123100. The Legislature finds and declares that every person having
ultimate responsibility for decisions respecting his or her own
health care also possesses a concomitant right of access to complete
information respecting his or her condition and care provided.
Similarly, persons having responsibility for decisions respecting the
health care of others should, in general, have access to information
on the patient's condition and care. It is, therefore, the intent of
the Legislature in enacting this chapter to establish procedures for
providing access to health care records or summaries of those
records by patients and by those persons having responsibility for
decisions 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 (commencing
with Section 1250) of Division 2.
(2) A clinic licensed pursuant to Chapter 1 (commencing with
Section 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 and
Professions Code or pursuant to the Osteopathic Act.
(5) A podiatrist licensed pursuant to Article 22 (commencing with
Section 2460) of Chapter 5 of Division 2 of the Business and
Professions Code.
(6) A dentist licensed pursuant to Chapter 4 (commencing with
Section 1600) of Division 2 of the Business and Professions Code.
(7) A psychologist licensed pursuant to Chapter 6.6 (commencing
with Section 2900) of Division 2 of the Business and Professions
Code.
(8) An optometrist licensed pursuant to Chapter 7 (commencing with
Section 3000) of Division 2 of the Business and Professions Code.
(9) A chiropractor licensed pursuant to the Chiropractic
Initiative Act.
(10) A marriage and family therapist licensed pursuant to Chapter
13 (commencing with Section 4980) of Division 2 of the Business and
Professions Code.
(11) A clinical social worker licensed pursuant to Chapter 14
(commencing with Section 4990) of Division 2 of the Business and
Professions Code.
(12) A physical therapist licensed pursuant to Chapter 5.7
(commencing with Section 2600) of Division 2 of the Business and
Professions Code.
(13) An occupational therapist licensed pursuant to Chapter 5.6
(commencing with Section 2570).
(b) "Mental health records" means patient records, or discrete
portions thereof, specifically relating to evaluation or treatment of
a mental disorder. "Mental health records" includes, but is not
limited to, all alcohol and drug abuse records.
(c) "Patient" means a patient or former patient of a health care
provider.
(d) "Patient records" means records in any form or medium
maintained by, or in the custody or control of, a health care
provider relating to the health history, diagnosis, or condition of a
patient, or relating to treatment provided or proposed to be
provided to the patient. "Patient records" includes only records
pertaining to the patient requesting the records or whose
representative requests the records. "Patient records" does not
include information given in confidence to a health care provider by
a person other than another health care provider or the patient, and
that material may be removed from any records prior to inspection or
copying under Section 123110 or 123115. "Patient records" does not
include information contained in aggregate form, such as indices,
registers, or logs.
(e) "Patient's representative" or "representative" means any of
the 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, to
the extent necessary for the agent to fulfill his or her duties as
set forth in Division 4.7 (commencing with Section 4600) of the
Probate Code.
(4) The beneficiary as defined in Section 24 of the Probate Code
or personal representative as defined in Section 58 of the Probate
Code, of a deceased patient.
(f) "Alcohol and drug abuse records" means patient records, or
discrete portions thereof, specifically relating to evaluation and
treatment of alcoholism or drug abuse.
123110. (a) Notwithstanding Section 5328 of the Welfare and
Institutions Code, and except as provided in Sections 123115 and
123120, any adult patient of a health care provider, any minor
patient authorized by law to consent to medical treatment, and any
patient representative shall be entitled to inspect patient records
upon presenting to the health care provider a written request for
those records and upon payment of reasonable clerical costs incurred
in locating and making the records available. However, a patient who
is a minor shall be entitled to inspect patient records pertaining
only to health care of a type for which the minor is lawfully
authorized to consent. A health care provider shall permit this
inspection during business hours within five working days after
receipt of the written request. The inspection shall be conducted by
the 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 be
entitled to copies of all or any portion of the patient records that
he or she has a right to inspect, upon presenting a written request
to the health care provider specifying the records to be copied,
together with a fee to defray the cost of copying, that shall not
exceed twenty-five cents ($0.25) per page or fifty cents ($0.50) per
page for records that are copied from microfilm and any additional
reasonable clerical costs incurred in making the records available.
The health care provider shall ensure that the copies are transmitted
within 15 days after receiving the written request.
(c) Copies of X-rays or tracings derived from electrocardiography,
electroencephalography, or electromyography need not be provided to
the patient or patient's representative under this section, if the
original X-rays or tracings are transmitted to another health care
provider upon written request of the patient or patient's
representative and within 15 days after receipt of the request. The
request shall specify the name and address of the health care
provider to whom the records are to be delivered. All reasonable
costs, not exceeding actual costs, incurred by a health care provider
in providing copies pursuant to this subdivision may be charged to
the patient or representative requesting the copies.
(d) (1) Notwithstanding any provision of this section, and except
as provided in Sections 123115 and 123120, any patient or former
patient or the patient's representative shall be entitled to a copy,
at no charge, of the relevant portion of the patient's records, upon
presenting to the provider a written request, and proof that the
records are needed to support an appeal regarding eligibility for a
public benefit program. These programs shall be the Medi-Cal program,
social security disability insurance benefits, and Supplemental
Security Income/State Supplementary Program for the Aged, Blind and
Disabled (SSI/SSP) benefits. For purposes of this subdivision,
"relevant portion of the patient's records" means those records
regarding services rendered to the patient during the time period
beginning with the date of the patient's initial application for
public benefits up to and including the date that a final
determination is made by the public benefits program with which the
patient'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 more
than one copy of any relevant portion of his or her record free of
charge.
(3) This subdivision shall not apply to any patient who is
represented by a private attorney who is paying for the costs related
to the patient's appeal, pending the outcome of that appeal. For
purposes of this subdivision, "private attorney" means any attorney
not employed by a nonprofit legal services entity.
(e) If the patient's appeal regarding eligibility for a public
benefit program specified in subdivision (d) is successful, the
hospital or other health care provider may bill the patient, at the
rates specified in subdivisions (b) and (c), for the copies of the
medical records previously provided free of charge.
(f) If a patient or his or her representative requests a record
pursuant to subdivision (d), the health care provider shall ensure
that the copies are transmitted within 30 days after receiving the
written request.
(g) This section shall not be construed to preclude a health care
provider from requiring reasonable verification of identity prior to
permitting inspection or copying of patient records, provided this
requirement is not used oppressively or discriminatorily to frustrate
or delay compliance with this section. Nothing in this chapter shall
be deemed to supersede any rights that a patient or representative
might otherwise have or exercise under Section 1158 of the Evidence
Code or any other provision of law. Nothing in this chapter shall
require a health care provider to retain records longer than required
by applicable statutes or administrative regulations.
(h) This chapter shall not be construed to render a health care
provider liable for the quality of his or her records or the copies
provided in excess of existing law and regulations with respect to
the quality of medical records. A health care provider shall not be
liable to the patient or any other person for any consequences that
result from disclosure of patient records as required by this
chapter. A health care provider shall not discriminate against
classes or categories of providers in the transmittal of X-rays or
other patient records, or copies of these X-rays or records, to other
providers as authorized by this section.
Every health care provider shall adopt policies and establish
procedures for the uniform transmittal of X-rays and other patient
records that effectively prevent the discrimination described in this
subdivision. A health care provider may establish reasonable
conditions, including a reasonable deposit fee, to ensure the return
of original X-rays transmitted to another health care provider,
provided the conditions do not discriminate on the basis of, or in a
manner related to, the license of the provider to which the X-rays
are transmitted.
(i) Any health care provider described in paragraphs (4) to (10),
inclusive, of subdivision (a) of Section 123105 who willfully
violates this chapter is guilty of unprofessional conduct. Any health
care provider described in paragraphs (1) to (3), inclusive, of
subdivision (a) of Section 123105 that willfully violates this
chapter is guilty of an infraction punishable by a fine of not more
than one hundred dollars ($100). The state agency, board, or
commission that issued the health care provider's professional or
institutional license shall consider a violation as grounds for
disciplinary action with respect to the licensure, including
suspension or revocation of the license or certificate.
(j) This section shall be construed as prohibiting a health care
provider from withholding patient records or summaries of patient
records because of an unpaid bill for health care services. Any
health care provider who willfully withholds patient records or
summaries of patient records because of an unpaid bill for health
care services shall be subject to the sanctions specified in
subdivision (i).
