The Unpaid Balance and the Record Request
An optometrist’s practice receives a written request from a 42-year-old patient for a complete copy of her record. The account has an unpaid $85 balance for a contact lens fitting, and the office manager wants to withhold the record until it is paid. The same week, the patient’s 16-year-old daughter asks that her own contact lens records be sent to a school nurse, and the practice receives a subpoena signed by a court clerk demanding the mother’s records in a divorce case. The record includes a note that the mother disclosed she is HIV-positive and asked that this not be shared with her spouse.
1. May the practice withhold the mother’s record because of the unpaid $85 balance? What is the correct response to her request?
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No. The patient’s right to access her own record is independent of her billing status. Withholding records to collect a fee can violate records and privacy law and can itself become a professional-conduct complaint. The practice should verify the mother’s identity, provide a complete copy within the required time, and charge only a reasonable, cost-based copying fee if state law permits one. The prior $85 balance may be billed separately, but it cannot be used as leverage. The HIV note is part of the mother’s record and should be included in the copy sent to her; the practice should not send it to the spouse or anyone else without a valid authorization or legal compulsion. If any portion is withheld, the practice must identify a specific legal basis and notify the patient, not simply refuse because the account is overdue.
2. How should the practice handle the 16-year-old daughter’s request and the subpoena?
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The daughter’s request requires a separate analysis. A minor generally cannot authorize release of her own records unless Alaska law gives her confidential consent authority for the service at issue; a contact lens fitting is not usually sensitive care, but the practice should still obtain a parent or guardian’s written authorization or verify the daughter’s legal authority. The school nurse should receive only the records covered by the authorization. The subpoena is not automatically a court order. The practice should verify its validity, notify the mother unless legally prohibited, and seek her authorization or a qualified protective order. It should release only the records described, redact HIV or other sensitive information that is not relevant, and not send the entire chart to the spouse’s attorney. When in doubt, consult counsel and document the decision.