(a) Release of Records Pursuant to Written Request.
As required by the Medical Practice Act, §159.006, a physician
shall furnish copies of medical and/or billing records requested or
a summary or narrative of the records pursuant to a written release
of the information as provided by the Medical Practice Act, §159.005,
except if the physician determines that access to the information
would be harmful to the physical, mental, or emotional health of the
patient. The physician may delete confidential information about another
patient or family member of the patient who has not consented to the
release. If requested, the physician shall provide the requested records
in electronic format, if such records are readily producible. If the
requested records are not readily producible in a readable electronic
format, the records shall be produced in a format as agreed to by
the physician and the requestor. If by the nature of the physician's
practice, the physician transmits health information in electronic
form, the physician may be subject to the Health Insurance Portability
and Accountability Act (HIPAA) 45 C.F.R. Parts 160-164. Unless otherwise
provided under HIPAA, physicians subject to HIPAA must permit the
patient or an authorized representative access to inspect medical
and/or billing records and may not provide summaries in lieu of actual
copies unless the patient authorizes the summary and related charges.
(b) Deadline for Release of Records. The requested
copies of medical and/or billing records or a summary or narrative
of the records shall be furnished by the physician within 15 business
days after the date of receipt of the request and reasonable fees
for furnishing the information.
(c) Denial of Requests for Records. If the physician
denies the request for copies of medical and/or billing records or
a summary or narrative of the records, either in whole or in part,
the physician shall furnish the patient a written statement, signed
and dated, within 15 business days of receipt of the request stating
the reason for the denial and how the patient can file a complaint
with the federal Department of Health and Human Services (if the physician
is subject to HIPAA) and the Texas Medical Board. A copy of the statement
denying the request shall be placed in the patient's medical and/or
billing records as appropriate.
(d) Contents of Records. For purposes of this section,
"medical records" shall include those records as defined in §165.1(a)
of this title (relating to Medical Records) and shall include copies
of medical records of other health care practitioners contained in
the records of the physician to whom a request for release of records
has been made.
(e) Allowable Charges.
(1) Paper Format.
(A) The physician responding to a request for such
information in paper format shall be entitled to receive a reasonable,
cost-based fee for providing the requested information.
(B) A reasonable fee for providing the requested records
in paper format shall be a charge of no more than $25 for the first
twenty pages and $.50 per page for every copy thereafter.
(2) Electronic Format.
(A) The physician responding to a request for such
information to be provided in electronic format shall be entitled
to receive a reasonable, cost-based fee for providing the requested
information in electronic format.
(B) A reasonable fee for providing the requested records
in electronic format shall be a charge of no more than: $25 for 500
pages or less; $50 for more than 500 pages.
(3) Hybrid Records Format.
(A) The physician responding to a request for such
information that is contained partially in electronic format and partially
in paper format ("hybrid"), may provide the requested information
in a hybrid format and shall be entitled to receive a reasonable,
cost based fee for providing the requested information.
(B) A reasonable fee for providing the requested records
in a hybrid format may be a combination of the fees as set forth in
paragraphs (1) and (2) of this subsection.
(4) Other Charges.
(A) If an affidavit is requested, certifying that the
information is a true and correct copy of the records, whether in
paper, electronic or hybrid format, a reasonable fee of up to $15
may be charged for executing the affidavit.
(B) A physician may charge separate fees for medical
and billing records requested.
(C) Allowable charges for copies of diagnostic imaging
studies are set forth in §165.3 of this title (relating to Patient
Access to Diagnostic Imaging Studies in Physician's Office) and are
separate from the charges set forth in this section.
(5) A reasonable fee for records provided in a paper,
electronic or hybrid format may not include costs associated with
searching for and retrieving the requested information, and shall
include only the cost of:
(A) copying and labor, including, compiling, extracting,
scanning, burning onto media, and distributing media;
(B) cost of supplies for creating the paper copy or
electronic media (if the individual requests portable media) that
are not prohibited by federal law;
(C) postage, when the individual has requested the
copy or summary be mailed; and
(D) preparing a summary of the records when appropriate.
(f) Emergency Requests. The physician providing copies
of requested medical and/or billing records or a summary or a narrative
of such records shall be entitled to payment of a reasonable fee prior
to release of the information unless the information is requested
by a licensed Texas health care provider or a physician licensed by
any state, territory, or insular possession of the United States or
any State or province of Canada if requested for purposes of emergency
or acute medical care.
(g) Non-emergent Requests. In the event the physician
receives a proper request for copies of medical and/or billing records
or a summary or narrative of the records for purposes other than for
emergency or acute medical care, the physician may retain the requested
information until payment is received. If payment is not routed with
such a request, within ten calendar days from receiving a request
for the release of such records, the physician shall notify the requesting
party in writing of the need for payment and may withhold the information
until payment of a reasonable fee is received. A copy of the letter
regarding the need for payment shall be made part of the patient's
medical and/or billing record as appropriate.
(h) Improper Withholding for Past Due Accounts. Medical
and/or billing records requested pursuant to a proper request for
release may not be withheld from the patient, the patient's authorized
agent, or the patient's designated recipient for such records based
on a past due account for medical care or treatment previously rendered
to the patient.
(i) Subpoena Not Required. A subpoena shall not be
required for the release of medical and/or billing records requested
pursuant to a proper release for records under this section and the
Medical Practice Act, §159.006, made by a patient or by the patient's
guardian or other representative duly authorized to obtain such records.
(j) Billing Record Requests. In response to a proper
request for release of medical records, a physician shall not be required
to provide copies of billing records pertaining to medical treatment
of a patient unless specifically requested pursuant to the request
for release of medical records.
(k) Prohibited Fees for Records Released Related to
Disability Claims. The allowable charges as set forth in this chapter
shall be maximum amounts, and this chapter shall be construed and
applied so as to be consistent with lower fees or the prohibition
or absence of such fees as required by state statute or prevailing
federal law. In particular, under §161.202 of the Texas Health
and Safety Code, a physician may not charge a fee for a medical or
mental health record requested by a patient, former patient or authorized
representative of the patient if the request is related to a benefits
or assistance claim based on the patient's disability.
(l) Applicable Federal Law. Whenever federal law or
applicable federal regulations affecting the release of patient information
are inconsistent with provisions of this section, the provisions of
federal law or federal regulations shall be controlling, unless the
state law is more restrictive/stringent. Physicians are responsible
for ensuring that they are in compliance with federal law and regulations
including the Health Insurance Portability and Accountability Act
(HIPAA) 45 C.F.R. Parts 160-164.
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Source Note: The provisions of this §165.2 adopted to be effective December 29, 1997, 22 TexReg 12490; amended to be effective May 21, 2000, 25 TexReg 4349; amended to be effective November 19, 2000, 25 TexReg 11282; amended to be effective September 19, 2002, 27 TexReg 8769; amended to be effective March 4, 2004, 29 TexReg 1946; amended to be effective January 20, 2014, 39 TexReg 273 |