123111. (a) Any adult patient who inspects his or her patient
records pursuant to Section 123110 shall have the right to provide to
the health care provider a written addendum with respect to any item
or statement in his or her records that the patient believes to be
incomplete or incorrect. The addendum shall be limited to 250 words
per alleged incomplete or incorrect item in the patient's record and
shall clearly indicate in writing that the patient wishes the
addendum to be made a part of his or her record.
(b) The health care provider shall attach the addendum to the
patient's records and shall include that addendum whenever the health
care provider makes a disclosure of the allegedly incomplete or
incorrect portion of the patient's records to any third party.
(c) The receipt of information in a patient's addendum which
contains defamatory or otherwise unlawful language, and the inclusion
of this information in the patient's records, in accordance with
subdivision (b), shall not, in and of itself, subject the health care
provider to liability in any civil, criminal, administrative, or
other proceeding.
(d) Subdivision (f) of Section 123110 and Section 123120 shall be
applicable with respect to any violation of this section by a health
care provider.
123115. (a) The representative of a minor shall not be entitled to
inspect or obtain copies of the minor's patient records in either of
the following circumstances:
(1) With respect to which the minor has a right of inspection
under Section 123110.
(2) Where the health care provider determines that access to the
patient records requested by the representative would have a
detrimental effect on the provider's professional relationship with
the minor patient or the minor's physical safety or psychological
well-being. The decision of the health care provider as to whether or
not a minor's records are available for inspection or copying under
this section shall not attach any liability to the provider, unless
the decision is found to be in bad faith.
(b) When a health care provider determines there is a substantial
risk of significant adverse or detrimental consequences to a patient
in seeing or receiving a copy of mental health records requested by
the patient, the provider may decline to permit inspection or provide
copies of the records to the patient, subject to the following
conditions:
(1) The health care provider shall make a written record, to be
included with the mental health records requested, noting the date of
the request and explaining the health care provider's reason for
refusing to permit inspection or provide copies of the records,
including a description of the specific adverse or detrimental
consequences to the patient that the provider anticipates would occur
if inspection or copying were permitted.
(2) The health care provider shall permit inspection by, or
provide copies of the mental health records to, a licensed physician
and surgeon, licensed psychologist, licensed marriage and family
therapist, or licensed clinical social worker, designated by request
of the patient. Any marriage and family therapist registered intern,
as defined in Chapter 13 (commencing with Section 4980) of Division 2
of the Business and Professions Code, may not inspect the patient's
mental health records or obtain copies thereof, except pursuant to
the direction or supervision of a licensed professional specified in
subdivision (g) of Section 4980.03 of the Business and Professions
Code. Prior to providing copies of mental health records to a
marriage and family therapist registered intern, a receipt for those
records shall be signed by the supervising licensed professional. The
licensed physician and surgeon, licensed psychologist, licensed
marriage and family therapist, licensed clinical social worker, or
marriage and family therapist registered intern to whom the records
are provided for inspection or copying shall not permit inspection or
copying by the patient.
(3) The health care provider shall inform the patient of the
provider's refusal to permit him or her to inspect or obtain copies
of the requested records, and inform the patient of the right to
require the provider to permit inspection by, or provide copies to, a
licensed physician and surgeon, licensed psychologist, licensed
marriage 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 health
records of the patient whether the request was made under paragraph
(2).
123120. Any patient or representative aggrieved by a violation of
Section 123110 may, in addition to any other remedy provided by law,
bring an action against the health care provider to enforce the
obligations prescribed by Section 123110. Any judgment rendered in
the action may, in the discretion of the court, include an award of
costs and reasonable attorney fees to the prevailing party.
123125. (a) This chapter shall not require a health care provider
to permit inspection or provide copies of alcohol and drug abuse
records where, or in a manner, prohibited by Section 408 of the
federal Drug Abuse Office and Treatment Act of 1972 (Public Law
92-255) or Section 333 of the federal Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970
(Public Law 91-616), or by regulations adopted pursuant to these
federal laws. Alcohol and drug abuse records subject to these federal
laws shall also be subject to this chapter, to the extent that these
federal laws do not prohibit disclosure of the records. All other
alcohol and drug abuse records shall be fully subject to this
chapter.
(b) This chapter shall not require a health care provider to
permit inspection or provide copies of records or portions of records
where or in a manner prohibited by existing law respecting the
confidentiality of information regarding communicable disease
carriers.
123130. (a) A health care provider may prepare a summary of the
record, according to the requirements of this section, for inspection
and copying by a patient. If the health care provider chooses to
prepare a summary of the record rather than allowing access to the
entire record, he or she shall make the summary of the record
available to the patient within 10 working days from the date of the
patient's request. However, if more time is needed because the record
is of extraordinary length or because the patient was discharged
from a licensed health facility within the last 10 days, the health
care provider shall notify the patient of this fact and the date that
the summary will be completed, but in no case shall more than 30
days elapse between the request by the patient and the delivery of
the summary. In preparing the summary of the record the health care
provider shall not be obligated to include information that is not
contained in the original record.
(b) A health care provider may confer with the patient in an
attempt to clarify the patient's purpose and goal in obtaining his or
her record. If as a consequence the patient requests information
about only certain injuries, illnesses, or episodes, this subdivision
shall not require the provider to prepare the summary required by
this subdivision for other than the injuries, illnesses, or episodes
so requested by the patient. The summary shall contain for each
injury, illness, or episode any information included in the record
relative to the following:
(1) Chief complaint or complaints including pertinent history.
(2) Findings from consultations and referrals to other health care
providers.
(3) Diagnosis, where determined.
(4) Treatment plan and regimen including medications prescribed.
(5) Progress of the treatment.
(6) Prognosis including significant continuing problems or
conditions.
(7) Pertinent reports of diagnostic procedures and tests and all
discharge summaries.
(8) Objective findings from the most recent physical examination,
such as blood pressure, weight, and actual values from routine
laboratory tests.
(c) This section shall not be construed to require any medical
records to be written or maintained in any manner not otherwise
required by law.
(d) The summary shall contain a list of all current medications
prescribed, including dosage, and any sensitivities or allergies to
medications recorded by the provider.
(e) Subdivision (c) of Section 123110 shall be applicable whether
or not the health care provider elects to prepare a summary of the
record.
(f) The health care provider may charge no more than a reasonable
fee based on actual time and cost for the preparation of the summary.
The cost shall be based on a computation of the actual time spent
preparing the summary for availability to the patient or the patient'
s representative. It is the intent of the Legislature that summaries
of the records be made available at the lowest possible cost to the
patient.
123135. Except as otherwise provided by law, nothing in this
chapter shall be construed to grant greater access to individual
patient records by any person, firm, association, organization,
partnership, business trust, company, corporation, or municipal or
other 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 Confidentiality
of Medical Information Act (Part 2.6 (commencing with Section 56) of
Division 1 of the Civil Code).
(b) Relieve any person subject to the Insurance Information and
Privacy Protection Act (Article 6.6 (commencing with Section 791) of
Chapter 1 of Part 2 of Division 1 of the Insurance Code) from the
requirements of that act.
(c) Relieve government agencies of the requirements of the
Information Practices Act of 1977 (Title 1.8 (commencing with Section
1798) 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 Civil
Code) shall prevail over this chapter with respect to records
maintained by a state agency.
123145. (a) Providers of health services that are licensed pursuant
to Sections 1205, 1253, 1575 and 1726 have an obligation, if the
licensee ceases operation, to preserve records for a minimum of seven
years following discharge of the patient, except that the records of
unemancipated minors shall be kept at least one year after the minor
has reached the age of 18 years, and in any case, not less than
seven years.
(b) The department or any person injured as a result of the
licensee's abandonment of health records may bring an action in a
proper court for the amount of damage suffered as a result thereof.
In the event that the licensee is a corporation or partnership that
is dissolved, the person injured may take action against that
corporation's or partnership's principle officers of record at the
time of dissolution.
(c) Abandoned means violating subdivision (a) and leaving patients
treated by the licensee without access to medical information to
which they are entitled pursuant to Section 123110.
123147. (a) Except as provided in subdivision (b), all health
facilities, as defined in Section 1250, and all primary care clinics
that are either licensed under Section 1204 or exempt from licensure
under Section 1206, shall include a patient's principal spoken
language on the patient's health records.
