Who Has to Follow These Laws?

Most District of Columbia health care providers (such as doctors, hospitals, clinics and others) must follow both the HIPAA Privacy Rule and local rules that give patients rights with respect to their medical records.

There are some health care providers, however, that do not have to follow the HIPAA Privacy Rule. The HIPAA Privacy Rule only covers health care providers that use computers to send health information for certain administrative or financial purposes (such as filing claims for insurance).

Sometimes Ashley goes to a doctor at a free clinic for medical treatment. The doctor does not accept private insurance, Medicaid, or Medicare. The doctor does not file any insurance claims. Ashley’s doctor probably does not have to follow the HIPAA Privacy Rule because the doctor does not appear to send health information for the types of administrative or financial purposes that would make her a covered health care provider under the Rule.

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If you have questions about whether your health care provider must follow the federal HIPAA Privacy Rule, you can contact the Office for Civil Rights, U.S. Department of Health and Human Services (OCR), the agency that is in charge of enforcing the HIPAA Privacy Rule. Section 4 of this guide lists contact information for OCR.

Are nursing homes covered by HIPAA?

Yes. Most nursing homes are covered by the HIPAA Privacy Rule. They also have to follow other specific rules that only apply to nursing homes and long term care facilities. Because the rules for nursing homes are different than they are for other health care providers, they are not covered by this guide.

What if my health care provider does not have to follow HIPAA?

Even if your provider does not have to follow the HIPAA Privacy Rule, they still have to follow District of Columbia rules that give you rights with respect your medical record. Section 6 lists some resources where you can read some of these local rules.

This guide, however, only explains how to get your medical record from District of Columbia providers who have to follow the HIPAA Privacy Rule and local rules.

What Records Do I Have the Right to Get and Amend?

You have the right to see and get a copy of your medical record. This right often is called the right to access your medical record. You also have the right to have more information added to your medical record to make it more complete or accurate. This right is called the right to amend your record. (This guide will call these rights the "right to get and amend.")

Your medical record includes such things as:

• Information that identifies you, such as your name and Social Security number.
• Information that you tell your doctor, such as:
  • Your medical history.
  • How you feel at the time of your visit.
  • Your family health history.
• The results of your examination.
• Test results.
• Treatment received in a hospital.
• Medicine prescribed.
• Notes your doctor makes about you.
• Other information about things that can affect your health or health care.

You have the right to see, get a copy of, and amend these records whether they are kept on paper, on a computer, or in other format.

What happens if my medical record has information in it that came from a different health care provider?

Generally, if your provider has the medical information that you request, they must give it to you. You have the right to get the information no matter who originally put it in the record. Your right to amend this information may be limited, though. For more information about how to amend information in your record you can read Section 3 of this guide.

Do I have the right to get and amend records related to substance abuse or mental health treatment?

Maybe. The rules for when you can get and amend your records about mental health and substance abuse treatment can be different. For example, the District of Columbia has a detailed law that deals specifically with mental health records. Because the rules for mental health and substance abuse records can be different they are not discussed in this guide. You can find some resources that explain your rights in these types of records in Section 6.

Who Has the Right to Get and Amend My Medical Record?

You have the right to see and get a copy of medical records that are about you. You also have the right to have information added to your medical record to make it more complete and accurate. (This guide calls these rights the right to "get and amend" your medical record.) If there is someone who acts as your personal representative, they usually have the right to get and amend your record on your behalf.

Do I have the right to get and amend my minor child’s medical record?

Generally, yes. As a parent or guardian, you generally have the right to get and amend your minor child’s medical record. In the District of Columbia, you usually have these rights when your child is younger than 18 years old.

As a parent, do I always have the right to get and amend my child’s medical record?

No. A parent does not always have the right to get and amend a minor child’s medical record. For example, if a health care provider reasonably believes that a parent is abusing or neglecting a child, the provider does not have to give the parent access to the child’s medical record.

Some other situations where parents do not have the right to get and amend their child’s medical records are discussed in the following questions and answers

Who has the right to get and amend my child’s medical record once she turns 18?

