SECTIONS 123100-123149.5

123100.  The Legislature finds and declares that every person havingultimate responsibility for decisions respecting his or her ownhealth care also possesses a concomitant right of access to completeinformation respecting his or her condition and care provided.Similarly, persons having responsibility for decisions respecting thehealth care of others should, in general, have access to informationon the patient's condition and care. It is, therefore, the intent ofthe Legislature in enacting this chapter to establish procedures forproviding access to health care records or summaries of thoserecords by patients and by those persons having responsibility fordecisions respecting the health care of others.123105.  As used in this chapter: (a) "Health care provider" means any of the following: (1) A health facility licensed pursuant to Chapter 2 (commencingwith Section 1250) of Division 2. (2) A clinic licensed pursuant to Chapter 1 (commencing withSection 1200) of Division 2. (3) A home health agency licensed pursuant to Chapter 8(commencing with Section 1725) of Division 2. (4) A physician and surgeon licensed pursuant to Chapter 5(commencing with Section 2000) of Division 2 of the Business andProfessions Code or pursuant to the Osteopathic Act. (5) A podiatrist licensed pursuant to Article 22 (commencing withSection 2460) of Chapter 5 of Division 2 of the Business andProfessions Code. (6) A dentist licensed pursuant to Chapter 4 (commencing withSection 1600) of Division 2 of the Business and Professions Code. (7) A psychologist licensed pursuant to Chapter 6.6 (commencingwith Section 2900) of Division 2 of the Business and ProfessionsCode. (8) An optometrist licensed pursuant to Chapter 7 (commencing withSection 3000) of Division 2 of the Business and Professions Code. (9) A chiropractor licensed pursuant to the ChiropracticInitiative Act. (10) A marriage and family therapist licensed pursuant to Chapter13 (commencing with Section 4980) of Division 2 of the Business andProfessions Code. (11) A clinical social worker licensed pursuant to Chapter 14(commencing with Section 4990) of Division 2 of the Business andProfessions Code. (12) A physical therapist licensed pursuant to Chapter 5.7(commencing with Section 2600) of Division 2 of the Business andProfessions Code. (13) An occupational therapist licensed pursuant to Chapter 5.6(commencing with Section 2570). (b) "Mental health records" means patient records, or discreteportions thereof, specifically relating to evaluation or treatment ofa mental disorder. "Mental health records" includes, but is notlimited to, all alcohol and drug abuse records. (c) "Patient" means a patient or former patient of a health careprovider. (d) "Patient records" means records in any form or mediummaintained by, or in the custody or control of, a health careprovider relating to the health history, diagnosis, or condition of apatient, or relating to treatment provided or proposed to beprovided to the patient. "Patient records" includes only recordspertaining to the patient requesting the records or whoserepresentative requests the records. "Patient records" does notinclude information given in confidence to a health care provider bya person other than another health care provider or the patient, andthat material may be removed from any records prior to inspection orcopying under Section 123110 or 123115. "Patient records" does notinclude information contained in aggregate form, such as indices,registers, or logs. (e) "Patient's representative" or "representative" means any ofthe following: (1) A parent or guardian of a minor who is a patient. (2) The guardian or conservator of the person of an adult patient. (3) An agent as defined in Section 4607 of the Probate Code, tothe extent necessary for the agent to fulfill his or her duties asset forth in Division 4.7 (commencing with Section 4600) of theProbate Code. (4) The beneficiary as defined in Section 24 of the Probate Codeor personal representative as defined in Section 58 of the ProbateCode, of a deceased patient. (f) "Alcohol and drug abuse records" means patient records, ordiscrete portions thereof, specifically relating to evaluation andtreatment of alcoholism or drug abuse.123110.  (a) Notwithstanding Section 5328 of the Welfare andInstitutions Code, and except as provided in Sections 123115 and123120, any adult patient of a health care provider, any minorpatient authorized by law to consent to medical treatment, and anypatient representative shall be entitled to inspect patient recordsupon presenting to the health care provider a written request forthose records and upon payment of reasonable clerical costs incurredin locating and making the records available. However, a patient whois a minor shall be entitled to inspect patient records pertainingonly to health care of a type for which the minor is lawfullyauthorized to consent. A health care provider shall permit thisinspection during business hours within five working days afterreceipt