Fact Sheet

HOW TO ACCESS YOUR HEALTH RECORDS

What information should be in medical records?

Medical records should contain all of a patient's important medical history, such as illnesses and allergies. The doctor should also record details of each consultation, including medications prescribed, procedures carried out, tests ordered and their results.

How confidential are my medical records?

Medical records should remain confidential between the patient and the doctor. The doctor's staff will need to see them. They may sometimes be required in a court upon the issuing of a subpoena if a court case is on foot. Otherwise, information from the records should not be made available to third parties (such as insurers, pathologists or other medical practitioners) without your written permission.

Who owns the medical records?

Medical records are the property of the doctor or practice attended by the patient but the patient has a right to the information contained in the records. Therefore the physical record belongs to the doctor, but the patient is entitled to access the contents. This is supported by state and federal legislation.

The records concern my health - why don't I own them?

The records are the notes the doctor makes to assist the doctor. While the records contain confidential information about the patient, they are made by the doctor and are the doctor’s property. However, as noted above, the law now gives a patient a right of access to the medical records. This was not always the case.

What happens when a doctor receives my request for medical records?

The doctor is required to respond to the request within a reasonable time. If the doctor declines access, then a written reason must be given. If no response is given, then the doctor is deemed to have declined to give access. The request for access to medical records is best handled by a solicitor as the law governing access to medical records is complex.

When might my application for access be refused?

If the doctor forms the opinion that by releasing the records the patient might be harmed (due to the very confidential or distressing nature of the records), access may be denied. However, the decision to decline access can be challenged legally. The patient can request the records that are said to be too damaging be released to another doctor of that patient’s choice and this request must be made within a reasonable time.

Does it cost any money to obtain access to my medical records?

Yes – most doctors will charge a fee for handling and copying their records but this should reflect only the administrative costs involved. The charge is generally the cost associated with photocopying the records and is calculated on a ‘per page’ basis.

What happens when a practice changes hands?

When a practice is disposed of, the doctor disposing of the practice should make reasonable efforts to ensure the maintenance of the records eg: by providing the records to the patient to whom they relate. The records may also be provided to another doctor identified by the patient at the request of the patient.

And in the case where the doctor dies?

Unfortunately, there is no easy solution to the problem that arises when a doctor in solo practice dies suddenly (or leaves the practice without handover arrangements). Technically, his or her estate is liable for the safe keeping of records, but in the turmoil of the circumstances, the family may not be able to handle such matters efficiently. Patients involved in such a situation should approach the estate and ask for the records to be sent to another doctor.

How long is a doctor required to keep my records?

Records must be kept for at least seven (7) years for adults and up to twenty five (25) years for children from the date that the patient was last provided with medical treatment or services by the doctor or medical practice. Some doctors keep records indefinitely; others cull them regularly.

< Back to Medical Health Law