MEDICAL RECORDS

TITLE 12, CHAPTER 13, ARTICLE 7.1

 12-2291. Definitions

 

In this article, unless the context otherwise requires: 

  1. "Clinical laboratory" has the same meaning prescribed in section 36-451. 
  2. "Contractor" means an agency or service that duplicates medical records on behalf of health care providers. 
  3. "Department" means the department of health services. 
  4. "Health care decision maker" means an individual who is authorized to make health care treatment decisions for the patient, including a parent of a minor or an individual who is authorized pursuant to section 8-514.05, title 14, chapter 5, article 2 or 3 or section 36-3221, 36-3231 or 36-3281. 
  5. "Health care provider" means: 

(a)  A person who is licensed pursuant to title 32 and who maintains medical records. 

(b)  A health care institution as defined in section 36-401. 

(c)  An ambulance service as defined in section 36-2201. 

(d)  A health care services organization licensed pursuant to title 20, chapter 4, article 9.

 "Medical records" means all communications related to a patient's physical or mental health or condition that are recorded in any form or medium and that are maintained for purposes of patient diagnosis or treatment, including medical records that are prepared by a health care provider or by other providers. Medical records do not include materials that are prepared in connection with utilization review, peer review or quality assurance activities, including records that a health care provider prepares pursuant to section 36-441, 36-445, 36-2402 or 36-2917. Medical records do not include recorded telephone and radio calls to and from a publicly operated emergency dispatch office relating to requests for emergency services or reports of suspected criminal activity, but include communications that are recorded in any form or medium between emergency medical personnel and medical personnel concerning the diagnosis or treatment of a person. 

  1. "Payment records" means all communications related to payment for a patient's health care that contain individually identifiable information. 
  2. "Source data" means information that is summarized, interpreted or reported in the medical record, including x-rays and other diagnostic images. 

12-2292. Confidentiality of medical records and payment records 

  1. Unless otherwise provided by law, all medical records and payment records, and the information contained in medical records and payment records, are privileged and confidential. A health care provider may only disclose that part or all of a patient's medical records and payment records as authorized by state or federal law or written authorization signed by the patient or the patient's health care decision maker. 
  2. This article does not limit the effect of any other federal or state law governing the confidentiality of medical records and payment records.

12-2293. Release of medical records and payment records to patients and health care decision makers; definition 

Except as provided in subsections B and C of this section, on the written request of a patient or the patient's health care decision maker for access to or copies of the patient's medical records and payment records, the health care provider in possession of the record shall provide access to or copies of the records to the patient or the patient's health care decision maker.
  1. A health care provider may deny a request for access to or copies of medical records or payment records if a health professional determines that either: 
  2. Access by the patient is reasonably likely to endanger the life or physical safety of the patient or another person. 
  3. The records make reference to a person other than a health professional and access by the patient or the patient's health care decision maker is reasonably likely to cause substantial harm to that other person.
  4. Access by the patiens health care decision maker is reasonably likely to cause substantial harm to the patient or another person. 
  5. Access by the patient or the patient's health care decision maker would reveal information obtained under a promise of confidentiality with someone other than a health professional and access would be reasonably likely to reveal the source of the information. 
  6. A health care provider may deny a request for access to or copies of medical records or payment records if the health care provider determines that either: 
  7. The information was created or obtained in the course of clinical research and the patient or the patient's health care decision maker agreed to the denial of access when consenting to participate in the research and was informed that the right of access will be reinstated on completion of the research.
  8. A health care provider is a correctional institution or is acting under the direction of a correctional institution and access by a patient who is an inmate in the correctional institution would jeopardize the health, safety, security, custody or rehabilitation of the patient or other inmates or the safety of any officer, employee or other person at the correctional institution or of a person who is responsible for transporting the inmate.
  9. If the health care provider denies a request for access to or copies of the medical records or payment records, the health care provider must note this determination in the patient's records and provide to the patient or the patient's health care decision maker a written explanation of the reason for the denial of access. The health care provider must release the medical records or payment records information for which there is not a basis to deny access under subsection B of this section.
  10. For the purposes of this section, "health professional" has the same meaning prescribed in section 32-3201.

12-2294. Release of medical records and payment records to third parties

 

A health care provider shall disclose medical records or payment records, or the information contained in medical records or payment records, without the patient's written authorization as otherwise required by law or when ordered by a court or tribunal of competent jurisdiction.
A health care provider may disclose medical records or payment records, or the information contained in medical records or payment records, pursuant to written authorization signed by the patient or the patient's health care decision maker.

