Medical Record Policy | Teri Perryman, MD

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Medical Record Copy Policy

EFFECTIVE October 1, 2011

Last Update EFFECTIVE July 15, 2014

Medical records will continue to be available after August 29, 2014 by a written request mailed to:

Medical Records - Teri Perryman, MD
218 Quinlan St, PMB 382
Kerrville, Texas 78028

DO NOT REQUEST MEDICAL RECORDS IF YOU HAVE A FUTURE APPOINTMENT. IF YOU REQUEST MEDICAL RECORDS BEFORE YOUR LAST VISIT THE COPY YOU RECEIVE WILL NOT BE COMPLETE. WAIT UNTIL AFTER THE LAST VISIT OR EVEN UNTIL SEPTEMBER 2014 TO REQUEST RECORDS.

Our office charges the allowed Texas Medical Board fees on all Requests for Medical Record Transfers and/or Copies except where prohibited.

According to the Texas Medical Board:

"The physician shall be entitled to payment of a reasonable fee prior to release of the information unless the information is requested by a licensed Texas health care provider or physician, if requested for purposes of emergency or acute medical care. In the event payment is not included with the request, within ten calendar days from receiving a request for the release of records for reasons other than emergency or acute medical care, the physician shall notify the requesting party in writing of the need for payment and may withhold the information until payment of a reasonable fee is received." From Texas Medical Board Website, Copied October 1, 2011

Request MUST be made in writing.
Request should include name of child(ren) along with date(s) of birth.
Request should indicate that you are the Mother/Father -or- Legal Custodial Guardian of the named minor(s)
Request should include address for where to send medical records.
OUR OFFICE DOES NOT FAX, EMAILor ELECTRONICALLY TRANSFER MEDICAL RECORDS.
We charge $25.00 for the first twenty (20) pages plus $0.50 per page thereafter for ALL medical record copies/transfers, unless such transfer is being made to another licensed physician for the purpose of EMERGENCY or ACUTE onset of illness.
All request for MEDICAL RECORD TRANSFERS are treated as if they are a NON-EMERGENT TRANSFER OF CARE if the request is either A) not from a licensed physicians office (i.e. patient letter requesting records) OR B) from a licensed physicians office that does not inidcate ACUTE or EMERGENCY TREATMENT.

PLEASE NOTE: Request for records from a licensed physicians office indicating "Patient currently in office for immunizations" are treated as a "NON-EMERGENCY" request since immunizations are ROUTINE care and not EMERGENT/URGENT/ACUTE care. Our office will send over the shot record as soon as feasible. Additionally, unless our office is otherwise notified, we consider a request for "SHOT RECORD ONLY" to another physicians office for immunizations as the same as a request to transfer medical care to another provider. Upon such receipt of request our office will mark your child(ren)'s records as TRANSFERRED and we will no longer see them.

PLEASE NOTE: Legal Custodial Guardians - Our office must have on file a copy of legal documents stating that you are in fact the Guardian of the minor. If you have previously provided these documents to our office then we can comply with the request. If we do not have copies of the documents on file, then the request is not a valid request and we will not respond to the request other than a letter stating that we can not comply with the request pending receipt of the necessary documents.

Special Note for Shot Record Only Request: We will provide personal copies of shot records at no charge provided there has been a change in immunization status (i.e. child has received more immunizations since the last shot record was provided). At any time, after the first shot record has been provided our office may impose a $5.00 per shot record charge for each additional copy.

The above items related to request for medical records applies
Again, there is no charge for sending the first shot record copy..
When additional immunizations are given a new "first" copy of the shot record will be provided at no charge, typically upon completion of the visit.
We may charge $5.00 for each additional copy of a shot record, provided there has been no change in immunization status.

Sample Written Request for Release of Medical Records

Your Name

Your Address

Your City, State Zipcode

Contact Phone Number <---- In case we have problems and need to contact you.

Date

To: Teri Perryman, M.D. Prof. Assoc. -or- {other physician office}

I { state your name} am requesting as the mother/father of the below named child(ren) a copy of my child(ren)'s medical record(s) to be sent to {name of where we are sending records [Teri Perryman, MD, PA], [Self], [Other Physician Office]} for the purpose of _________________________ {i.e.transfer of medical care, continued medical care, moved out of area, personal copy}.

My child(ren)'s names and dates of birth that I am requesting these copies for are:

Childs Name #1, DOB : Month/Day/Year

Childs Name #2, DOB : Month/Day/Year

etc.

{Include either of the following:}

{Please call me at (xxx) xxx-xxxx and I will come by to pick up the medical records when they are ready.}

- or -

{Please mail the medical records to:

Name (i.e. Your Name, Teri Perryman, MD, other physician office)

Address

City, State, Zipcode}

Please email me an invoice to {myemailname}@{emailprovider}.{com/net/org}.

Sincerely,

Signature

Please note that this sample letter can be used for requesting records from our office or any other physician office. Simply fill in the approprate information as indicated. Instead of using " To: Teri Perryman, M.D., Prof. Assoc." you could simply insert another physicians office name. In the area for providing information on where to send records you can simply fill in your personal information, for a personal copy of records, our office information or the name of another physician office where the records need to go.

INCLUDE YOUR CURRENT ADDRESS AS THE ADDRESS WE HAVE IN OUR SYSTEM COULD BE OUTDATED.

INCLUDE EMAIL ADDRESS FOR PayPal Invoicing of charges. You can pay online with credit card, check or mail a check in or drop a check or cash off at the office once you receive the invoice.

If you do not include EMAIL address then we will mail you an invoice.

Be sure to check with the office prior to requesting records regarding their fees. Our office charges a variable fee based on the Texas Medical Board's rules and regulations. We will invoice you for the fees once we have calculated them.

DO NOT SEND PAYMENT WITH REQUEST UNLESS YOU ARE SURE THAT THE AMOUNT BEING SENT IN IS THE FULL FEE.

The above is just a sample of wording and some offices may ask that you use a "form" from their office or another physicians office. Under Texas State law and Texas Medical Board rules there is not a requirement for the use of any "form", only that any request for release of medical records must be made in writing. Under Federal HIPAA Privacy Act, there is a requirement, for any "form" used by an office to request medical records or disclosure of protect health information to provide notification to the person filling out the form certain "standard" HIPAA required elements. Such elements are related to use of the disclosed information, length of time the request is good for, how to terminate the request, further disclosures and scope of previously provided authorizations. If you are not using a "form" provided by an office then the HIPAA notifications are not required.

A few additional notes:

Per Texas Medical Board Rules and Regulations we have ten (10) business days to provide you with an invoice after you make your request.
Once payment is received our office will make copies and mail them to you.
Once we receive payment our office has fifteen (15) business days to make copies and drop them into the mail.
We do not use certified mail but keep a record of the date request is received, date invoice sent, date payment received, date copies made and the date the records are mailed.

If you have any questions about this or any office policy please feel free to contact our office.

We are not attorneys or HIPAA compliance officials. This is the understanding our office has of this issue. The laws, rules, regulations and any and all other requirements for release of medical records can change at any time, with or without notice. Our office will always strive to remain current in our internal use and disclosure of protected health informaton and medical records, but our website may or may not have been updated.