You can ask to have a diagnosis of a condition you have never had corrected in your medical record, however long ago it was entered and however many offices have copied it since. The HIPAA Privacy Rule, a federal law that health plans and most health care providers, including most doctors, clinics and hospitals, must follow, gives you the right to ask an office to amend your health information in its designated record set, the records it uses to make decisions about you, for as long as it keeps them. Amending does not have to mean erasing: at a minimum, the office identifies the records the correction affects and attaches the correction to them or links to it.
Which office to send the request to, when two others already have the entry
Send your request to the office whose staff created the entry, even if the entry has since reached two other offices and it is their staff reading it back to you. The provider or health plan must respond to your request, and it must amend inaccurate or incomplete information it created. That office is also the party responsible for acting on an amendment request: a company working for it as a business associate, such as a health information organization that runs an electronic exchange of records between offices, may be required by its contract to take on parts of the work, such as telling others in the exchange about an amendment, but the office still owes you the answer.
Your request can reach anything in that designated record set. The set takes in any record the office uses, in whole or in part, to make decisions about you, and it always includes a provider's medical and billing records and a health plan's enrollment, payment, claims and case or medical management records. A wrong diagnosis on a bill, or in your insurer's claims file, is inside it.
Before you write, ask the office's front desk who handles amendment requests, since every office must keep a record of the titles of the people or offices responsible for receiving and processing them. The office may require the request in writing, with a reason for the change, provided it has told you so in advance. Say which entry is wrong, where it appears and when it was entered, and that you have never had the condition.
Name each office that has the entry in the request itself, by practice name. If the office accepts your request, it must make reasonable efforts to get the amendment to the people you have identified as needing it, and to those it knows might rely on the wrong information to your detriment. On accepting, it also has to ask you which offices and people need the amendment and get your agreement to notify them, and because your request already names them, it has that list from the start. Each office on the list that must follow HIPAA, once told of the amendment, has to amend its own records as well.
If you have only heard the entry read out and have not seen it, you have a separate right, with few exceptions, to inspect, review and get a copy of your medical and billing records (see Does your old doctor have to send your file to the new one?).
The right to an amendment reaches only organizations that must follow HIPAA. A practice of any size is one of them if it sends health information electronically for certain transactions, such as claims to a health plan, but many organizations that hold health information about you do not have to follow it. Examples include:
- life insurers
- employers
- workers' compensation carriers
- most schools and school districts
- many state agencies, such as child protective service agencies
- most law enforcement agencies
- many municipal offices
How long the office has to answer you
The deadline is 60 days from the day the office receives your request, and by then it must either make the amendment or send you a written denial. If it cannot act in time, it may extend the deadline once, by no more than 30 days, and only by giving you, within those first 60 days, a written statement of the reasons for the delay and the date it will finish. Without that statement there is no extension, and with it the outer limit is 90 days from receipt.
Because the 60 days run from receipt, keep proof of the date the office received the request, such as a dated portal message or a delivery receipt for a letter. Under the Privacy Rule, you and the office may agree to handle the request and the replies electronically, which should speed the process up, so ask the front desk whether the office takes amendment requests through its patient portal or by email.
Grounds the office is allowed to refuse on
An office can refuse your request only on specified grounds, four in all, and only one of them turns on whether you are right. It may refuse if it:
- is allowed to exclude the information from your access
- did not create the information, unless you give a reasonable basis to believe that whoever created it is no longer available
- determines that the information is accurate and complete
- does not hold the information in its designated record set
The first ground covers information the office may keep from you. That includes psychotherapy notes and information compiled for legal proceedings, and in certain specified situations other information too, such as when a health care professional believes access could cause harm to you or another person.
The second ground is why the request belongs with the office that created the entry, because an office holding a copy of an entry typed at another practice can refuse on that ground alone. If the practice or hospital that created it has closed, say so in your request to the office that now holds the entry, and include whatever shows the closure. With a reasonable basis to believe the originator is no longer available, the office holding the copy cannot refuse because it did not create the entry.
Suppose the practice you are writing to typed the wrong diagnosis into your own visit notes, for example one meant for another patient. That practice created the entry and holds it in your medical record, so the second and fourth grounds do not fit, and ordinary visit notes are, with few exceptions, part of the record you are entitled to see. That leaves a finding that the entry is accurate and complete as the ground the practice is most likely to rely on.
What happens to the wrong entry if the office refuses
After a refusal the wrong entry stays where it is. Once you file a written statement disagreeing with the refusal, documentation of the dispute has to be linked to the entry and has to go with any future disclosure of it.
A refusal has to come as a written denial, and the office has to let you submit a statement of disagreement for inclusion in your record. The denial must be in plain language and must set out:
- the reason, which has to be one of the four grounds above
- your right to submit a written statement disagreeing with the denial, and how to file it
- that if you file no statement, you can ask the office to send your request and its denial with any future disclosure of the entry
- how to complain to the office or to the U.S. Department of Health and Human Services (HHS), with the name or title and phone number of the office's contact person
Your statement of disagreement says that you disagree and why, and the office may reasonably limit its length, so lead with the fact that the condition has never been yours. The office may write a rebuttal, and if it does, it must give you a copy. Whether the dispute leaves the office with the entry then turns on whether you filed a statement:
| You filed a statement of disagreement | You filed none | |
|---|---|---|
| Linked to the entry in the office's records | Your request, the denial, your statement and any rebuttal | Your request and the denial |
| Sent with any later disclosure of the entry | That material, or an accurate summary of it | Your request and the denial, or an accurate summary, only if you have asked for that |
You write only two of the documents in the process: the request and, after a denial, the statement of disagreement. If you believe the office is denying your rights, you can complain to the provider or health insurer, or to HHS, and a denial must tell you how to do either.
The amendment is for the office that created the entry to make. Care for a condition that has nothing to do with weight care is not part of a NicoCares subscription, and your checkups and screenings stay with your own doctor (see Weight care is not a checkup, so the screenings are still yours to book). If the wrong diagnosis also reached NicoCares, you can email NicoCares and ask it to correct the personal information it holds about you. If the condition could matter to your weight care, let your care team know in the Spruce messaging app that the entry is wrong and that you have asked the practice to amend it.