of the written request. The inspection shall be conducted bythe patient or patient's representative requesting the inspection,who may be accompanied by one other person of his or her choosing. (b) Additionally, any patient or patient's representative shall beentitled to copies of all or any portion of the patient records thathe or she has a right to inspect, upon presenting a written requestto the health care provider specifying the records to be copied,together with a fee to defray the cost of copying, that shall notexceed twenty-five cents ($0.25) per page or fifty cents ($0.50) perpage for records that are copied from microfilm and any additionalreasonable clerical costs incurred in making the records available.The health care provider shall ensure that the copies are transmittedwithin 15 days after receiving the written request. (c) Copies of X-rays or tracings derived from electrocardiography,electroencephalography, or electromyography need not be provided tothe patient or patient's representative under this section, if theoriginal X-rays or tracings are transmitted to another health careprovider upon written request of the patient or patient'srepresentative and within 15 days after receipt of the request. Therequest shall specify the name and address of the health careprovider to whom the records are to be delivered. All reasonablecosts, not exceeding actual costs, incurred by a health care providerin providing copies pursuant to this subdivision may be charged tothe patient or representative requesting the copies. (d) (1) Notwithstanding any provision of this section, and exceptas provided in Sections 123115 and 123120, any patient or formerpatient or the patient's representative shall be entitled to a copy,at no charge, of the relevant portion of the patient's records, uponpresenting to the provider a written request, and proof that therecords are needed to support an appeal regarding eligibility for apublic benefit program. These programs shall be the Medi-Cal program,social security disability insurance benefits, and SupplementalSecurity Income/State Supplementary Program for the Aged, Blind andDisabled (SSI/SSP) benefits. For purposes of this subdivision,"relevant portion of the patient's records" means those recordsregarding services rendered to the patient during the time periodbeginning with the date of the patient's initial application forpublic benefits up to and including the date that a finaldetermination is made by the public benefits program with which thepatient's application is pending. (2) Although a patient shall not be limited to a single request,the patient or patient's representative shall be entitled to no morethan one copy of any relevant portion of his or her record free ofcharge. (3) This subdivision shall not apply to any patient who isrepresented by a private attorney who is paying for the costs relatedto the patient's appeal, pending the outcome of that appeal. Forpurposes of this subdivision, "private attorney" means any attorneynot employed by a nonprofit legal services entity. (e) If the patient's appeal regarding eligibility for a publicbenefit program specified in subdivision (d) is successful, thehospital or other health care provider may bill the patient, at therates specified in subdivisions (b) and (c), for the copies of themedical records previously provided free of charge. (f) If a patient or his or her representative requests a recordpursuant to subdivision (d), the health care provider shall ensurethat the copies are transmitted within 30 days after receiving thewritten request. (g) This section shall not be construed to preclude a health careprovider from requiring reasonable verification of identity prior topermitting inspection or copying of patient records, provided thisrequirement is not used oppressively or discriminatorily to frustrateor delay compliance with this section. Nothing in this chapter shallbe deemed to supersede any rights that a patient or representativemight otherwise have or exercise under Section 1158 of the EvidenceCode or any other provision of law. Nothing in this chapter shallrequire a health care provider to retain records longer than requiredby applicable statutes or administrative regulations. (h) This chapter shall not be construed to render a health careprovider liable for the quality of his or her records or the copiesprovided in excess of existing law and regulations with respect tothe quality of medical records. A health care provider shall not beliable to the patient or any other person for any consequences thatresult from disclosure of patient records as required by thischapter. A health care provider shall not discriminate againstclasses or categories of providers in the transmittal of X-rays orother patient records, or copies of these X-rays or records, to otherproviders as authorized by this section. Every health care provider shall adopt policies and establishprocedures for the uniform transmittal of X-rays and other patientrecords that effectively prevent