Hard lesson learned get your medical records

Discussion in 'Fibromyalgia Main Forum' started by marti_zavala, Jul 24, 2008.

  1. marti_zavala

    marti_zavala Member

    I just found out that the medical practice that I went to some years ago (Sadler Clinic) does not have my medical records. They have been destroyed.

    The time they use is 6 years. If I had remained a patient, they would be intact but since I left the Clinic, they are destroyed after 6 years.

    It makes sense but I am disappointed and concerned as my first SSDI review is approaching.

    Please get copies of each test, lab work, MRI, and even the doctors notes.

    I started keeping a notebook with several dividers. First section is normal labs in reverse chronological order with date, doctors name and abnormal results highlighted.

    The next section is other tests like EMG's or MRI's.

    The third section is for doctors notes.

    The last section is for my research papers backing up a test or treatment protocol that I want to discuss with the docs.

    On the inside of the notebook cover, I list the meds that I take.

    I need to add a symptom list that can be easily updated. Still working on that. I would love any other tips to keep my medical info at my fingertips.

    Unfortunately, my old records may be lost.

    Please protect yourself by getting all the records you can.

  2. Honora88

    Honora88 Member

    Perhaps you can get a note from your previous dr?
  3. lrning2cope

    lrning2cope New Member

    Your advice and system for organizing medical history are great ! I want to get all my medical records , and I needed an organization method , so this is a great post for those of us who may be organizationally challenged !

  4. marti_zavala

    marti_zavala Member

    I am mostly upset about the lab results of when I first got sick.

    I had a terrible doctor so the notes wouldn't help much plus he is long gone.

    I may be able to salvage my record because I am hoping that I transferred my records to two other docs so there is a possibility.

    This was just not on my radar.

    Holly, I hope that helps. That is something I still have alittle bit of - organization (not that you could tell from my house...)

    I also have a word document on my laptop where I list all of my doctors, their phone numbers, my next visit and when they want to see me again (like see me in 6 months).

    I have that open when I call for an appt and I try to set two appts on the same day. It is saving a lot of wear and tear on me and my gas bill.

  5. moreinfoplease

    moreinfoplease New Member

    I recently got copies of some of my medical records and have been wondering about how to go about getting copies of doctor's notes on an ongoing basis?

    In the past I have sometimes requested copies of lab test results while at the drs appointment. I have always gotten them, sometimes easily and sometimes with a lot of attitude on their part and stress on my part.

    I never requested the drs notes though. Now, obviously, when you are at the appt the dr has not written the note, so it can not be given to you at that time.

    What I am wondering is if I can ask the dr, nurse, or front office staff to mail me a copy when it is written?

    Have others done this and if so:
    -who specifically did you ask?
    -what was the response?
    -can you put in an ongoing "order" or do you have to make a special request each time?


    PS. Thanks Marti for the ideas on how to organize medical info. I am trying to get a handle on it all, and the ideas help.
  6. jasminetee

    jasminetee Member

    That really sucks. Good luck with getting SSDI, I'll keep my fingers crossed for you.

    I call my doctors and ask for my records twice a year but once is enough really. I have to pay a small fee sometimes but I don't mind. We have a FAX machine at our home and that makes it easier. They FAX me a form to sign for my records, I sign it and FAX it back then they mail me my records and I file them. I've been doing this for years.

  7. marti_zavala

    marti_zavala Member

    Thanks teejkay and bdtmu.

    Well, I will be going up for my first 3 year review so I guess the older records are not as critical as current stuff.

    Moreinfo, I think I will do it like teej, asking for the records twice a year or even once a year. I think about the best ways to do this. About six months ago, I had several offices send records to a small local doctors office and then I asked her to send them on to a new large clinic. They do it for free as a professional courtesy for other doctors offices. I offered to pick them up before my appt and handcarry them to the office (which saved them the postage (it was a hefty file). They were happy and I got a chance to photocopy my records before taking them to the new doc.

    I don't like how they charge but I may try asking them to use my own paper and see if they waive the charge.

    One office here charges $30 to copy the file.

    That is too much in my opinion.

  8. Granniluvsu

    Granniluvsu Well-Known Member


    So sorry to hear aboaut that !! Since I agressively started asking for my labs and tests(before my actual dx and afterwards) I have just had to ask for my bloodwork, Bone density, etc. without a fee. I have not asked for all the doctors notes though.

    I went for over 20 years when absolutely nothing was known about CFS/FM/CMPS, etc. and then just gave up cause they hadn't a clue and I was tired of people looking at me like I had two heads and was crazy cause all looked "normal".

