The Unpaid Balance and the Transfer Records
Mr. Nguyen, 47, has generalized moderate periodontitis. He accepted scaling and root planing, but missed two appointments and now owes $640. He asks that a copy of his records be sent to his new dentist in Henderson. The office manager tells hygienist Priya: 'Do not release anything until he pays. And add a note that he refused all treatment and was dismissed-backdate it to last month so it looks like we gave him notice.' Priya knows no dismissal letter was ever sent and that Mr. Nguyen did accept the treatment plan. The patient says he is moving and needs the records for continuity. The practice's written policy says records are released only after payment in full.
1. Must the practice release Mr. Nguyen's records? Can it condition release on payment of the $640 balance?
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The practice should release the records. A patient has a right to a copy of his dental records for continuity of care, and a policy that withholds records until a bill is paid is problematic under patient-rights and privacy principles. The practice may charge a reasonable, cost-based copying fee, but it should not use the unpaid balance as leverage to deny access. Priya should route the request to the dentist or privacy officer, confirm the patient's identity and authorization, send the records to the new dentist promptly, and document the request and response. The $640 balance can still be pursued through normal billing, but it is a separate issue from record access. If the practice refuses, it risks a complaint and discipline.
2. Should Priya add the requested dismissal note and backdate it? What are the consequences, and what would a proper dismissal require?
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No. Backdating a note to make it appear the patient was dismissed last month is falsifying a record. Priya should document only what happened, on the date it happened, in an addendum. She should state that the patient accepted the treatment plan, missed two appointments, and has an outstanding balance; she should not write 'refused all treatment' because that is not true. Altering or backdating records is unprofessional conduct and undermines the credibility of the entire chart. If the dentist wants to dismiss the patient for noncompliance or nonpayment, the practice should send a written dismissal notice, offer emergency care for a reasonable period, explain how records will be transferred, and allow time for another provider to take over. Dismissal without notice can be patient abandonment.