the discrimination described in thissubdivision. A health care provider may establish reasonableconditions, including a reasonable deposit fee, to ensure the returnof original X-rays transmitted to another health care provider,provided the conditions do not discriminate on the basis of, or in amanner related to, the license of the provider to which the X-raysare transmitted. (i) Any health care provider described in paragraphs (4) to (10),inclusive, of subdivision (a) of Section 123105 who willfullyviolates this chapter is guilty of unprofessional conduct. Any healthcare provider described in paragraphs (1) to (3), inclusive, ofsubdivision (a) of Section 123105 that willfully violates thischapter is guilty of an infraction punishable by a fine of not morethan one hundred dollars ($100). The state agency, board, orcommission that issued the health care provider's professional orinstitutional license shall consider a violation as grounds fordisciplinary action with respect to the licensure, includingsuspension or revocation of the license or certificate. (j) This section shall be construed as prohibiting a health careprovider from withholding patient records or summaries of patientrecords because of an unpaid bill for health care services. Anyhealth care provider who willfully withholds patient records orsummaries of patient records because of an unpaid bill for healthcare services shall be subject to the sanctions specified insubdivision (i).123111.  (a) Any adult patient who inspects his or her patientrecords pursuant to Section 123110 shall have the right to provide tothe health care provider a written addendum with respect to any itemor statement in his or her records that the patient believes to beincomplete or incorrect. The addendum shall be limited to 250 wordsper alleged incomplete or incorrect item in the patient's record andshall clearly indicate in writing that the patient wishes theaddendum to be made a part of his or her record. (b) The health care provider shall attach the addendum to thepatient's records and shall include that addendum whenever the healthcare provider makes a disclosure of the allegedly incomplete orincorrect portion of the patient's records to any third party. (c) The receipt of information in a patient's addendum whichcontains defamatory or otherwise unlawful language, and the inclusionof this information in the patient's records, in accordance withsubdivision (b), shall not, in and of itself, subject the health careprovider to liability in any civil, criminal, administrative, orother proceeding. (d) Subdivision (f) of Section 123110 and Section 123120 shall beapplicable with respect to any violation of this section by a healthcare provider.123115.  (a) The representative of a minor shall not be entitled toinspect or obtain copies of the minor's patient records in either ofthe following circumstances: (1) With respect to which the minor has a right of inspectionunder Section 123110. (2) Where the health care provider determines that access to thepatient records requested by the representative would have adetrimental effect on the provider's professional relationship withthe minor patient or the minor's physical safety or psychologicalwell-being. The decision of the health care provider as to whether ornot a minor's records are available for inspection or copying underthis section shall not attach any liability to the provider, unlessthe decision is found to be in bad faith. (b) When a health care provider determines there is a substantialrisk of significant adverse or detrimental consequences to a patientin seeing or receiving a copy of mental health records requested bythe patient, the provider may decline to permit inspection or providecopies of the records to the patient, subject to the followingconditions: (1) The health care provider shall make a written record, to beincluded with the mental health records requested, noting the date ofthe request and explaining the health care provider's reason forrefusing to permit inspection or provide copies of the records,including a description of the specific adverse or detrimentalconsequences to the patient that the provider anticipates would occurif inspection or copying were permitted. (2) The health care provider shall permit inspection by, orprovide copies of the mental health records to, a licensed physicianand surgeon, licensed psychologist, licensed marriage and familytherapist, or licensed clinical social worker, designated by requestof the patient. Any marriage and family therapist registered intern,as defined in Chapter 13 (commencing with Section 4980) of Division 2of the Business and Professions Code, may not inspect the patient'smental health records or obtain copies thereof, except pursuant tothe direction or supervision of a licensed professional specified insubdivision (g) of Section 4980.03 of the Business and ProfessionsCode. Prior to providing copies of mental health records to amarriage and family therapist registered intern, a receipt for