(b) Any long-term health care facility, as defined in Section
1418, that already completes the minimum data set form as specified
in Section 14110.15 of the Welfare and Institutions Code, including
documentation of a patient's principal spoken language, shall be
deemed to be in compliance with subdivision (a).
123148. (a) Notwithstanding any other provision of law, a health
care professional at whose request a test is performed shall provide
or arrange for the provision of the results of a clinical laboratory
test to the patient who is the subject of the test if so requested by
the patient, in oral or written form. The results shall be conveyed
in plain language and in oral or written form, except the results may
be conveyed in electronic form if requested by the patient and if
deemed most appropriate by the health care professional who requested
the test.
(b) (1) Consent of the patient to receive his or her laboratory
results by Internet posting or other electronic means shall be
obtained in a manner consistent with the requirements of Section
56.10 or 56.11 of the Civil Code. In the event that a health care
professional arranges for the provision of test results by Internet
posting or other electronic manner, the results shall be delivered to
a patient in a reasonable time period, but only after the results
have been reviewed by the health care professional. Access to
clinical laboratory test results shall be restricted by the use of a
secure personal identification number when the results are delivered
to a patient by Internet posting or other electronic manner.
(2) Nothing in paragraph (1) shall prohibit direct communication
by Internet posting or the use of other electronic means to convey
clinical laboratory test results by a treating health care
professional who ordered the test for his or her patient or by a
health care professional acting on behalf of, or with the
authorization of, the treating health care professional who ordered
the test.
(c) When a patient requests to receive his or her laboratory test
results by Internet posting, the health care professional shall
advise the patient of any charges that may be assessed directly to
the patient or insurer for the service and that the patient may call
the health care professional for a more detailed explanation of the
laboratory test results when delivered.
(d) The electronic provision of test results under this section
shall be in accordance with any applicable federal law governing
privacy and security of electronic personal health records. However,
any state statute, if enacted, that governs privacy and security of
electronic personal health records, shall apply to test results under
this section and shall prevail over federal law if federal law
permits.
(e) The test results to be reported to the patient pursuant to
this section shall be recorded in the patient's medical record, and
shall be reported to the patient within a reasonable time period
after the test results are received at the offices of the health care
professional who requested the test.
(f) Notwithstanding subdivisions (a) and (b), none of the
following clinical laboratory test results and any other related
results shall be conveyed to a patient by Internet posting or other
electronic 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, including
skin biopsies, Pap smear tests, products of conception, and bone
marrow aspirations for morphological evaluation, if they reveal a
malignancy.
(g) Patient identifiable test results and health information that
have been provided under this section shall not be used for any
commercial purpose without the consent of the patient, obtained in a
manner consistent with the requirements of Section 56.11 of the Civil
Code.
(h) Any third party to whom laboratory test results are disclosed
pursuant to this section shall be deemed a provider of administrative
services, as that term is used in paragraph (3) of subdivision (c)
of Section 56.10 of the Civil Code, and shall be subject to all
limitations and penalties applicable to that section.
(i) A patient may not be required to pay any cost, or be charged
any fee, for electing to receive his or her laboratory results in any
manner other than by Internet posting or other electronic form.
(j) A patient or his or her physician may revoke any consent
provided under this section at any time and without penalty, except
to the extent that action has been taken in reliance on that consent.
123149. (a) Providers of health services, licensed pursuant to
Sections 1205, 1253, 1575, and 1726, that utilize electronic
recordkeeping systems only, shall comply with the additional
requirements of this section. These additional requirements do not
apply to patient records if hard copy versions of the patient records
are retained.
(b) Any use of electronic recordkeeping to store patient records
shall ensure the safety and integrity of those records at least to
the extent of hard copy records. All providers set forth in
subdivision (a) shall ensure the safety and integrity of all
electronic media used to store patient records by employing an
offsite backup storage system, an image mechanism that is able to
copy signature documents, and a mechanism to ensure that once a
record is input, it is unalterable.
(c) Original hard copies of patient records may be destroyed once
the record has been electronically stored.
(d) The printout of the computerized version shall be considered
the original as defined in Section 255 of the Evidence Code for
purposes of providing copies to patients, the Division of Licensing
and Certification, and for introduction into evidence in accordance
with Sections 1550 and 1551 of the Evidence Code, in administrative
or court proceedings.
(e) Access to electronically stored patient records shall be made
available to the Division of Licensing and Certification staff
promptly, upon request.
(f) This section does not exempt licensed clinics, health
facilities, adult day health care centers, and home health agencies
from the requirement of maintaining original copies of patient
records that cannot be electronically stored.
(g) Any health care provider subject to this section, choosing to
utilize an electronic recordkeeping system, shall develop and
implement policies and procedures to include safeguards for
confidentiality and unauthorized access to electronically stored
patient health records, authentication by electronic signature keys,
and systems maintenance.
(h) Nothing contained in this chapter shall affect the existing
regulatory requirements for the access, use, disclosure,
confidentiality, retention of record contents, and maintenance of
health information in patient records by health care providers.
(i) This chapter does not prohibit any provider of health care
services from maintaining or retaining patient records
electronically.
123149.5. (a) It is the intent of the Legislature that all medical
information transmitted during the delivery of health care via
telemedicine, as defined in subdivision (a) of Section 2290.5 of the
Business and Professions Code, become part of the patient's medical
record maintained by the licensed health care provider.
(b) This section shall not be construed to limit or waive any of
the requirements of Chapter 1 (commencing with Section 123100) of
Part 1 of Division 106 of the Health and Safety Code.
123100. The Legislature finds and declares that every person having
ultimate responsibility for decisions respecting his or her own
health care also possesses a concomitant right of access to complete
information respecting his or her condition and care provided.
Similarly, persons having responsibility for decisions respecting the
health care of others should, in general, have access to information
on the patient's condition and care. It is, therefore, the intent of
the Legislature in enacting this chapter to establish procedures for
providing access to health care records or summaries of those
records by patients and by those persons having responsibility for
decisions 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 (commencing
with Section 1250) of Division 2.
(2) A clinic licensed pursuant to Chapter 1 (commencing with
Section 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 and
Professions Code or pursuant to the Osteopathic Act.
(5) A podiatrist licensed pursuant to Article 22 (commencing with
Section 2460) of Chapter 5 of Division 2 of the Business and
Professions Code.
(6) A dentist licensed pursuant to Chapter 4 (commencing with
Section 1600) of Division 2 of the Business and Professions Code.
(7) A psychologist licensed pursuant to Chapter 6.6 (commencing
with Section 2900) of Division 2 of the Business and Professions
Code.
(8) An optometrist licensed pursuant to Chapter 7 (commencing with
Section 3000) of Division 2 of the Business and Professions Code.
(9) A chiropractor licensed pursuant to the Chiropractic
Initiative Act.
(10) A marriage and family therapist licensed pursuant to Chapter
13 (commencing with Section 4980) of Division 2 of the Business and
Professions Code.
(11) A clinical social worker licensed pursuant to Chapter 14
(commencing with Section 4990) of Division 2 of the Business and
Professions Code.
(12) A physical therapist licensed pursuant to Chapter 5.7
(commencing with Section 2600) of Division 2 of the Business and
Professions Code.
(13) An occupational therapist licensed pursuant to Chapter 5.6
(commencing with Section 2570).
(b) "Mental health records" means patient records, or discrete
portions thereof, specifically relating to evaluation or treatment of
a mental disorder. "Mental health records" includes, but is not
limited to, all alcohol and drug abuse records.
(c) "Patient" means a patient or former patient of a health care
provider.
(d) "Patient records" means records in any form or medium
maintained by, or in the custody or control of, a health care
provider relating to the health history, diagnosis, or condition of a
patient, or relating to treatment provided or proposed to be
provided to the patient. "Patient records" includes only records
pertaining to the patient requesting the records or whose
representative requests the records. "Patient records" does not
include information given in confidence to a health care provider by
a person other than another health care provider or the patient, and
that material may be removed from any records prior to inspection or
copying under Section 123110 or 123115. "Patient records" does not
include information contained in aggregate form, such as indices,
registers, or logs.
(e) "Patient's representative" or "representative" means any of
the 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, to
the extent necessary for the agent to fulfill his or her duties as
set forth in Division 4.7 (commencing with Section 4600) of the
Probate Code.