    I finally got dxed about 2 yrs ago I guess. When I did change docs cause she was no longer coming to my area she charged to have records changed. I think it was either $25 or $50. However, when I handed my lab work to the new doc (rheumy) I asked her if she needed anything else from the labs I had gotten and she said NO. So that was a good thing for me. I now also keep a record of my thyrold labs, etc. bone density etc since I have osteoporosis also. Also have my x ray info that showed some athritis in the cervical/ neck area (no surprise)ouch !!

    I hope you can get something from the past to help you. I am sorry to hear that the records were destroyed, Many years ago I was dxed with Ebstein Barr but I just had to tell her that and she took note of that. I know the doc is either dead and not practicing any more for sure who told me about the EBV. It was also in Houston where I no longer live. Someone told me sometime ago about keeing the records and they have really come in handy.

    Good luck in your search for info to help you with your SSD. Please keep me informed how you are coming along.

    Since you are trying to get SSD you many need more detailed info . I do not know.

    Blessings and hugs,

    [This Message was Edited on 07/25/2008]
  9. lrning2cope

    lrning2cope New Member

    that if you ask for a copy during your doctor appointment(of the results they are giving you ) that you don't have to pay . It has been that way for me. One doctor sends me the results for free. She is the best !

    Marti - It sounds like it is good that you don't go to that doctor anymore ! I agree that they are supposed to keep the records longer.

    I had an interesting thing happen . I went to get copies of my x-rays and MRI's once and they gave me the originals. No charge . I wonder how anyone can use the information from these unless I provide it ? Maybe the hospital has copies ?

    [This Message was Edited on 07/25/2008]
  10. bellydonna

    bellydonna New Member

    I'm trying to get all of my records and it seems harder and harder.
    I've encountered "the Attitude" and the process itself just gets harder. maybe that's fms speaking but I find the release forms overly intrusive. One I just filled out wants as specific reason. It lists about 15 reasons. I don't think it is relevant to them "why". the records are mine, too. not just their property. I paid for them dearly and need them for continued care& archival.
    and the fees! thank you for suggesting "hand carry to next doctor"
  11. tooks

    tooks Member

    Hi, awful they lost them. I'm trying to get some now from a few years ago and the doctor has relocated--his nurse hadn't even starting looking for the records and it had been 3 weeks since another doctor had requested them with my release.

    Here is a thought though: if the tests were done at an outside lab, they should still have the records.

    And to others having trouble, take or send a copy of the relevant parts of the Hippa law with you. Here is a link: http://www.hhs.gov/ocr/hipaa/consumer_rights.pdf

    And to quote: "Providers and health insurers who are required to follow this law must comply with your right to…

    1) Ask to see and get a copy of your health records
    You can ask to see and get a copy of your medical record and other health information. You may not be able to get all of your information in a few special cases. For example, if your doctor decides something in your file might endanger you or someone else, the doctor may not have to give this information to you.

    2) In most cases, your copies must be given to you within 30 days, but this can be extended for another 30 days if you are given a reason.

    You may have to pay for the cost of copying and mailing if you request copies and mailing."

    Also you can..."Have corrections added to your health information. You can ask to change any wrong information in your file or add information to your file if it is incomplete. For example, if you and your hospital agree that your file has the wrong result for a test, the hospital must change it. Even if the hospital believes the test result is correct, you still have the right to have your disagreement noted in your file.

    In most cases the file should be changed within 60 days, but the hospital can take an extra 30 days if you are given a reason."

    And here is another quote that should cover doctors' notes:

    "The Privacy Rule requires covered entities to provide individuals with access to protected health information about themselves that is contained in their “designated record sets.” The term “record” in the term “designated record set” does not include oral information; rather, it connotes information that has been recorded in some manner."

    This is important information for us all. There is also a section about how to file a complaint.

    [This Message was Edited on 07/25/2008]
  12. Didoe

    Didoe New Member

    the flip side of having records deleted...
    i asked 2 shrinks who treated me for depression more than a decade ago to send diagnosis and med list to a more current doctor. They also had destroyed all records.
    The hosptial i had been treated inpatient psych for 3 weeks also had no record of me, they destroy after 7 years.

    goody goody gum drops is all i'll say. it must be like hearing your misdemeanors were wiped clean and you dont have a police record.
  13. marti_zavala

    marti_zavala Member

    Didoe, that was funny. I never thought about it that way.

    I am currently on SSDI, was trying to get some records to prepare for my first review sometime next year (yes, I am starting early!).

    There have been some great suggestions. Thanks everyone.

    My current medical practice - Kelsey Seybold, usually will send a paper copy of the results of labwork. I think I will insist on it every time.