thoserecords shall be signed by the supervising licensed professional. Thelicensed physician and surgeon, licensed psychologist, licensedmarriage and family therapist, licensed clinical social worker, ormarriage and family therapist registered intern to whom the recordsare provided for inspection or copying shall not permit inspection orcopying by the patient. (3) The health care provider shall inform the patient of theprovider's refusal to permit him or her to inspect or obtain copiesof the requested records, and inform the patient of the right torequire the provider to permit inspection by, or provide copies to, alicensed physician and surgeon, licensed psychologist, licensedmarriage and family therapist, or licensed clinical social worker,designated by written authorization of the patient. (4) The health care provider shall indicate in the mental healthrecords of the patient whether the request was made under paragraph(2).123120.  Any patient or representative aggrieved by a violation ofSection 123110 may, in addition to any other remedy provided by law,bring an action against the health care provider to enforce theobligations prescribed by Section 123110. Any judgment rendered inthe action may, in the discretion of the court, include an award ofcosts and reasonable attorney fees to the prevailing party.123125.  (a) This chapter shall not require a health care providerto permit inspection or provide copies of alcohol and drug abuserecords where, or in a manner, prohibited by Section 408 of thefederal Drug Abuse Office and Treatment Act of 1972 (Public Law92-255) or Section 333 of the federal Comprehensive Alcohol Abuse andAlcoholism Prevention, Treatment, and Rehabilitation Act of 1970(Public Law 91-616), or by regulations adopted pursuant to thesefederal laws. Alcohol and drug abuse records subject to these federallaws shall also be subject to this chapter, to the extent that thesefederal laws do not prohibit disclosure of the records. All otheralcohol and drug abuse records shall be fully subject to thischapter. (b) This chapter shall not require a health care provider topermit inspection or provide copies of records or portions of recordswhere or in a manner prohibited by existing law respecting theconfidentiality of information regarding communicable diseasecarriers.123130.  (a) A health care provider may prepare a summary of therecord, according to the requirements of this section, for inspectionand copying by a patient. If the health care provider chooses toprepare a summary of the record rather than allowing access to theentire record, he or she shall make the summary of the recordavailable to the patient within 10 working days from the date of thepatient's request. However, if more time is needed because the recordis of extraordinary length or because the patient was dischargedfrom a licensed health facility within the last 10 days, the healthcare provider shall notify the patient of this fact and the date thatthe summary will be completed, but in no case shall more than 30days elapse between the request by the patient and the delivery ofthe summary. In preparing the summary of the record the health careprovider shall not be obligated to include information that is notcontained in the original record. (b) A health care provider may confer with the patient in anattempt to clarify the patient's purpose and goal in obtaining his orher record. If as a consequence the patient requests informationabout only certain injuries, illnesses, or episodes, this subdivisionshall not require the provider to prepare the summary required bythis subdivision for other than the injuries, illnesses, or episodesso requested by the patient. The summary shall contain for eachinjury, illness, or episode any information included in the recordrelative to the following: (1) Chief complaint or complaints including pertinent history. (2) Findings from consultations and referrals to other health careproviders. (3) Diagnosis, where determined. (4) Treatment plan and regimen including medications prescribed. (5) Progress of the treatment. (6) Prognosis including significant continuing problems orconditions. (7) Pertinent reports of diagnostic procedures and tests and alldischarge summaries. (8) Objective findings from the most recent physical examination,such as blood pressure, weight, and actual values from routinelaboratory tests. (c) This section shall not be construed to require any medicalrecords to be written or maintained in any manner not otherwiserequired by law. (d) The summary shall contain a list of all current medicationsprescribed, including dosage, and any sensitivities or allergies tomedications recorded by the provider. (e) Subdivision (c) of Section 123110 shall be applicable whetheror not the health care provider elects to prepare a summary of therecord. (f) The health care provider may charge no more than a reasonablefee based on actual time and cost for the preparation of the summary.The cost shall be based on a computation of the actual time spentpreparing the summary for availability to the patient or the patient's representative. It is the intent of the Legislature that summariesof the records be made available at the lowest possible cost to thepatient.123135.  