(4) The beneficiary as defined in Section 24 of the Probate Code
or personal representative as defined in Section 58 of the Probate
Code, of a deceased patient.
(f) "Alcohol and drug abuse records" means patient records, or
discrete portions thereof, specifically relating to evaluation and
treatment of alcoholism or drug abuse.
123110. (a) Notwithstanding Section 5328 of the Welfare and
Institutions Code, and except as provided in Sections 123115 and
123120, any adult patient of a health care provider, any minor
patient authorized by law to consent to medical treatment, and any
patient representative shall be entitled to inspect patient records
upon presenting to the health care provider a written request for
those records and upon payment of reasonable clerical costs incurred
in locating and making the records available. However, a patient who
is a minor shall be entitled to inspect patient records pertaining
only to health care of a type for which the minor is lawfully
authorized to consent. A health care provider shall permit this
inspection during business hours within five working days after
receipt of the written request. The inspection shall be conducted by
the 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 be
entitled to copies of all or any portion of the patient records that
he or she has a right to inspect, upon presenting a written request
to the health care provider specifying the records to be copied,
together with a fee to defray the cost of copying, that shall not
exceed twenty-five cents ($0.25) per page or fifty cents ($0.50) per
page for records that are copied from microfilm and any additional
reasonable clerical costs incurred in making the records available.
The health care provider shall ensure that the copies are transmitted
within 15 days after receiving the written request.
(c) Copies of X-rays or tracings derived from electrocardiography,
electroencephalography, or electromyography need not be provided to
the patient or patient's representative under this section, if the
original X-rays or tracings are transmitted to another health care
provider upon written request of the patient or patient's
representative and within 15 days after receipt of the request. The
request shall specify the name and address of the health care
provider to whom the records are to be delivered. All reasonable
costs, not exceeding actual costs, incurred by a health care provider
in providing copies pursuant to this subdivision may be charged to
the patient or representative requesting the copies.
(d) (1) Notwithstanding any provision of this section, and except
as provided in Sections 123115 and 123120, any patient or former
patient or the patient's representative shall be entitled to a copy,
at no charge, of the relevant portion of the patient's records, upon
presenting to the provider a written request, and proof that the
records are needed to support an appeal regarding eligibility for a
public benefit program. These programs shall be the Medi-Cal program,
social security disability insurance benefits, and Supplemental
Security Income/State Supplementary Program for the Aged, Blind and
Disabled (SSI/SSP) benefits. For purposes of this subdivision,
"relevant portion of the patient's records" means those records
regarding services rendered to the patient during the time period
beginning with the date of the patient's initial application for
public benefits up to and including the date that a final
determination is made by the public benefits program with which the
patient'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 more
than one copy of any relevant portion of his or her record free of
charge.
(3) This subdivision shall not apply to any patient who is
represented by a private attorney who is paying for the costs related
to the patient's appeal, pending the outcome of that appeal. For
purposes of this subdivision, "private attorney" means any attorney
not employed by a nonprofit legal services entity.
(e) If the patient's appeal regarding eligibility for a public
benefit program specified in subdivision (d) is successful, the
hospital or other health care provider may bill the patient, at the
rates specified in subdivisions (b) and (c), for the copies of the
medical records previously provided free of charge.
(f) If a patient or his or her representative requests a record
pursuant to subdivision (d), the health care provider shall ensure
that the copies are transmitted within 30 days after receiving the
written request.
(g) This section shall not be construed to preclude a health care
provider from requiring reasonable verification of identity prior to
permitting inspection or copying of patient records, provided this
requirement is not used oppressively or discriminatorily to frustrate
or delay compliance with this section. Nothing in this chapter shall
be deemed to supersede any rights that a patient or representative
might otherwise have or exercise under Section 1158 of the Evidence
Code or any other provision of law. Nothing in this chapter shall
require a health care provider to retain records longer than required
by applicable statutes or administrative regulations.
(h) This chapter shall not be construed to render a health care
provider liable for the quality of his or her records or the copies
provided in excess of existing law and regulations with respect to
the quality of medical records. A health care provider shall not be
liable to the patient or any other person for any consequences that
result from disclosure of patient records as required by this
chapter. A health care provider shall not discriminate against
classes or categories of providers in the transmittal of X-rays or
other patient records, or copies of these X-rays or records, to other
providers as authorized by this section.
Every health care provider shall adopt policies and establish
procedures for the uniform transmittal of X-rays and other patient
records that effectively prevent the discrimination described in this
subdivision. A health care provider may establish reasonable
conditions, including a reasonable deposit fee, to ensure the return
of original X-rays transmitted to another health care provider,
provided the conditions do not discriminate on the basis of, or in a
manner related to, the license of the provider to which the X-rays
are transmitted.
(i) Any health care provider described in paragraphs (4) to (10),
inclusive, of subdivision (a) of Section 123105 who willfully
violates this chapter is guilty of unprofessional conduct. Any health
care provider described in paragraphs (1) to (3), inclusive, of
subdivision (a) of Section 123105 that willfully violates this
chapter is guilty of an infraction punishable by a fine of not more
than one hundred dollars ($100). The state agency, board, or
commission that issued the health care provider's professional or
institutional license shall consider a violation as grounds for
disciplinary action with respect to the licensure, including
suspension or revocation of the license or certificate.
(j) This section shall be construed as prohibiting a health care
provider from withholding patient records or summaries of patient
records because of an unpaid bill for health care services. Any
health care provider who willfully withholds patient records or
summaries of patient records because of an unpaid bill for health
care services shall be subject to the sanctions specified in
subdivision (i).
123111. (a) Any adult patient who inspects his or her patient
records pursuant to Section 123110 shall have the right to provide to
the health care provider a written addendum with respect to any item
or statement in his or her records that the patient believes to be
incomplete or incorrect. The addendum shall be limited to 250 words
per alleged incomplete or incorrect item in the patient's record and
shall clearly indicate in writing that the patient wishes the
addendum to be made a part of his or her record.
(b) The health care provider shall attach the addendum to the
patient's records and shall include that addendum whenever the health
care provider makes a disclosure of the allegedly incomplete or
incorrect portion of the patient's records to any third party.
(c) The receipt of information in a patient's addendum which
contains defamatory or otherwise unlawful language, and the inclusion
of this information in the patient's records, in accordance with
subdivision (b), shall not, in and of itself, subject the health care
provider to liability in any civil, criminal, administrative, or
other proceeding.
(d) Subdivision (f) of Section 123110 and Section 123120 shall be
applicable with respect to any violation of this section by a health
care provider.
123115. (a) The representative of a minor shall not be entitled to
inspect or obtain copies of the minor's patient records in either of
the following circumstances:
(1) With respect to which the minor has a right of inspection
under Section 123110.
(2) Where the health care provider determines that access to the
patient records requested by the representative would have a
detrimental effect on the provider's professional relationship with
the minor patient or the minor's physical safety or psychological
well-being. The decision of the health care provider as to whether or
not a minor's records are available for inspection or copying under
this section shall not attach any liability to the provider, unless
the decision is found to be in bad faith.
(b) When a health care provider determines there is a substantial
risk of significant adverse or detrimental consequences to a patient
in seeing or receiving a copy of mental health records requested by
the patient, the provider may decline to permit inspection or provide
copies of the records to the patient, subject to the following
conditions:
(1) The health care provider shall make a written record, to be
included with the mental health records requested, noting the date of
the request and explaining the health care provider's reason for
refusing to permit inspection or provide copies of the records,
including a description of the specific adverse or detrimental
consequences to the patient that the provider anticipates would occur
if inspection or copying were permitted.
(2) The health care provider shall permit inspection by, or
provide copies of the mental health records to, a licensed physician
and surgeon, licensed psychologist, licensed marriage and family
therapist, or licensed clinical social worker, designated by request
of the patient. Any marriage and family therapist registered intern,
as defined in Chapter 13 (commencing with Section 4980) of Division 2
of the Business and Professions Code, may not inspect the patient's
mental health records or obtain copies thereof, except pursuant to
the direction or supervision of a licensed professional specified in
subdivision (g) of Section 4980.03 of the Business and Professions
Code. Prior to providing copies of mental health records to a
marriage and family therapist registered intern, a receipt for those
records shall be signed by the supervising licensed professional. The
licensed physician and surgeon, licensed psychologist, licensed
marriage and family therapist, licensed clinical social worker, or
marriage and family therapist registered intern to whom the records
are provided for inspection or copying shall not permit inspection or
copying by the patient.
