because...WE want to hear the follow up.
It's time for a THROW-DOWN! 
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