Once your child turns 18, your child has the right to see, get a copy of, and amend her own medical record. This includes getting access to records that were created when she was still a minor. After your child turns 18, you usually no longer have the right to get and amend your child’s medical record just because you are her parent.

I am under 18 and am emancipated. Who has the right to get and amend my medical record?

In the District of Columbia, if you are married or are serving in the armed forces (or have done these things in the past), you are considered to be emancipated. There are also other circumstances, which depend on the amount of control a minor has over his support or life, where minors are considered emancipated. If you are under 18 and emancipated, you have the right to consent to your own medical treatment. You also have the right to get and amend medical records that are related to this treatment. Your parents generally do not have the right to access your medical record once you are emancipated.

I am an unemancipated minor but I can legally consent to certain kinds of medical treatment without my parents’ permission. Who has the right to get and amend my records that are related to this treatment?

It depends. In the District of Columbia, as an unemancipated minor you can consent to certain types of medical treatment without the permission of your parents. For example, minors can consent to services and treatment for the following without the permission of their parents:

• Contraceptive information, services and devices.
• Pregnancy and its lawful termination.
• Drug and alcohol abuse.
• Mental or emotional conditions.
• Sexually transmitted disease.

When you consent to such treatment, you have the right to get and amend your medical records related to this treatment.

Usually, your parents do not have the right to access medical records related to this treatment unless you give your permission. However, there are times when your provider is allowed to tell your parents about treatment for which you, alone, have given consent. For example, if a minor is found to be infected with a sexually transmitted disease and refuses treatment, their provider must tell their parents about the treatment that they need.

Jason is 15 and is sexually active. He consents to be tested for chlamydia, a sexually transmitted disease. Jason tests positive and agrees to undergo treatment. Later, Jason's mother requests a copy of his medical record. The doctor may not give Jason's mother the part of Jason's medical record related to his chlamydia test and treatment without Jason's permission.

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• Severe complications are present or anticipated;
• Major surgery or prolonged hospitalization is needed;
• Failure to inform the parents or legal guardian would seriously jeopardize the safety and health of the minor patient; and
• Informing the parents would benefit the minor's physical and mental health and family harmony.

In these cases, the provider may inform the parents of the minor's treatment without the minor's permission when, because of the minor's age, the provider can reasonably presume the minor's consent.

The rules may be different for information related to mental health treatment, which is not discussed in this guide.

If you have questions or concerns about whether your parent will have access to your medical information, you should talk to your health care provider.

I am listed as my mother’s "attorney in fact" on her durable power of attorney for health care. Do I have the right to get her medical records?

Yes. If you are listed as your mother's attorney in fact on her health care power of attorney, you generally have the right to get and correct her medical records that are relevant to making health care decisions on her behalf. You have the right of access only while the power of attorney is actually in effect.

Maria’s mother signed a health care power of attorney form that names Maria as her attorney in fact (the person with the power to make health care decisions if her mother is unable to make such decisions). Maria’s mother was in a bad accident and is not able to make decisions about her health care. Maria now has the right to make health care decisions on her mother’s behalf. She also has the right to get her mother’s medical records. For example, Maria has the right to see the records about her mother’s current medical condition and treatment.

Maria is curious about the time her mother had a miscarriage. Maria wants to look at these old medical records. Maria does not have the right to get and amend these old medical records because the records have nothing to do with her mother’s current condition or treatment.

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My father recently died. Do I have the right to get his medical record?

It depends. You do not have the right to get a deceased person’s medical records just because you are a close relative of theirs. You have the right to get a deceased person’s medical records from a District of Columbia health care provider if you are the personal representative (such as the executor or administrator) of the deceased person's estate or if you are the deceased's next of kin, such as their surviving spouse, competent adult child, or surviving parent..

How Long Does My Provider Have to Keep My Medical Record?

District of Columbia law requires many health care providers to keep your medical record for a specific period of time. For example, hospitals must keep your medical record for at least 10 years following your date of discharge. Doctors must keep your medical record for at least 3 years after they last saw you. If the patient was a minor, a doctor must keep their medical record at least until the patient reaches 21 years of age. In practice, many health care providers keep their medical records longer.

You have a right to see, get a copy of, and amend your medical record for as long as your health care provider has it.