(3) The health care provider shall inform the patient of the
provider's refusal to permit him or her to inspect or obtain copies
of the requested records, and inform the patient of the right to
require the provider to permit inspection by, or provide copies to, a
licensed physician and surgeon, licensed psychologist, licensed
marriage 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 health
records of the patient whether the request was made under paragraph
(2).
123120. Any patient or representative aggrieved by a violation of
Section 123110 may, in addition to any other remedy provided by law,
bring an action against the health care provider to enforce the
obligations prescribed by Section 123110. Any judgment rendered in
the action may, in the discretion of the court, include an award of
costs and reasonable attorney fees to the prevailing party.
123125. (a) This chapter shall not require a health care provider
to permit inspection or provide copies of alcohol and drug abuse
records where, or in a manner, prohibited by Section 408 of the
federal Drug Abuse Office and Treatment Act of 1972 (Public Law
92-255) or Section 333 of the federal Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970
(Public Law 91-616), or by regulations adopted pursuant to these
federal laws. Alcohol and drug abuse records subject to these federal
laws shall also be subject to this chapter, to the extent that these
federal laws do not prohibit disclosure of the records. All other
alcohol and drug abuse records shall be fully subject to this
chapter.
(b) This chapter shall not require a health care provider to
permit inspection or provide copies of records or portions of records
where or in a manner prohibited by existing law respecting the
confidentiality of information regarding communicable disease
carriers.
123130. (a) A health care provider may prepare a summary of the
record, according to the requirements of this section, for inspection
and copying by a patient. If the health care provider chooses to
prepare a summary of the record rather than allowing access to the
entire record, he or she shall make the summary of the record
available to the patient within 10 working days from the date of the
patient's request. However, if more time is needed because the record
is of extraordinary length or because the patient was discharged
from a licensed health facility within the last 10 days, the health
care provider shall notify the patient of this fact and the date that
the summary will be completed, but in no case shall more than 30
days elapse between the request by the patient and the delivery of
the summary. In preparing the summary of the record the health care
provider shall not be obligated to include information that is not
contained in the original record.
(b) A health care provider may confer with the patient in an
attempt to clarify the patient's purpose and goal in obtaining his or
her record. If as a consequence the patient requests information
about only certain injuries, illnesses, or episodes, this subdivision
shall not require the provider to prepare the summary required by
this subdivision for other than the injuries, illnesses, or episodes
so requested by the patient. The summary shall contain for each
injury, illness, or episode any information included in the record
relative to the following:
(1) Chief complaint or complaints including pertinent history.
(2) Findings from consultations and referrals to other health care
providers.
(3) Diagnosis, where determined.
(4) Treatment plan and regimen including medications prescribed.
(5) Progress of the treatment.
(6) Prognosis including significant continuing problems or
conditions.
(7) Pertinent reports of diagnostic procedures and tests and all
discharge summaries.
(8) Objective findings from the most recent physical examination,
such as blood pressure, weight, and actual values from routine
laboratory tests.
(c) This section shall not be construed to require any medical
records to be written or maintained in any manner not otherwise
required by law.
(d) The summary shall contain a list of all current medications
prescribed, including dosage, and any sensitivities or allergies to
medications recorded by the provider.
(e) Subdivision (c) of Section 123110 shall be applicable whether
or not the health care provider elects to prepare a summary of the
record.
(f) The health care provider may charge no more than a reasonable
fee based on actual time and cost for the preparation of the summary.
The cost shall be based on a computation of the actual time spent
preparing the summary for availability to the patient or the patient'
s representative. It is the intent of the Legislature that summaries
of the records be made available at the lowest possible cost to the
patient.
123135. Except as otherwise provided by law, nothing in this
chapter shall be construed to grant greater access to individual
patient records by any person, firm, association, organization,
partnership, business trust, company, corporation, or municipal or
other 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 Confidentiality
of Medical Information Act (Part 2.6 (commencing with Section 56) of
Division 1 of the Civil Code).
(b) Relieve any person subject to the Insurance Information and
Privacy Protection Act (Article 6.6 (commencing with Section 791) of
Chapter 1 of Part 2 of Division 1 of the Insurance Code) from the
requirements of that act.
(c) Relieve government agencies of the requirements of the
Information Practices Act of 1977 (Title 1.8 (commencing with Section
1798) 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 Civil
Code) shall prevail over this chapter with respect to records
maintained by a state agency.
123145. (a) Providers of health services that are licensed pursuant
to Sections 1205, 1253, 1575 and 1726 have an obligation, if the
licensee ceases operation, to preserve records for a minimum of seven
years following discharge of the patient, except that the records of
unemancipated minors shall be kept at least one year after the minor
has reached the age of 18 years, and in any case, not less than
seven years.
(b) The department or any person injured as a result of the
licensee's abandonment of health records may bring an action in a
proper court for the amount of damage suffered as a result thereof.
In the event that the licensee is a corporation or partnership that
is dissolved, the person injured may take action against that
corporation's or partnership's principle officers of record at the
time of dissolution.
(c) Abandoned means violating subdivision (a) and leaving patients
treated by the licensee without access to medical information to
which they are entitled pursuant to Section 123110.
123147. (a) Except as provided in subdivision (b), all health
facilities, as defined in Section 1250, and all primary care clinics
that are either licensed under Section 1204 or exempt from licensure
under Section 1206, shall include a patient's principal spoken
language on the patient's health records.
(b) Any long-term health care facility, as defined in Section
1418, that already completes the minimum data set form as specified
in Section 14110.15 of the Welfare and Institutions Code, including
documentation of a patient's principal spoken language, shall be
deemed to be in compliance with subdivision (a).
123148. (a) Notwithstanding any other provision of law, a health
care professional at whose request a test is performed shall provide
or arrange for the provision of the results of a clinical laboratory
test to the patient who is the subject of the test if so requested by
the patient, in oral or written form. The results shall be conveyed
in plain language and in oral or written form, except the results may
be conveyed in electronic form if requested by the patient and if
deemed most appropriate by the health care professional who requested
the test.
(b) (1) Consent of the patient to receive his or her laboratory
results by Internet posting or other electronic means shall be
obtained in a manner consistent with the requirements of Section
56.10 or 56.11 of the Civil Code. In the event that a health care
professional arranges for the provision of test results by Internet
posting or other electronic manner, the results shall be delivered to
a patient in a reasonable time period, but only after the results
have been reviewed by the health care professional. Access to
clinical laboratory test results shall be restricted by the use of a
secure personal identification number when the results are delivered
to a patient by Internet posting or other electronic manner.
(2) Nothing in paragraph (1) shall prohibit direct communication
by Internet posting or the use of other electronic means to convey
clinical laboratory test results by a treating health care
professional who ordered the test for his or her patient or by a
health care professional acting on behalf of, or with the
authorization of, the treating health care professional who ordered
the test.
(c) When a patient requests to receive his or her laboratory test
results by Internet posting, the health care professional shall
advise the patient of any charges that may be assessed directly to
the patient or insurer for the service and that the patient may call
the health care professional for a more detailed explanation of the
laboratory test results when delivered.
(d) The electronic provision of test results under this section
shall be in accordance with any applicable federal law governing
privacy and security of electronic personal health records. However,
any state statute, if enacted, that governs privacy and security of
electronic personal health records, shall apply to test results under
this section and shall prevail over federal law if federal law
permits.
(e) The test results to be reported to the patient pursuant to
this section shall be recorded in the patient's medical record, and
shall be reported to the patient within a reasonable time period
after the test results are received at the offices of the health care
professional who requested the test.
(f) Notwithstanding subdivisions (a) and (b), none of the
following clinical laboratory test results and any other related
results shall be conveyed to a patient by Internet posting or other
electronic 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, including
skin biopsies, Pap smear tests, products of conception, and bone
marrow aspirations for morphological evaluation, if they reveal a
malignancy.
(g) Patient identifiable test results and health information that
have been provided under this section shall not be used for any
commercial purpose without the consent of the patient, obtained in a
manner consistent with the requirements of Section 56.11 of the Civil
Code.