Except as otherwise provided by law, nothing in thischapter shall be construed to grant greater access to individualpatient records by any person, firm, association, organization,partnership, business trust, company, corporation, or municipal orother public corporation, or government officer or agency. Therefore,this chapter does not do any of the following: (a) Relieve employers of the requirements of the Confidentialityof Medical Information Act (Part 2.6 (commencing with Section 56) ofDivision 1 of the Civil Code). (b) Relieve any person subject to the Insurance Information andPrivacy Protection Act (Article 6.6 (commencing with Section 791) ofChapter 1 of Part 2 of Division 1 of the Insurance Code) from therequirements of that act. (c) Relieve government agencies of the requirements of theInformation Practices Act of 1977 (Title 1.8 (commencing with Section1798) of Part 4 of Division 3 of the Civil Code).123140.  The Information Practices Act of 1977 (Title 1.8(commencing with Section 1798) of Part 4 of Division 3 of the CivilCode) shall prevail over this chapter with respect to recordsmaintained by a state agency.123145.  (a) Providers of health services that are licensed pursuantto Sections 1205, 1253, 1575 and 1726 have an obligation, if thelicensee ceases operation, to preserve records for a minimum of sevenyears following discharge of the patient, except that the records ofunemancipated minors shall be kept at least one year after the minorhas reached the age of 18 years, and in any case, not less thanseven years. (b) The department or any person injured as a result of thelicensee's abandonment of health records may bring an action in aproper court for the amount of damage suffered as a result thereof.In the event that the licensee is a corporation or partnership thatis dissolved, the person injured may take action against thatcorporation's or partnership's principle officers of record at thetime of dissolution. (c) Abandoned means violating subdivision (a) and leaving patientstreated by the licensee without access to medical information towhich they are entitled pursuant to Section 123110.123147.  (a) Except as provided in subdivision (b), all healthfacilities, as defined in Section 1250, and all primary care clinicsthat are either licensed under Section 1204 or exempt from licensureunder Section 1206, shall include a patient's principal spokenlanguage on the patient's health records. (b) Any long-term health care facility, as defined in Section1418, that already completes the minimum data set form as specifiedin Section 14110.15 of the Welfare and Institutions Code, includingdocumentation of a patient's principal spoken language, shall bedeemed to be in compliance with subdivision (a).123148.  (a) Notwithstanding any other provision of law, a healthcare professional at whose request a test is performed shall provideor arrange for the provision of the results of a clinical laboratorytest to the patient who is the subject of the test if so requested bythe patient, in oral or written form. The results shall be conveyedin plain language and in oral or written form, except the results maybe conveyed in electronic form if requested by the patient and ifdeemed most appropriate by the health care professional who requestedthe test. (b) (1) Consent of the patient to receive his or her laboratoryresults by Internet posting or other electronic means shall beobtained in a manner consistent with the requirements of Section56.10 or 56.11 of the Civil Code. In the event that a health careprofessional arranges for the provision of test results by Internetposting or other electronic manner, the results shall be delivered toa patient in a reasonable time period, but only after the resultshave been reviewed by the health care professional. Access toclinical laboratory test results shall be restricted by the use of asecure personal identification number when the results are deliveredto a patient by Internet posting or other electronic manner. (2) Nothing in paragraph (1) shall prohibit direct communicationby Internet posting or the use of other electronic means to conveyclinical laboratory test results by a treating health careprofessional who ordered the test for his or her patient or by ahealth care professional acting on behalf of, or with theauthorization of, the treating health care professional who orderedthe test. (c) When a patient requests to receive his or her laboratory testresults by Internet posting, the health care professional shalladvise the patient of any charges that may be assessed directly tothe patient or insurer for the service and that the patient may callthe health care professional for a more detailed explanation of thelaboratory test results when delivered. (d) The electronic provision of test results