    Good idea,
  14. PVLady

    PVLady New Member

    There are normally laws governing the time to retain records. In my profession it is 5 years. In this age where data an be saved on computers, I think medical records should be kept forever.

  15. RatsWife

    RatsWife New Member

    I won't name names but there are services now that will put your hard copy records onto CDs for you. I use one.

    I learned my records had been destroyed also. Gall bladder surgery gone. Hysterectomy/Oovaectomy (sp) gone.

    Psychiatric records are never available according to my research. Standard practice is to call any visit "depression" even if you're there for something entirely different. I've never liked the idea of my psych records being available to anyone, even me.

    I've been told 2 different time lines for recordkeeping. 7 years and 10 years.

    I have annual gastro exams so I have a complete history for this area but all others are gone.

    I asked the doctors for something in writing but each said, in writing, that it was impossible to recollect any details of my care so each declined.

    I also understand that there shouldn't be any charge except for those from hospitals as most of them do not have any staff to spare for sending out patient records. I paid a minimal sum to one company and did manage to get the hospital portions of my early surgeries that the doctors had destroyed the records for. That's something. The cost was like $6 for 100 pages worth, I think.

    None of my doctor's offices have ever charged me for copies.

    Some respond right away, others I have to fax and fax and fax to get what I want. Once I even had to make an appt so I could tell the doctor how crummy his staff was. Yes, I did this. LOL! Hey, if they can't make copies, then what else can't they not do? Right?

    Only one practice got nasty but not real nasty. They assumed I was angry about something and was taking my records somewhere else. I called later to make an appt and was told I wasn't a patient there any longer. I said, HUH? The office manager was very embarassed because she's the one who misunderstood why I wanted copies.

    All you need to say is you want them in one place for your personal use.

    I learned one neurologist I saw in the early 1980s just had the records thrown in a dumpster. Now how professional and confidential was that, I ask. Ummm-hmmm. Bad doctor!!

    Peace and Gentle Hugs,
  16. marti_zavala

    marti_zavala Member

    Pvlady, I guess I was under the impression that they would get converted to digital form and stored. I just wasn't thinking.

    Ratswife - That is a good idea - tell them up front that it is for personal use.

    Every single one of my doctors charges if I want them for me but if I send them to another doctor, they are free.

  17. Leaknits

    Leaknits New Member


    I'm going through a battle with dr for my records right now. He says "Lea, if I copy your records for you I'll have to do it for everbody else"...I resisted the urge right here to look behind me and see just who else was standing there asking for records, lol..."and I'll get nothing else done."

    Right. As if I expect he wouldn't shove the job off onto his wife who works in the office and takes people's blood pressure readings, also temp and weight, or the poor front desk girl who has to run his six ring circus AND she makes it look easy.

    Knowing full well those records are mine, he's just holding onto my property FOR me, I thought I'd just be able to ask and would get them.

    I now have a Privacy Act Form 810, made out so that he will release my records to me, and he'll get it at next appt.

    Hmm. Wonder if he, like another person who was written about here, will decide "Lea isn't my patient any more."

    Yipes, great big grown up me is scared. As I've said before this dr is the last in my area who will accept my insurance...mightn't this jump up and bite me?

    My resolve is getting wobbly...

  18. Ginner

    Ginner New Member

    Good info
    keeping for ref
  19. marti_zavala

    marti_zavala Member

    ginner, I am glad you found this info helpful.

    lea, i have been thinking all weekend about your dilemma.

    one, I would wonder why your doc is taking this attitude. Is it because he does not want you to see his notes?

    two, I definitely would want to stay on his good side because he is the last doc in your area.

    but I wonder if you feel he is helping you. His attitude of your records would be a red flag to me.

    Hope you are able to move forward with his help but with your records in your hands.

    Could you suggest to bring in paper of your own and that you can stand there and photocopy them so his assistant doesn't have to do it.

    I just don't understand his reasoning.

    Good luck and let us know how it goes.
  20. mjwarchol

    mjwarchol New Member

    I have always suggested to people to get copies of their medical records and keep a set in your file at home. Inactive patient files are either put in long term storage or detroyed after years. Also, sometimes the doctor retires, dies or the clinic closes.

    You don't need to get the records constantly. I would suggest yearly. You will most likely be charged a fee. So, keep track of the day you last got them and request only the dates you need.

    Marti, for your file, I did mine the same way. I had a list of the dates and names of specialists I saw over the years. It makes it so much easier when you are trying to get things together. One of my doctors had passed away, and other records were very old (18 years) so it came in handy to have all of it in my hands when I filed.

    Good luck.

    M J