 
A health care provider may disclose medical records or payment records or the information contained in medical records or payment records and a clinical laboratory may disclose clinical laboratory results without the written authorization of the patient or the patient's health care decision maker as otherwise authorized by state or federal law, including the health insurance portability and accountability act privacy standards (45 Code of Federal Regulations part 160 and part 164, subpart E), or as follows:
 
To health care providers who are currently providing health care to the patient for the purpose of diagnosis or treatment of the patient.
 
To health care providers who have previously provided treatment to the patient, to the extent that the records pertain to the provided treatment.
 
To ambulance attendants as defined in section 36-2201 for the purpose of providing care to or transferring the patient whose records are requested.
 
To a private agency that accredits health care providers and with whom the health care provider has an agreement requiring the agency to protect the confidentiality of patient information.
 
To a health profession regulatory board as defined in section 32-3201.
 
To health care providers for the purpose of conducting utilization review, peer review and quality assurance pursuant to section 36-441, 36-445, 36-2402 or 36-2917.
 
To a person or entity that provides services to the patient's health care providers or clinical laboratories and with whom the health care provider or clinical laboratory has an agreement requiring the person or entity to protect the confidentiality of patient information and as required by the health insurance portability and accountability act privacy standards, 45 Code of Federal Regulations part 164, subpart E.
 
To the legal representative of a health care provider in possession of the medical records or payment records for the purpose of securing legal advice.
 
To the patient's third party payor or the payor's contractor.
To the industrial commission of Arizona or parties to an industrial commission claim pursuant to title 23, chapter 6.

 
A health care provider may disclose a deceased patient's medical records or payment records or the information contained in medical records or payment records to the patient's health care decision maker at the time of the patient's death. A health care provider also may disclose a deceased patient's medical records or payment records or the information contained in medical records or payment records to the personal representative or administrator of the estate of a deceased patient, or if a personal representative or administrator has not been appointed, to the following persons in the following order of priority, unless the deceased patient during the deceased patient's lifetime or a person in a higher order of priority has notified the health care provider in writing that the deceased patient opposed the release of the medical records or payment records:
 
The deceased patient's spouse, unless the patient and the patient's spouse were legally separated at the time of the patient's death.
 
The acting trustee of a trust created by the deceased patient either alone or with the deceased patient's spouse if the trust was a revocable inter vivos trust during the deceased patient's lifetime and the deceased patient was a beneficiary of the trust during the deceased patient's lifetime.
 
An adult child of the deceased patient.
 
A parent of the deceased patient.
 
An adult brother or sister of the deceased patient.
 
A guardian or conservator of the deceased patient at the time of the patient's death.
 
A person who receives medical records or payment records pursuant to this section shall not disclose those records without the written authorization of the patient or the patient's health care decision maker, unless otherwise authorized by law.
 
If a health care provider releases a patient's medical records or payment records to a contractor for the purpose of duplicating or disclosing the records on behalf of the health care provider, the contractor shall not disclose any part or all of a patient's medical records or payment records in its custody except as provided in this article. After duplicating or disclosing a patient's medical records or payment records on behalf of a health care provider, a contractor must return the records to the health care provider who released the medical records or payment records to the contractor.

 

 

12-2294.01. Release of medical records or payment records to third parties pursuant to subpoena 

  1. A subpoena seeking medical records or payment records shall be served on the health care provider and any party to the proceedings at least ten days before the production date on the subpoena. 
  2. A subpoena that seeks medical records or payments records must meet one of the following requirements:
  3. The subpoena is accompanied by a written authorization signed by the patient or the patient's health care decision maker.
  4. The subpoena is accompanied by a court or tribunal order that requires the release of the records to the party seeking the records or that meets the requirements for a qualified protective order under the health insurance portability and accountability act privacy standards (42 Code of Federal Regulations section 164.512(e)).
  5. The subpoena is a grand jury subpoena issued in a criminal investigation.
  6. The subpoena is issued by a health profession regulatory board as defined in section 32-3201.
  7. The health care provider is required by another law to release the records to the party seeking the records.
  8. If a subpoena does not meet one of the requirements of subsection B of this section, a health care provider shall not produce the medical records or payment records to the party seeking the records, but may either file the records under seal pursuant to subsection D of this section, object to production under subsection E of this section or file a motion to quash or modify the subpoena under rule 45 of the Arizona rules of civil procedure. 
  9. It is sufficient compliance with a subpoena issued in a court or tribunal proceeding if a health care provider delivers the medical records or payment records under seal as follows: 
  10. The health care provider may deliver by certified mail or in person a copy of all the records described in the subpoena by the production date to the clerk of the court ortribunal or if there is no clerk then to the court or tribunal, together with the affidavit described in paragraph 4 of this subsection.
  11. The health care provider shall separately enclose and seal a copy of the records in an inner envelope or wrapper, with the title and number of the action, name of the health care provider and date of the subpoena clearly inscribed on the copy of the records. The health care provider shall enclose the sealed envelope or wrapper in an outer envelope or wrapper that is sealed and directed to the clerk of the court or tribunal or if there is no clerk then to the court or tribunal.
  12. The copy of the records shall remain sealed and shall be opened only on order of the court or tribunal conducting the proceeding.
  13. The records shall be accompanied by the affidavit of the custodian or other qualified witness, stating in substance each of the following:

(a)  That the affiant is the duly authorized custodian of the records and has authority to certify the records.

