Who Has to Follow These Laws?

Most Missouri health care providers (such as doctors, dentists, chiropractors, and hospitals) must follow both the HIPAA Privacy Rule and state laws that give patients rights in their medical records.

There are some health care providers, however, that do not have to follow the HIPAA Privacy Rule. The HIPAA Privacy Rule only covers health care providers that use computers to send health information for certain administrative or financial purposes (such as filing claims for insurance).

Sometimes Ashley goes to a doctor at a free clinic for medical treatment. The doctor does not accept private insurance, Medicaid, or Medicare. The doctor does not file any insurance claims. Ashley’s doctor probably does not have to follow the HIPAA Privacy Rule because the doctor does not appear to send health information for the types of administrative or financial purposes that would make her a covered health care provider under the Rule.

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If you have questions about whether your health care provider must follow the federal HIPAA Privacy Rule, you can contact the Office for Civil Rights, U.S. Department of Health and Human Services (OCR), the agency that is in charge of enforcing the HIPAA Privacy Rule. Section 4 of this guide lists contact information for OCR.

Are nursing homes covered by HIPAA?

Yes. Most nursing homes are covered by the HIPAA Privacy Rule. They also have to follow other specific rules that only apply to nursing homes and long term care facilities. Because the rules for nursing homes are different than they are for other health care providers, they are not covered by this guide.

What if my health care provider does not have to follow HIPAA?

Even if your provider does not have to follow the HIPAA Privacy Rule, they still have to follow Missouri laws that give you rights to your medical record. Section 6 lists some resources where you can read these state laws.

This guide, however, only explains getting your medical record from Missouri providers who have to follow the HIPAA Privacy Rule and state law.

What Records Do I Have the Right to Get and Amend?

You have the right to see and get a copy of your medical record. This right often is called the right to access your medical record. You also have the right to have information added to your medical record to make it more complete or accurate. This right is called the right to amend your record. (This guide will call these rights the "right to get and amend.")

Your medical record includes such things as:

• Information that identifies you, such as your name and Social Security number.
• Information that you tell your doctor, such as:
  • Your medical history.
  • How you feel at the time of your visit.
  • Your family health history.
• The results of your examination.
• Test results.
• Treatment received in a hospital.
• Medicine prescribed.
• Notes your doctor makes about you.
• Other information about things that can affect your health or health care.

You have the right to get these records whether they are kept on paper, on a computer or in another format.

Who owns my medical record?

Under Missouri law, your health care provider owns the actual medical record. For example, if your provider maintains paper medical records, they own and have the right to keep the original record, but you have the right to see and get a copy of it.

What happens if my medical record has information in it that came from a different health care provider?

Generally, if your provider has the medical information that you request, they must give it to you. You have the right to get the information no matter who originally put it in the record. Your right to amend this information may be limited, though. For more information about how to amend information in your record you can read Section 3 of this guide.

Do I have the right to get and amend records related to substance abuse or mental health treatment?

Maybe. The rules for when you can get and amend your records about mental health and substance abuse treatment can be different. For example, psychotherapy notes are treated differently than other records under HIPAA. Because the rules for mental health and substance abuse records can be different they are not discussed in this guide. You can find some resources that explain your rights in these types of records in Section 6.

Who Has the Right to Get and Amend My Medical Record?

You have the right to see and get a copy of medical records that are about you. You also have the right to add information to your medical record to make it more accurate or complete. (This guide calls these rights the right to "get and amend" your medical record.) If there is someone who acts as your personal representative, they usually have the right to get and amend your record on your behalf. 

Do I have the right to get and amend my minor child’s medical record?

Generally, yes. As a parent or guardian, you are usually considered to be the personal representative of your minor child. As a personal representative, you have the right to get and amend your minor child’s medical record. In Missouri, you have these rights when your child is younger than 18 years old.

As a parent, do I always have the right to get and amend my child’s medical record?

No. A parent does not always have the right to get and amend a minor child’s medical record. For example, if a health care provider reasonably believes that a parent is abusing or neglecting a child, the provider does not have to treat the parent as the child’s personal representative. This means the provider does not have to give the parent access to the child’s medical record.

Some other situations where parents do not have the right to get and amend their child’s medical records are discussed in the following questions and answers.

Who has the right to get and amend my child’s medical record once she turns 18?

Once your child turns 18, your child has the right to see, get a copy of, and amend her own medical record. This includes getting access to records that were created when she was still a minor. You usually no longer have the right to get and amend your child’s medical record just because you are her parent.

My minor child is married. Who has the right to get her medical record?

Minors who have been lawfully married are considered adults for purposes of consenting to health care treatment. The married minor, not the parent, has the right of access to the minor's medical record.

I am an unemancipated minor but I can legally consent to certain kinds of medical treatment without my parents’ permission. Who has the right to get and amend my records that are related to this treatment?

It depends. In Missouri, as an unemancipated minor you can consent to certain types of medical treatment without the permission of your parents. For example, as a minor you can consent to treatment or procedures for:

• Pregnancy (excluding abortions).
• Venereal disease.
• Drug or substance abuse.

When you consent to such treatment or procedures, you have the right to get and amend your medical record related to this treatment.

Whether your parents also have access to information related to this treatment is more complicated. In Missouri, if it turns out that you are not pregnant, not afflicted with venereal disease or not suffering from drug or substance abuse, then your provider may not give any information about your appointment, test, or procedure to your parents. On the other hand, if you do have one of these conditions, your provider may, with or without your permission, tell your parents about the examination, treatment, or care given or needed. Similarly, your provider will not be punished if they tell your parents the results of an HIV test.

Jason is sexually active and under 18. He consents to be treated for chlamydia (a sexually transmitted disease). He tests negative. Jason’s mother later requests a copy of his medical record. The doctor may not give Jason’s mother the part of Jason's medical record related to this treatment without Jason's permission.

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The rules may be different when you, as a minor, obtain testing or treatment for other medical conditions without parental consent. If you have questions or concerns about whether your parent will have access to your medical information, you should talk to your health care provider.

I am listed as my mother’s agent on her durable power of attorney for health care. Do I have the right to get her medical records?

Yes. If you have your mother’s durable power of attorney for health care, you generally have the right to get and correct her medical records. You have the right of access during the time that you have the authority to make health care decisions on her behalf.

Maria’s mother signed a health care power of attorney form that gives Maria the power to make health care decisions if her mother is unable to make such decisions. Maria’s mother was in a bad accident and is not able to make decisions about her health care. Maria now has the right to make health care decisions on her mother’s behalf. She also has the right to get her mother’s medical records. For example, Maria has the right to see the records about her mother’s current medical condition and treatment.

Maria is curious about the time her mother had a miscarriage. Maria wants to look at these old medical records. Maria does not have the right to get and amend these old medical records because the records have nothing to do with her mother’s current condition or treatment.

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It depends. You do not have the right to get a deceased person’s medical records just because you are a close relative of theirs. You have the right to get a deceased person’s medical records from a Missouri health care provider if you are the personal representative (such as the executor or administrator) of the deceased person's estate.

How Long Does My Provider Have to Keep My Medical Record?

Missouri law requires many health care providers to keep your medical record for a specific period of time. For example, doctors must keep your medical record for 7 years after your last treatment. Hospitals must keep your medical records for a minimum of 10 years or, in the case of a minor, until the minor is 23 years old, whichever is longer. In practice, many health care providers keep their medical records longer.

You have a right to see, get a copy of, and amend your medical record for as long as your health care provider has it.