Closing a Practice: Four Requests in One Week

The patient is entitled to a copy of his record, and the record is what it is - including the former associate's opinion. The two mistakes to avoid are removing the note and paraphrasing it into something gentler. Deleting or rewriting a contemporaneous entry is falsification of a patient record and is a far more serious disciplinary matter than the original comment. Produce the complete record, including the note, within the time the applicable law allows (HIPAA generally sets an outer limit of 30 days, with one extension; check whether Idaho imposes a shorter period).

What she may do is add a clearly labeled, separately dated addendum stating her own observations and, if accurate, that the note reflects a prior clinician's impression rather than a documented clinical finding. The original stays legible and intact.

On fees: a reasonable, cost-based fee for copying, labor, and supplies is generally permissible; a vendor's per-chart export charge may be passed through only to the extent it reflects actual cost, not as a markup or a profit center. Confirm the current federal fee guidance before quoting a number. Respond in writing, keep a copy of what was sent, and do not let the request sit while the practice winds down - delay is the most common way a records complaint becomes a disciplinary complaint.

A subpoena is a discovery device, not a patient authorization, and it does not by itself override confidentiality. The correct sequence is: verify that the subpoena is genuine and properly issued (court, caption, correct patient, correct practice, realistic deadline); then either obtain a signed authorization from that patient or obtain satisfactory assurances - notice to the patient so he can object, or a qualified protective order. Under HIPAA, disclosure in response to a subpoena without authorization requires those assurances; ignoring the subpoena, on the other hand, risks contempt.

Practically: contact the issuing attorney in writing, explain what is needed, and calendar the return date. Produce only the named patient's record - not the spouse's, not a sibling's, not the whole family file. Redact information about other people where it appears. Keep a log of exactly what was produced and when, and charge only permitted fees. If the patient objects, do not produce until the court rules, and tell the attorney why. If she is closing the practice, identify now who will hold the records and can respond to later subpoenas, because a subpoena served after she moves still has to be answered.

Requests (3) and (4) both fail on authority. A spouse has no right to another adult patient's record merely because they share insurance or a household; sharing a policy is not authorization. The front desk should decline politely, offer to give the wife a release form, and document the interaction. The non-custodial father is a closer question: a parent or legal guardian ordinarily may act for a minor, but custody orders can limit that, and Idaho law allows minors to consent to certain categories of care, which can affect what a parent may see. Ask for the custody order, and if access is restricted, decline and refer him to counsel.

On closing: the records are not hers to discard or take without a plan. Confirm the retention period in the current rule (typically measured from the last visit, and longer for minors), then arrange a custodian - a successor practice, a records service, or herself with a secure off-site arrangement - notify patients by mail, website, and voicemail where records will be and how to request them, and keep the EHR exportable rather than trapped behind a lapsed vendor subscription. Destroy only after the retention period, by secure method, with a destruction log.