(h) Any third party to whom laboratory test results are disclosed
pursuant to this section shall be deemed a provider of administrative
services, as that term is used in paragraph (3) of subdivision (c)
of Section 56.10 of the Civil Code, and shall be subject to all
limitations and penalties applicable to that section.
(i) A patient may not be required to pay any cost, or be charged
any fee, for electing to receive his or her laboratory results in any
manner other than by Internet posting or other electronic form.
(j) A patient or his or her physician may revoke any consent
provided under this section at any time and without penalty, except
to the extent that action has been taken in reliance on that consent.
123149. (a) Providers of health services, licensed pursuant to
Sections 1205, 1253, 1575, and 1726, that utilize electronic
recordkeeping systems only, shall comply with the additional
requirements of this section. These additional requirements do not
apply to patient records if hard copy versions of the patient records
are retained.
(b) Any use of electronic recordkeeping to store patient records
shall ensure the safety and integrity of those records at least to
the extent of hard copy records. All providers set forth in
subdivision (a) shall ensure the safety and integrity of all
electronic media used to store patient records by employing an
offsite backup storage system, an image mechanism that is able to
copy signature documents, and a mechanism to ensure that once a
record is input, it is unalterable.
(c) Original hard copies of patient records may be destroyed once
the record has been electronically stored.
(d) The printout of the computerized version shall be considered
the original as defined in Section 255 of the Evidence Code for
purposes of providing copies to patients, the Division of Licensing
and Certification, and for introduction into evidence in accordance
with Sections 1550 and 1551 of the Evidence Code, in administrative
or court proceedings.
(e) Access to electronically stored patient records shall be made
available to the Division of Licensing and Certification staff
promptly, upon request.
(f) This section does not exempt licensed clinics, health
facilities, adult day health care centers, and home health agencies
from the requirement of maintaining original copies of patient
records that cannot be electronically stored.
(g) Any health care provider subject to this section, choosing to
utilize an electronic recordkeeping system, shall develop and
implement policies and procedures to include safeguards for
confidentiality and unauthorized access to electronically stored
patient health records, authentication by electronic signature keys,
and systems maintenance.
(h) Nothing contained in this chapter shall affect the existing
regulatory requirements for the access, use, disclosure,
confidentiality, retention of record contents, and maintenance of
health information in patient records by health care providers.
(i) This chapter does not prohibit any provider of health care
services from maintaining or retaining patient records
electronically.
123149.5. (a) It is the intent of the Legislature that all medical
information transmitted during the delivery of health care via
telemedicine, as defined in subdivision (a) of Section 2290.5 of the
Business and Professions Code, become part of the patient's medical
record maintained by the licensed health care provider.
(b) This section shall not be construed to limit or waive any of
the requirements of Chapter 1 (commencing with Section 123100) of
Part 1 of Division 106 of the Health and Safety Code.
123100. The Legislature finds and declares that every person having
ultimate responsibility for decisions respecting his or her own
health care also possesses a concomitant right of access to complete
information respecting his or her condition and care provided.
Similarly, persons having responsibility for decisions respecting the
health care of others should, in general, have access to information
on the patient's condition and care. It is, therefore, the intent of
the Legislature in enacting this chapter to establish procedures for
providing access to health care records or summaries of those
records by patients and by those persons having responsibility for
decisions 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 (commencing
with Section 1250) of Division 2.
(2) A clinic licensed pursuant to Chapter 1 (commencing with
Section 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 and
Professions Code or pursuant to the Osteopathic Act.
(5) A podiatrist licensed pursuant to Article 22 (commencing with
Section 2460) of Chapter 5 of Division 2 of the Business and
Professions Code.
(6) A dentist licensed pursuant to Chapter 4 (commencing with
Section 1600) of Division 2 of the Business and Professions Code.
(7) A psychologist licensed pursuant to Chapter 6.6 (commencing
with Section 2900) of Division 2 of the Business and Professions
Code.
(8) An optometrist licensed pursuant to Chapter 7 (commencing with
Section 3000) of Division 2 of the Business and Professions Code.
(9) A chiropractor licensed pursuant to the Chiropractic
Initiative Act.
(10) A marriage and family therapist licensed pursuant to Chapter
13 (commencing with Section 4980) of Division 2 of the Business and
Professions Code.
(11) A clinical social worker licensed pursuant to Chapter 14
(commencing with Section 4990) of Division 2 of the Business and
Professions Code.
(12) A physical therapist licensed pursuant to Chapter 5.7
(commencing with Section 2600) of Division 2 of the Business and
Professions Code.
(13) An occupational therapist licensed pursuant to Chapter 5.6
(commencing with Section 2570).
(b) "Mental health records" means patient records, or discrete
portions thereof, specifically relating to evaluation or treatment of
a mental disorder. "Mental health records" includes, but is not
limited to, all alcohol and drug abuse records.
(c) "Patient" means a patient or former patient of a health care
provider.
(d) "Patient records" means records in any form or medium
maintained by, or in the custody or control of, a health care
provider relating to the health history, diagnosis, or condition of a
patient, or relating to treatment provided or proposed to be
provided to the patient. "Patient records" includes only records
pertaining to the patient requesting the records or whose
representative requests the records. "Patient records" does not
include information given in confidence to a health care provider by
a person other than another health care provider or the patient, and
that material may be removed from any records prior to inspection or
copying under Section 123110 or 123115. "Patient records" does not
include information contained in aggregate form, such as indices,
registers, or logs.
(e) "Patient's representative" or "representative" means any of
the 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, to
the extent necessary for the agent to fulfill his or her duties as
set forth in Division 4.7 (commencing with Section 4600) of the
Probate Code.
(4) The beneficiary as defined in Section 24 of the Probate Code
or personal representative as defined in Section 58 of the Probate
Code, of a deceased patient.
(f) "Alcohol and drug abuse records" means patient records, or
discrete portions thereof, specifically relating to evaluation and
treatment of alcoholism or drug abuse.
123110. (a) Notwithstanding Section 5328 of the Welfare and
Institutions Code, and except as provided in Sections 123115 and
123120, any adult patient of a health care provider, any minor
patient authorized by law to consent to medical treatment, and any
patient representative shall be entitled to inspect patient records
upon presenting to the health care provider a written request for
those records and upon payment of reasonable clerical costs incurred
in locating and making the records available. However, a patient who
is a minor shall be entitled to inspect patient records pertaining
only to health care of a type for which the minor is lawfully
authorized to consent. A health care provider shall permit this
inspection during business hours within five working days after
receipt of the written request. The inspection shall be conducted by
the 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 be
entitled to copies of all or any portion of the patient records that
he or she has a right to inspect, upon presenting a written request
to the health care provider specifying the records to be copied,
together with a fee to defray the cost of copying, that shall not
exceed twenty-five cents ($0.25) per page or fifty cents ($0.50) per
page for records that are copied from microfilm and any additional
reasonable clerical costs incurred in making the records available.
The health care provider shall ensure that the copies are transmitted
within 15 days after receiving the written request.
(c) Copies of X-rays or tracings derived from electrocardiography,
electroencephalography, or electromyography need not be provided to
the patient or patient's representative under this section, if the
original X-rays or tracings are transmitted to another health care
provider upon written request of the patient or patient's
representative and within 15 days after receipt of the request. The
request shall specify the name and address of the health care
provider to whom the records are to be delivered. All reasonable
costs, not exceeding actual costs, incurred by a health care provider
in providing copies pursuant to this subdivision may be charged to
the patient or representative requesting the copies.
(d) (1) Notwithstanding any provision of this section, and except
as provided in Sections 123115 and 123120, any patient or former
patient or the patient's representative shall be entitled to a copy,
at no charge, of the relevant portion of the patient's records, upon
presenting to the provider a written request, and proof that the
records are needed to support an appeal regarding eligibility for a
public benefit program. These programs shall be the Medi-Cal program,
social security disability insurance benefits, and Supplemental
Security Income/State Supplementary Program for the Aged, Blind and
Disabled (SSI/SSP) benefits. For purposes of this subdivision,
"relevant portion of the patient's records" means those records
regarding services rendered to the patient during the time period
beginning with the date of the patient's initial application for
public benefits up to and including the date that a final
determination is made by the public benefits program with which the
patient'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 more
than one copy of any relevant portion of his or her record free of
charge.
