The Records Request, the Daughter, and the Subpoena
A 58-year-old patient has been seen at a Connecticut practice for three years. She is moving to Florida and asks for a complete copy of her dental record, including radiographs, periodontal charting, and progress notes. The office manager says the records belong to the dentist, that the practice will send only a summary to the new dentist, and that a complete copy costs $75 plus $1 per page. The patient refuses to pay and says she will complain. The next day the patient’s adult daughter calls and asks whether her mother is taking any medications because the mother is “forgetful.” Later that week the practice receives a subpoena from an attorney for the patient’s former employer, seeking all records, including hepatitis C status, in a disability benefits dispute. The hygienist is asked to prepare the copies.
1. Must the office give the patient a complete copy of her record? Discuss ownership, fee, and format.
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The patient is entitled to a copy of her record. In Connecticut, the dentist is the custodian of the record, but the patient has a right of access to her own health information. Ownership of the physical file does not justify refusing a copy or substituting a summary for the record the patient requested. A reasonable copying fee may be charged, but the fee must be consistent with applicable law and cannot be used to obstruct access. The office should provide the complete record, including radiographs and periodontal charting, in a readable format. Reasoning: the manager’s statement confuses custody with ownership and access. The patient’s request is not limited to a transfer summary; she asked for the record itself. The hygienist should not alter the record to remove difficult entries. If the office believes a fee or format rule applies, it should cite the specific rule and give the patient a clear written response rather than a blanket refusal.
2. How should the office respond to the daughter’s call and the attorney’s subpoena?
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Daughter’s call: the daughter is not automatically entitled to the mother’s health information merely because she is family. The office should not confirm medications, diagnoses, or even that the mother is a patient without a valid authorization or a legal exception. The staff can offer to contact the mother directly or ask the daughter to have the mother sign an authorization. If the mother lacks capacity, the office should follow the applicable representative-consent process rather than improvising. Subpoena: a subpoena is not a blank check. The office should verify that it is valid, determine the deadline and scope, and notify the patient or her attorney so she can object or seek a protective order. Hepatitis C information is sensitive; release should be limited to what the subpoena requires and what the law permits. The hygienist should copy only the requested records and document what was released, to whom, and when. Reasoning: confidentiality protects the patient even against family members and against overbroad requests.
3. What should the hygienist do if the dentist asks her to remove a negative progress note before responding to the subpoena?
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She must refuse. Altering, removing, or backdating a record in anticipation of litigation is unprofessional conduct and may constitute obstruction or fraud. The hygienist should state that she cannot alter the record, preserve the original entry, and escalate the request to the dentist or practice attorney in writing. If the dentist insists, the hygienist should document the instruction and seek her own legal or Board guidance. Reasoning: the record is evidence, and the patient and the legal system are entitled to the contemporaneous entry. The hygienist’s license is at risk even if she did not originate the note. The correct response to an unfavorable note is a later addendum that identifies the date, author, and reason for the addition-not deletion. This preserves both the patient’s record and the hygienist’s integrity.