(b)  That the copy is a true complete copy of the records described in the subpoena.

(c)  If applicable, that the health care provider is subject to the confidentiality requirements in 42 United States Code sections 290dd-3 and 290ee-3 and applicable regulations and that those confidentiality requirements may apply to the requested records. The affidavit shall request that the court make a determination, if required under applicable federal law and regulations, as to the confidentiality of the records submitted.

(d)  If applicable, that the health care provider has none of the records described or only part of the records described in the subpoena. 

  1. The copy of the records is admissible in evidence as provided under rule 902(11), Arizona rules of evidence. The affidavit is admissible as evidence of the matters stated in the affidavit and the matters stated are presumed true. If more than one person has knowledge of the facts, more than one affidavit may be made. The presumption established by this paragraph is a presumption affecting the burden of producing evidence. 
  2. If a subpoena does not meet one of the requirements of subsection B of this section or if grounds for objection exist under rule 45 of the Arizona rules of civil procedure, a health care provider may file with the court or tribunal an objection to the inspection or copying of any or all of the records as follows:
    1. On filing an objection, the health care provider shall send a copy of the objection to the patient at the patient's last known address, to the patient's attorney if known and to the party seeking the records, unless after reasonable inquiry the health care provider cannot determine the last known address of the patient.On fi
    2. ling the objection, the health care provider has no further obligation to assert a state or federal privilege pertaining to the records or to appear or respond to a motion to compel production of records, and may produce the records if ordered by a court or tribunal. If an objection is filed, the patient or the patient's attorney is responsible for asserting or waiving any state or federal privilege that pertains to the records.
    3. If an objection is filed, the party seeking production may request an order compelling production of the records. If the court or tribunal issues an order compelling production, a copy of the order shall be provided to the health care provider. On receipt of the order, the health care provider shall produce the recor
  3. If applicable, an objection shall state that the health care provider is subject to the confidentiality requirements in 42 United States Code sections 290dd-3 and 290ee-3, shall state that the records may be subject to those confidentiality requirements and shall request that the court make a determination, if required under applicable federal law and regulations, on whether the submitted records are subject to discovery. 
  4. If a party seeking medical records or payment records wishes to examine the original records maintained by a health care provider, the health care provider may permit the party to examine the original records if the subpoena meets one of the requirements of subsection B of this section. The party seeking the records also may petition a court or tribunal for an order directing the health care provider to allow the party to examine the original records or to file the original records under seal with the court or tribunal under subsection D of this section. 
12-2295. Charges
  1. Except as otherwise provided by law, a health care provider or contractor may charge a person who requests reproductions of medical records or payment records a reasonable fee for the reproduction of the records pursuant to this section. Except as necessary for continuity of care, a health care provider or contractor may require the payment of any fees in advance. 
  2. A health care provider or contractor shall not charge for the pertinent information contained in medical records provided to:
  3. Another health care provider for the purpose of providing continuing care to the patient to whom the medical record pertains. 
  4. The patient to whom the medical record pertains for the demonstrated purpose of obtaining health care. 
  5. The health care decision maker of the patient to whom the medical record pertains for the demonstrated purpose of obtaining health care for the patient. 
  6. The Arizona medical board, the Arizona board of osteopathic examiners in medicine and surgery or an officer of the department of health services or the local health department requesting records pursuant to section 36-662.
  7. The patient or the patient's legal representative for the purpose of appealing a denial of benefits under the social security act. Any additional request for medical records and a request for medical records that were previously provided free of charge in the same calendar year are subject to a reasonable fee pursuant to subsection A of this section, except that a fee may not be charged if no medical records are located in response to the request. A legal representative must provide an appointment of representative form SSA-1696 before obtaining a patient's medical records free of charge.  

12-2296. Immunity

A health care provider, contractor or clinical laboratory that acts in good faith under this article is not liable for damages in any civil action for the disclosure of medical records, payment records or clinical laboratory results or information contained in medical records, payment records or clinical laboratory results that is made pursuant to this article or as otherwise provided by law. The health care provider, contractor or clinical laboratory is presumed to have acted in good faith. The presumption may be rebutted by clear and convincing evidence.

602-932-8113.