Obtaining medical records from a nursing home is a structured process that ensures the continuity of a patient’s care and protects their privacy. These records offer a detailed clinical narrative necessary for transitioning care, appealing insurance decisions, or for legal documentation. The documentation provides a chronological account of the resident’s health status and the facility’s interventions, including admission assessments, physician progress notes, medication administration records (MARs), and individualized care plans.
Establishing the Right to Access
The fundamental right to access one’s own health information rests with the resident. Federal regulations ensure that a competent individual can inspect and obtain copies of their medical records, formally known as the Designated Record Set. This set includes medical, billing records, and other information used by the nursing home to make decisions about the resident’s care.
When the resident is unable to request the records themselves, a legally recognized “Authorized Representative” or “Personal Representative” must step in. This authorization is typically established through specific legal documents, such as a Power of Attorney for Healthcare Decisions, court-issued Guardianship papers, or Conservatorship documents. The nursing home is legally required to treat this representative as if they were the resident for the purpose of accessing the information.
If the resident is deceased, the executor or administrator of the estate generally holds the right to access the records. Some state laws may also permit access for a beneficiary or a legal heir, but this varies and requires appropriate documentation to prove legal standing. The facility must confirm that the requester is a personal representative authorized under state law before releasing any protected health information to comply with privacy laws.
The Formal Request Process
Obtaining records begins with initiating a formal, written request to the nursing home. While a verbal request may suffice for a resident to inspect records, a written submission is strongly advised for documentation and requesting copies. This request should be directed to the facility’s Medical Records Department, Administrator, or Privacy Officer.
The request must be precise to avoid delays and unnecessary costs, clearly stating the resident’s full legal name, date of birth, and the specific dates of service required. It is helpful to specify the exact documents needed, such as the comprehensive care plan, physician orders, or wound assessment reports, rather than asking for the entire chart. If the requester is not the resident, the written submission must include the necessary legal documentation, such as the Power of Attorney document, to confirm authorization.
Many nursing homes will provide their own standard “Authorization for Release of Information” form, which should be completed and signed by the resident or the authorized representative. It is also possible to direct the facility to send the records directly to a third party, such as a new physician or an attorney, by including this instruction in the request. The facility must honor this instruction, known as a “directed disclosure,” if the request is valid.
Understanding Timelines and Fees
Federal law mandates a clear timeframe for fulfilling medical record requests. Under the HIPAA Privacy Rule, the nursing home must respond without unreasonable delay, and no later than 30 calendar days after receiving the request. If the records are archived offsite and not readily accessible, the facility can invoke a single extension of up to an additional 30 days.
If an extension is needed, the facility must inform the requester in writing within the initial 30-day period, stating the reasons for the delay and providing a firm date for delivery. Some state laws may impose a shorter deadline for response, such as 15 days, and the nursing home must comply with the more stringent state requirement.
Providers can only charge a reasonable, cost-based fee for the labor associated with copying and mailing the records. For electronic health information (EHI) that is readily producible, the 21st Century Cures Act and HIPAA allow patients or representatives to obtain copies at little to no cost. If the records are provided electronically, the cost is often limited to a flat fee, such as $6.50 for a CD, or is free if accessed through a patient portal. If a fee is charged, the requester has the right to ask for an itemized list of the charges.
Dealing with Delays or Denials
If the deadline passes or the request is outright denied, the requester should initiate a written follow-up to the facility. This communication should reference the original request date and the legal timeline requirements. This prompts the facility to comply, often by speaking directly with a supervisor or the office manager.
A nursing home must provide a written explanation for any denial, including the basis for the decision and information on how to appeal. If the denial is based on authorization documentation issues, the requester should provide the correct or updated legal papers and resubmit. If communication fails or the facility continues to refuse access without a valid reason, external complaints are possible.
A complaint can be filed with the state’s licensing or health department, which oversees the operation of nursing homes. For federal violations, particularly those concerning the right to access and the timeliness of the response, a complaint can be submitted to the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR). The OCR is responsible for enforcing the HIPAA Privacy Rule and has the authority to issue penalties for non-compliance with access requests.