I want to point out that getting one's Medical records is not free.  You must pay for copying costs and the reality is that unless you are very specific in the same way one should be when filing a Freedom of Information Act, expect data to be missing or data to be duplicate or well horrifying.

When one requests all medical records you need the dates, the times, the Doctor(s) names to get the entire records. To get Nursing notes another request and any mental health data another and then it can be redacted or missing information for whatever obscure reason.

And like reading Police reports expect there to be bias, misinformation, misdiagnosis and well a lot of what appears to be cut and paste.

So you have questions and concerns about how that affects your treatment so you want to add an addendum, a note to your file that will allow any future or current provider to see your concerns and in turn respond to them. Well that may or may not happen. As Doctors and Hospitals have the right to refuse the addendum for no reason what.so.ever. 

In other words - you are fucked.   If you want to protect yourself in all reality, take someone with you as a witness.  Or ask to record the encounter and then verify the recording data to the notes. If they refuse ask why? If they are simply doing their job and you need this to ensure you are following any instructions or guidelines there should be no problem.   I find it interesting to say that few approve so you can again, both you and the Doctors sign a waiver that you consent to care with conditions to read any and all records and in turn the Doctor agrees to allow the Patient to addendum any and all notes or records in your file.  They usually oblige on that as they truly think you are nuts.. and that too goes into the records as well.  I say to Doctors this is a way better way to ensure no possibility of medical malpractice do you not agree?  They do and they are not happy but as in life let's film it all and that way everyone is aware of it, acknowledge it and we can make decisions based on it. Right NSA?

New Guidelines Nudge Doctors to Give Patients Access to Medical Records

By ROBERT PEAR
THE NEW YORK TIMES
JAN. 16, 2016



WASHINGTON — The Obama administration is tearing down barriers that make it difficult for patients to get access to their own medical records, telling doctors and hospitals that in most cases they must provide copies of these records within 30 days of receiving a request.

In theory, patients have long had a right to obtain copies of their records, but federal officials say they receive large numbers of complaints from consumers frustrated in trying to exercise that right.

In new guidelines, issued this month, the administration says doctors and hospitals cannot require patients to state a reason for requesting their records, and cannot deny access out of a general concern that patients might be upset by the information.

“Based on recent studies and our own enforcement experience, far too often individuals face obstacles to accessing their health information,” said Jocelyn Samuels, the director of the Office for Civil Rights at the Department of Health and Human Services, which enforces federal health privacy standards. “This must change.”

When patients can see their medical records, the administration said, it is easier for them to participate in their health care. They can, for example, review what they were told by their doctors and, perhaps, consider other options for care.

Christopher S. Moore of Alpharetta, Ga., said he had great difficulty obtaining hospital records for his 4-year-old son, Oliver, who has a rare genetic disorder and has seen at least eight medical specialists in Atlanta, Cincinnati and Boston.

“The hospital in Atlanta was very slow to respond,” Mr. Moore said. “We had to escalate our request to the hospital leadership to get the records.”

Mr. Moore said insurers had spent $800,000 on care for his son, generating several thousand pages of medical records.

“Some doctors seem to believe that medical records are intended only for doctor-to-doctor communication, and that patients would not understand those records,” Mr. Moore said. “We want the records so we have control over them — so we can provide them to any doctor who sees our son.”

Under the new guidelines, a health care provider cannot require patients to pick up their records in person if they ask that the records be sent by mail or email. A health care provider cannot deny a request for access to health information because a patient has failed to pay medical bills. A doctor or a hospital may charge a fee to cover the cost of copying, but cannot charge for the cost of searching for data and retrieving it.

Dr. Francis S. Collins, the director of the National Institutes of Health, said consumers needed access to their records so they could “take more control over decisions regarding their health,” follow treatment plans and correct errors in the files.

In addition, Dr. Collins said, some people want access to their records so they can contribute information to biomedical research projects like President Obama’s “precision medicine” initiative.

Researchers working on the project will collect data on the health, genetic characteristics and lifestyle habits of a million or more volunteers.

The same rules that protect the privacy of medical records also give patients a right to see a broad array of health information about themselves. The rules were issued under the Health Insurance Portability and Accountability Act of 1996.

Doctors and hospitals are supposed to provide consumers with access to personal health information within 30 days and, in some cases, can extend the deadline by 30 days. But, the administration said, most requests should be fulfilled in fewer than 30 days.

Melinda R. Hatton, a senior vice president of the American Hospital Association, said the guidelines were “a helpful reminder.” Hospitals, she said, “strongly support patients’ access to their medical records,” and many have web portals that let patients view information about their care.

But Deven McGraw, a deputy director of the Office for Civil Rights, said complaints about access to medical records were one of the top five issues investigated by her agency.

Megan O’Boyle of Arlington, Va., whose 15-year-old daughter has intellectual disabilities, autism and epilepsy, said, “It burns me up that I had to jump through hoops to get her records.”

She said she wanted copies so new doctors could see the history of her daughter’s illness and would not have to repeat medical tests and imaging procedures.

“It’s empowering when you get all this information,” Ms. O’Boyle said. “You can be a much better advocate for the patient. More information is better. It means better services for my daughter.”

For patients with chronic illnesses, the fees charged by doctors and hospitals for providing medical records can add up. “Why should I have to pay 25 cents to 50 cents a page for what really belongs to me in the first place?” Ms. O’Boyle asked.

Joy L. Pritts, a former privacy officer at the Department of Health and Human Services, said that “many health care providers still don’t understand that patients have a right to get their medical records,” and she suggested a possible reason.

“It may be contrary to the financial interests of health care providers to give patients broad access to their medical records,” Ms. Pritts said. “Once patients have that information, they can share it with competing health care providers.”

Under the rules, doctors and hospitals do not have to disclose psychotherapy notes that are kept separate from the rest of a patient’s medical record.

Health care providers may also deny requests if the disclosure of personal health information is “reasonably likely to endanger the life or physical safety” of a patient or another person. Thus, certain information might be denied to a suicidal patient.

But, the administration said, this exception is to be narrowly construed.