Records Request, Unpaid Balance, and Patient Dismissal
A patient who has been in the practice for six years requests copies of his complete dental record, including radiographs, because he is relocating to another state. He owes $640 for a crown seated three months ago. The front office tells him the practice will not release records until the balance is paid. The dentist also wants to dismiss the patient from the practice for nonpayment and asks whether she can simply send a letter saying he is no longer welcome. The patient has an upcoming hygiene appointment and has not reported any current pain. The practice uses a paper chart plus digital radiographs, and the original chart is stored at the office.
1. May the practice withhold the patient's records until he pays the $640 balance? Explain.
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Generally, no. A patient's right to access his or her dental record is not conditioned on payment of an outstanding treatment bill. Board rules and federal privacy law give patients a right to copies of their records, and withholding them for debt collection can itself generate a complaint. The practice may charge a reasonable, disclosed copying fee for the records, but it should not use the records as leverage for the debt.
The practice should provide the complete record-chart notes, radiographs, and relevant correspondence-promptly after receiving a written request and any permitted copying fee. The unpaid balance remains a separate billing matter. The dentist can pursue collection through ordinary means, but not by denying access to the record.
2. What must the practice consider about the original chart and the radiographs?
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The practice must retain the original record for the period required by the Board's record-retention rule; it provides copies to the patient, not the originals. Digital radiographs should be exported in a usable format, and the practice should keep its own copy. A record-release log should document what was sent, to whom, when, and what fee was charged.
If the patient requests a transfer to a new dentist, the practice should send the records directly with a signed authorization and keep proof of the transfer. The retention period is not measured from the date of the request but from the last treatment or the applicable rule. Destroying or losing the original after copying would create a separate records violation.
3. How should the dentist handle the proposed dismissal for nonpayment?
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Dismissal is possible but must be done carefully. The dentist should give written notice, allow a reasonable transition period, offer to transfer records, and provide emergency contact information so the patient is not abandoned. A bare letter saying he is no longer welcome is risky, especially with an upcoming appointment already on the schedule.
The notice should state the effective date, explain that the practice will provide records to a new dentist, and make clear how urgent problems will be handled during the transition. Because the patient has no current pain, this is not an emergency dismissal, but the practice should still avoid timing the dismissal to leave him without care. The unpaid balance can be addressed separately; dismissal should not be used as a collection threat.