The Record That Follows Her
A therapist receives a records request from an employer's third-party disability reviewer for a client's full chart, including progress notes from 3 years of treatment. The client signed a broad release at intake that names the practice but not this reviewer. The chart contains: a prior diagnosis of personality disorder later revised, a note about a marital affair, a child's name and school, and one note describing a client's statement about a past misdemeanor. The client is currently applying for disability benefits and has told the therapist she 'needs this to go through.' The request asks for 'all records, unredacted.' The state requires specific written authorization for release of mental health records and has heightened protection for substance use and HIV information (none present here).
1. What do you release, and what is your process before releasing anything?
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The intake release is probably insufficient. A broad release naming the practice does not necessarily authorize release to a specific third-party reviewer, and state law requires specific authorization for mental health records. Step one is to verify the authorization meets the legal standard: who is authorized to receive, what is being released, purpose, expiration, and signature.
Process before release:
- Verify and, if needed, obtain a compliant, specific authorization from the client - including the reviewer's identity.
- Talk to the client about what is in the chart and what the consequences of release may be. She wants the records to support her claim, but the chart also contains material that could be used against her (the revised personality disorder diagnosis, the affair, the misdemeanor note). Informed consent to release means she knows what she is consenting to.
- Release the minimum necessary. Disability review needs treatment dates, diagnoses, functional impairment, and prognosis - not every progress note. Offer a summary or the relevant subset.
- Redact third-party information - the child's name and school, and any information about other people - unless directly relevant and authorized.
- Do not release the misdemeanor note if it is not relevant to the disability determination; relevance, not completeness, governs.
'All records, unredacted' is a request, not an entitlement. The clinician's obligation is to the legal standard and the client's informed choice.
2. The reviewer pushes back, saying the client 'already signed.' How do you respond, and what goes in the record?
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Response: Explain that a signature is necessary but not sufficient - the authorization must be specific enough to be valid under state law, and the clinician is obligated to release only what is necessary. Offer the compliant path: a corrected authorization and a targeted release or summary. Do not argue about the client's motives; keep the exchange factual and documented. If the reviewer threatens or pressures, that is noted, not complied with.
In the record:
- The date and nature of the request.
- The authorization received and the determination of its sufficiency or deficiency.
- The client contact, what was explained, and her decision (with any specific consent to the targeted release).
- Exactly what was released, to whom, on what date, and what was withheld and why (third-party redaction, minimum necessary, irrelevance).
- The reviewer's pushback and the clinician's response.
Key principle: the client's stated need for benefits does not override the requirement for valid authorization and minimum necessary disclosure. The clinician protects the client by making the release accurate and narrow, not by making it total.