under this sectionshall be in accordance with any applicable federal law governingprivacy and security of electronic personal health records. However,any state statute, if enacted, that governs privacy and security ofelectronic personal health records, shall apply to test results underthis section and shall prevail over federal law if federal lawpermits. (e) The test results to be reported to the patient pursuant tothis section shall be recorded in the patient's medical record, andshall be reported to the patient within a reasonable time periodafter the test results are received at the offices of the health careprofessional who requested the test. (f) Notwithstanding subdivisions (a) and (b), none of thefollowing clinical laboratory test results and any other relatedresults shall be conveyed to a patient by Internet posting or otherelectronic means: (1) HIV antibody test. (2) Presence of antigens indicating a hepatitis infection. (3) Abusing the use of drugs. (4) Test results related to routinely processed tissues, includingskin biopsies, Pap smear tests, products of conception, and bonemarrow aspirations for morphological evaluation, if they reveal amalignancy. (g) Patient identifiable test results and health information thathave been provided under this section shall not be used for anycommercial purpose without the consent of the patient, obtained in amanner consistent with the requirements of Section 56.11 of the CivilCode. (h) Any third party to whom laboratory test results are disclosedpursuant to this section shall be deemed a provider of administrativeservices, as that term is used in paragraph (3) of subdivision (c)of Section 56.10 of the Civil Code, and shall be subject to alllimitations and penalties applicable to that section. (i) A patient may not be required to pay any cost, or be chargedany fee, for electing to receive his or her laboratory results in anymanner other than by Internet posting or other electronic form. (j) A patient or his or her physician may revoke any consentprovided under this section at any time and without penalty, exceptto the extent that action has been taken in reliance on that consent.123149.  (a) Providers of health services, licensed pursuant toSections 1205, 1253, 1575, and 1726, that utilize electronicrecordkeeping systems only, shall comply with the additionalrequirements of this section. These additional requirements do notapply to patient records if hard copy versions of the patient recordsare retained. (b) Any use of electronic recordkeeping to store patient recordsshall ensure the safety and integrity of those records at least tothe extent of hard copy records. All providers set forth insubdivision (a) shall ensure the safety and integrity of allelectronic media used to store patient records by employing anoffsite backup storage system, an image mechanism that is able tocopy signature documents, and a mechanism to ensure that once arecord is input, it is unalterable. (c) Original hard copies of patient records may be destroyed oncethe record has been electronically stored. (d) The printout of the computerized version shall be consideredthe original as defined in Section 255 of the Evidence Code forpurposes of providing copies to patients, the Division of Licensingand Certification, and for introduction into evidence in accordancewith Sections 1550 and 1551 of the Evidence Code, in administrativeor court proceedings. (e) Access to electronically stored patient records shall be madeavailable to the Division of Licensing and Certification staffpromptly, upon request. (f) This section does not exempt licensed clinics, healthfacilities, adult day health care centers, and home health agenciesfrom the requirement of maintaining original copies of patientrecords that cannot be electronically stored. (g) Any health care provider subject to this section, choosing toutilize an electronic recordkeeping system, shall develop andimplement policies and procedures to include safeguards forconfidentiality and unauthorized access to electronically storedpatient health records, authentication by electronic signature keys,and systems maintenance. (h) Nothing contained in this chapter shall affect the existingregulatory requirements for the access, use, disclosure,confidentiality, retention of record contents, and maintenance ofhealth information in patient records by health care providers. (i) This chapter does not prohibit any provider of health careservices from maintaining or retaining patient recordselectronically.123149.5.  (a) It is the intent of the Legislature that all medicalinformation transmitted during the delivery of health care viatelemedicine, as defined in subdivision (a) of Section 2290.5 of theBusiness and Professions Code, become part of the patient's medicalrecord maintained by the licensed health care provider. (b) This section shall not be construed to limit or waive any ofthe requirements of Chapter 1 (commencing with Section 123100) ofPart 1 of Division 106 of the Health and Safety Code.