(3) This subdivision shall not apply to any patient who is
represented by a private attorney who is paying for the costs related
to the patient's appeal, pending the outcome of that appeal. For
purposes of this subdivision, "private attorney" means any attorney
not employed by a nonprofit legal services entity.
(e) If the patient's appeal regarding eligibility for a public
benefit program specified in subdivision (d) is successful, the
hospital or other health care provider may bill the patient, at the
rates specified in subdivisions (b) and (c), for the copies of the
medical records previously provided free of charge.
(f) If a patient or his or her representative requests a record
pursuant to subdivision (d), the health care provider shall ensure
that the copies are transmitted within 30 days after receiving the
written request.
(g) This section shall not be construed to preclude a health care
provider from requiring reasonable verification of identity prior to
permitting inspection or copying of patient records, provided this
requirement is not used oppressively or discriminatorily to frustrate
or delay compliance with this section. Nothing in this chapter shall
be deemed to supersede any rights that a patient or representative
might otherwise have or exercise under Section 1158 of the Evidence
Code or any other provision of law. Nothing in this chapter shall
require a health care provider to retain records longer than required
by applicable statutes or administrative regulations.
(h) This chapter shall not be construed to render a health care
provider liable for the quality of his or her records or the copies
provided in excess of existing law and regulations with respect to
the quality of medical records. A health care provider shall not be
liable to the patient or any other person for any consequences that
result from disclosure of patient records as required by this
chapter. A health care provider shall not discriminate against
classes or categories of providers in the transmittal of X-rays or
other patient records, or copies of these X-rays or records, to other
providers as authorized by this section.
Every health care provider shall adopt policies and establish
procedures for the uniform transmittal of X-rays and other patient
records that effectively prevent the discrimination described in this
subdivision. A health care provider may establish reasonable
conditions, including a reasonable deposit fee, to ensure the return
of original X-rays transmitted to another health care provider,
provided the conditions do not discriminate on the basis of, or in a
manner related to, the license of the provider to which the X-rays
are transmitted.
(i) Any health care provider described in paragraphs (4) to (10),
inclusive, of subdivision (a) of Section 123105 who willfully
violates this chapter is guilty of unprofessional conduct. Any health
care provider described in paragraphs (1) to (3), inclusive, of
subdivision (a) of Section 123105 that willfully violates this
chapter is guilty of an infraction punishable by a fine of not more
than one hundred dollars ($100). The state agency, board, or
commission that issued the health care provider's professional or
institutional license shall consider a violation as grounds for
disciplinary action with respect to the licensure, including
suspension or revocation of the license or certificate.
(j) This section shall be construed as prohibiting a health care
provider from withholding patient records or summaries of patient
records because of an unpaid bill for health care services. Any
health care provider who willfully withholds patient records or
summaries of patient records because of an unpaid bill for health
care services shall be subject to the sanctions specified in
subdivision (i).
123111. (a) Any adult patient who inspects his or her patient
records pursuant to Section 123110 shall have the right to provide to
the health care provider a written addendum with respect to any item
or statement in his or her records that the patient believes to be
incomplete or incorrect. The addendum shall be limited to 250 words
per alleged incomplete or incorrect item in the patient's record and
shall clearly indicate in writing that the patient wishes the
addendum to be made a part of his or her record.
(b) The health care provider shall attach the addendum to the
patient's records and shall include that addendum whenever the health
care provider makes a disclosure of the allegedly incomplete or
incorrect portion of the patient's records to any third party.
(c) The receipt of information in a patient's addendum which
contains defamatory or otherwise unlawful language, and the inclusion
of this information in the patient's records, in accordance with
subdivision (b), shall not, in and of itself, subject the health care
provider to liability in any civil, criminal, administrative, or
other proceeding.
(d) Subdivision (f) of Section 123110 and Section 123120 shall be
applicable with respect to any violation of this section by a health
care provider.
123115. (a) The representative of a minor shall not be entitled to
inspect or obtain copies of the minor's patient records in either of
the following circumstances:
(1) With respect to which the minor has a right of inspection
under Section 123110.
(2) Where the health care provider determines that access to the
patient records requested by the representative would have a
detrimental effect on the provider's professional relationship with
the minor patient or the minor's physical safety or psychological
well-being. The decision of the health care provider as to whether or
not a minor's records are available for inspection or copying under
this section shall not attach any liability to the provider, unless
the decision is found to be in bad faith.
(b) When a health care provider determines there is a substantial
risk of significant adverse or detrimental consequences to a patient
in seeing or receiving a copy of mental health records requested by
the patient, the provider may decline to permit inspection or provide
copies of the records to the patient, subject to the following
conditions:
(1) The health care provider shall make a written record, to be
included with the mental health records requested, noting the date of
the request and explaining the health care provider's reason for
refusing to permit inspection or provide copies of the records,
including a description of the specific adverse or detrimental
consequences to the patient that the provider anticipates would occur
if inspection or copying were permitted.
(2) The health care provider shall permit inspection by, or
provide copies of the mental health records to, a licensed physician
and surgeon, licensed psychologist, licensed marriage and family
therapist, or licensed clinical social worker, designated by request
of the patient. Any marriage and family therapist registered intern,
as defined in Chapter 13 (commencing with Section 4980) of Division 2
of the Business and Professions Code, may not inspect the patient's
mental health records or obtain copies thereof, except pursuant to
the direction or supervision of a licensed professional specified in
subdivision (g) of Section 4980.03 of the Business and Professions
Code. Prior to providing copies of mental health records to a
marriage and family therapist registered intern, a receipt for those
records shall be signed by the supervising licensed professional. The
licensed physician and surgeon, licensed psychologist, licensed
marriage and family therapist, licensed clinical social worker, or
marriage and family therapist registered intern to whom the records
are provided for inspection or copying shall not permit inspection or
copying by the patient.
(3) The health care provider shall inform the patient of the
provider's refusal to permit him or her to inspect or obtain copies
of the requested records, and inform the patient of the right to
require the provider to permit inspection by, or provide copies to, a
licensed physician and surgeon, licensed psychologist, licensed
marriage 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 health
records of the patient whether the request was made under paragraph
(2).
123120. Any patient or representative aggrieved by a violation of
Section 123110 may, in addition to any other remedy provided by law,
bring an action against the health care provider to enforce the
obligations prescribed by Section 123110. Any judgment rendered in
the action may, in the discretion of the court, include an award of
costs and reasonable attorney fees to the prevailing party.
123125. (a) This chapter shall not require a health care provider
to permit inspection or provide copies of alcohol and drug abuse
records where, or in a manner, prohibited by Section 408 of the
federal Drug Abuse Office and Treatment Act of 1972 (Public Law
92-255) or Section 333 of the federal Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970
(Public Law 91-616), or by regulations adopted pursuant to these
federal laws. Alcohol and drug abuse records subject to these federal
laws shall also be subject to this chapter, to the extent that these
federal laws do not prohibit disclosure of the records. All other
alcohol and drug abuse records shall be fully subject to this
chapter.
(b) This chapter shall not require a health care provider to
permit inspection or provide copies of records or portions of records
where or in a manner prohibited by existing law respecting the
confidentiality of information regarding communicable disease
carriers.
123130. (a) A health care provider may prepare a summary of the
record, according to the requirements of this section, for inspection
and copying by a patient. If the health care provider chooses to
prepare a summary of the record rather than allowing access to the
entire record, he or she shall make the summary of the record
available to the patient within 10 working days from the date of the
patient's request. However, if more time is needed because the record
is of extraordinary length or because the patient was discharged
from a licensed health facility within the last 10 days, the health
care provider shall notify the patient of this fact and the date that
the summary will be completed, but in no case shall more than 30
days elapse between the request by the patient and the delivery of
the summary. In preparing the summary of the record the health care
provider shall not be obligated to include information that is not
contained in the original record.
(b) A health care provider may confer with the patient in an
attempt to clarify the patient's purpose and goal in obtaining his or
her record. If as a consequence the patient requests information
about only certain injuries, illnesses, or episodes, this subdivision
shall not require the provider to prepare the summary required by
this subdivision for other than the injuries, illnesses, or episodes
so requested by the patient. The summary shall contain for each
injury, illness, or episode any information included in the record
relative to the following:
(1) Chief complaint or complaints including pertinent history.
(2) Findings from consultations and referrals to other health care
providers.
