Nursing homes maintain comprehensive medical records documenting the resident’s condition and the care provided. These records include detailed clinical assessments, physician orders, medication administration sheets, and notes on Activities of Daily Living (ADLs). Obtaining these documents is often necessary for ensuring continuity of care when a resident transfers to a new facility, or for various legal and financial purposes.
Legal Foundation for Accessing Records
The right to access nursing home medical records is established by federal law, primarily through the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Under HIPAA, individuals have the right to inspect and obtain a copy of their Protected Health Information (PHI) maintained by covered entities like nursing homes. This right extends to the patient’s personal representative, who is legally authorized to act on the individual’s behalf regarding health care decisions.
A personal representative is typically designated through legal mechanisms determined by state law, such as a durable Power of Attorney (POA) for healthcare, a court-appointed legal guardian, or a conservator. For a deceased resident, the executor or administrator of the estate is generally considered the personal representative with the right to access the decedent’s medical records. The facility must treat the personal representative as if they were the individual, granting them the same rights to access information.
Nursing homes accepting Medicare or Medicaid must also adhere to Centers for Medicare & Medicaid Services (CMS) regulations, which reinforce the resident’s right to access their records. These federal regulations mandate that facilities maintain accurate and complete records, subject to inspection and copying by the resident or their authorized representative. When requesting records as a representative, you must present documentation, such as the POA or court order, to verify your legal authority to the facility.
The Formal Request Process
The first step in obtaining records is to submit a formal, written request directly to the nursing home. Direct this request to the facility’s Health Information Management (HIM) department, or the Administrator or Director of Nursing in smaller facilities. Making the request in writing is essential, as it creates a clear paper trail and helps prevent delays.
Many nursing homes require you to complete a specific “Authorization for Release of Information” form. If a standardized form is not provided, your written request must be comprehensive and include specific identifying details. Be sure to include the resident’s full name, date of birth, dates of stay, and a clear description of the exact records you are seeking.
Be specific about the scope of the records needed to avoid receiving an unnecessarily voluminous file. For instance, specify if you need only the physician’s orders, Minimum Data Set (MDS) assessments, or interdisciplinary progress notes. You must also clearly state the name and contact information of the person or entity authorized to receive the records, such as yourself, an attorney, or a subsequent medical provider.
You must include copies of all necessary supporting documentation to prove your identity and legal standing. This documentation includes a photocopy of your driver’s license and the legal document establishing your authority, such as a healthcare power of attorney or letters of testamentary. The formal request is considered valid only when the facility confirms both the request and the requester’s legal authority.
Timing, Format, and Associated Fees
Once a valid request is received, federal law dictates a specific timeframe for the nursing home to provide the records. Under the HIPAA Privacy Rule, a facility generally has a maximum of 30 days to respond to the request for Protected Health Information. If the records are not readily accessible, the facility may take a single 30-day extension, but the requester must be notified of the delay and the expected fulfillment date within the initial period.
The format provided should align with the requester’s preference, provided the nursing home can readily produce the records in that manner. Federal regulations encourage and often require covered entities to provide an electronic copy if the records are maintained electronically. Receiving a digital copy, such as a PDF, is generally the most efficient and cost-effective method.
Facilities are allowed to charge a reasonable, cost-based fee for fulfilling the request, but these fees are strictly limited to the direct costs of copying and preparing the records. Permissible charges include the cost of supplies, such as paper or a CD, and the labor involved in copying. Importantly, the facility is prohibited from charging for the time spent retrieving or searching for the requested records.
Recourse When Records Are Denied or Delayed
If the nursing home fails to provide the requested records within the mandated time frame or denies the request without a valid reason, several avenues for recourse are available. The primary federal enforcement body is the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR). A denial of access violates the HIPAA Privacy Rule, and you can file a formal complaint with OCR online or in writing, typically within 180 days of the violation.
State-level mechanisms offer another layer of oversight. You can file a complaint with your state’s Department of Health or the agency responsible for licensing and regulating long-term care facilities. These state agencies can investigate the facility’s compliance with patient rights and may initiate corrective action.
The Long-Term Care Ombudsman Program is mandated by federal law to investigate and resolve complaints made by or on behalf of residents. While the Ombudsman’s role is not a legal enforcement action, they can often intervene and mediate access to records. Their involvement can pressure a non-compliant facility to release the documents, as they have the authority to access a resident’s medical and social records with consent.