(3) Diagnosis, where determined.
(4) Treatment plan and regimen including medications prescribed.
(5) Progress of the treatment.
(6) Prognosis including significant continuing problems or
conditions.
(7) Pertinent reports of diagnostic procedures and tests and all
discharge summaries.
(8) Objective findings from the most recent physical examination,
such as blood pressure, weight, and actual values from routine
laboratory tests.
(c) This section shall not be construed to require any medical
records to be written or maintained in any manner not otherwise
required by law.
(d) The summary shall contain a list of all current medications
prescribed, including dosage, and any sensitivities or allergies to
medications recorded by the provider.
(e) Subdivision (c) of Section 123110 shall be applicable whether
or not the health care provider elects to prepare a summary of the
record.
(f) The health care provider may charge no more than a reasonable
fee based on actual time and cost for the preparation of the summary.
The cost shall be based on a computation of the actual time spent
preparing the summary for availability to the patient or the patient'
s representative. It is the intent of the Legislature that summaries
of the records be made available at the lowest possible cost to the
patient.
123135. Except as otherwise provided by law, nothing in this
chapter shall be construed to grant greater access to individual
patient records by any person, firm, association, organization,
partnership, business trust, company, corporation, or municipal or
other 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 Confidentiality
of Medical Information Act (Part 2.6 (commencing with Section 56) of
Division 1 of the Civil Code).
(b) Relieve any person subject to the Insurance Information and
Privacy Protection Act (Article 6.6 (commencing with Section 791) of
Chapter 1 of Part 2 of Division 1 of the Insurance Code) from the
requirements of that act.
(c) Relieve government agencies of the requirements of the
Information Practices Act of 1977 (Title 1.8 (commencing with Section
1798) 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 Civil
Code) shall prevail over this chapter with respect to records
maintained by a state agency.
123145. (a) Providers of health services that are licensed pursuant
to Sections 1205, 1253, 1575 and 1726 have an obligation, if the
licensee ceases operation, to preserve records for a minimum of seven
years following discharge of the patient, except that the records of
unemancipated minors shall be kept at least one year after the minor
has reached the age of 18 years, and in any case, not less than
seven years.
(b) The department or any person injured as a result of the
licensee's abandonment of health records may bring an action in a
proper court for the amount of damage suffered as a result thereof.
In the event that the licensee is a corporation or partnership that
is dissolved, the person injured may take action against that
corporation's or partnership's principle officers of record at the
time of dissolution.
(c) Abandoned means violating subdivision (a) and leaving patients
treated by the licensee without access to medical information to
which they are entitled pursuant to Section 123110.
123147. (a) Except as provided in subdivision (b), all health
facilities, as defined in Section 1250, and all primary care clinics
that are either licensed under Section 1204 or exempt from licensure
under Section 1206, shall include a patient's principal spoken
language on the patient's health records.
(b) Any long-term health care facility, as defined in Section
1418, that already completes the minimum data set form as specified
in Section 14110.15 of the Welfare and Institutions Code, including
documentation of a patient's principal spoken language, shall be
deemed to be in compliance with subdivision (a).
123148. (a) Notwithstanding any other provision of law, a health
care professional at whose request a test is performed shall provide
or arrange for the provision of the results of a clinical laboratory
test to the patient who is the subject of the test if so requested by
the patient, in oral or written form. The results shall be conveyed
in plain language and in oral or written form, except the results may
be conveyed in electronic form if requested by the patient and if
deemed most appropriate by the health care professional who requested
the test.
(b) (1) Consent of the patient to receive his or her laboratory
results by Internet posting or other electronic means shall be
obtained in a manner consistent with the requirements of Section
56.10 or 56.11 of the Civil Code. In the event that a health care
professional arranges for the provision of test results by Internet
posting or other electronic manner, the results shall be delivered to
a patient in a reasonable time period, but only after the results
have been reviewed by the health care professional. Access to
clinical laboratory test results shall be restricted by the use of a
secure personal identification number when the results are delivered
to a patient by Internet posting or other electronic manner.
(2) Nothing in paragraph (1) shall prohibit direct communication
by Internet posting or the use of other electronic means to convey
clinical laboratory test results by a treating health care
professional who ordered the test for his or her patient or by a
health care professional acting on behalf of, or with the
authorization of, the treating health care professional who ordered
the test.
(c) When a patient requests to receive his or her laboratory test
results by Internet posting, the health care professional shall
advise the patient of any charges that may be assessed directly to
the patient or insurer for the service and that the patient may call
the health care professional for a more detailed explanation of the
laboratory test results when delivered.
(d) The electronic provision of test results under this section
shall be in accordance with any applicable federal law governing
privacy and security of electronic personal health records. However,
any state statute, if enacted, that governs privacy and security of
electronic personal health records, shall apply to test results under
this section and shall prevail over federal law if federal law
permits.
(e) The test results to be reported to the patient pursuant to
this section shall be recorded in the patient's medical record, and
shall be reported to the patient within a reasonable time period
after the test results are received at the offices of the health care
professional who requested the test.
(f) Notwithstanding subdivisions (a) and (b), none of the
following clinical laboratory test results and any other related
results shall be conveyed to a patient by Internet posting or other
electronic 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, including
skin biopsies, Pap smear tests, products of conception, and bone
marrow aspirations for morphological evaluation, if they reveal a
malignancy.
(g) Patient identifiable test results and health information that
have been provided under this section shall not be used for any
commercial purpose without the consent of the patient, obtained in a
manner consistent with the requirements of Section 56.11 of the Civil
Code.
(h) Any third party to whom laboratory test results are disclosed
pursuant to this section shall be deemed a provider of administrative
services, as that term is used in paragraph (3) of subdivision (c)
of Section 56.10 of the Civil Code, and shall be subject to all
limitations and penalties applicable to that section.
(i) A patient may not be required to pay any cost, or be charged
any fee, for electing to receive his or her laboratory results in any
manner other than by Internet posting or other electronic form.
(j) A patient or his or her physician may revoke any consent
provided under this section at any time and without penalty, except
to the extent that action has been taken in reliance on that consent.
123149. (a) Providers of health services, licensed pursuant to
Sections 1205, 1253, 1575, and 1726, that utilize electronic
recordkeeping systems only, shall comply with the additional
requirements of this section. These additional requirements do not
apply to patient records if hard copy versions of the patient records
are retained.
(b) Any use of electronic recordkeeping to store patient records
shall ensure the safety and integrity of those records at least to
the extent of hard copy records. All providers set forth in
subdivision (a) shall ensure the safety and integrity of all
electronic media used to store patient records by employing an
offsite backup storage system, an image mechanism that is able to
copy signature documents, and a mechanism to ensure that once a
record is input, it is unalterable.
(c) Original hard copies of patient records may be destroyed once
the record has been electronically stored.
(d) The printout of the computerized version shall be considered
the original as defined in Section 255 of the Evidence Code for
purposes of providing copies to patients, the Division of Licensing
and Certification, and for introduction into evidence in accordance
with Sections 1550 and 1551 of the Evidence Code, in administrative
or court proceedings.
(e) Access to electronically stored patient records shall be made
available to the Division of Licensing and Certification staff
promptly, upon request.
(f) This section does not exempt licensed clinics, health
facilities, adult day health care centers, and home health agencies
from the requirement of maintaining original copies of patient
records that cannot be electronically stored.
(g) Any health care provider subject to this section, choosing to
utilize an electronic recordkeeping system, shall develop and
implement policies and procedures to include safeguards for
confidentiality and unauthorized access to electronically stored
patient health records, authentication by electronic signature keys,
and systems maintenance.
(h) Nothing contained in this chapter shall affect the existing
regulatory requirements for the access, use, disclosure,
confidentiality, retention of record contents, and maintenance of
health information in patient records by health care providers.
(i) This chapter does not prohibit any provider of health care
services from maintaining or retaining patient records
electronically.
123149.5. (a) It is the intent of the Legislature that all medical
information transmitted during the delivery of health care via
telemedicine, as defined in subdivision (a) of Section 2290.5 of the
Business and Professions Code, become part of the patient's medical
record maintained by the licensed health care provider.
(b) This section shall not be construed to limit or waive any of
the requirements of Chapter 1 (commencing with Section 123100) of
Part 1 of Division 106 of the Health and Safety Code.
