This last category includes records that are used to make decisions about any individuals, whether or not the records have been used to make a decision about the particular individual requesting access. Other records that are used, in whole or in part, by or for the covered entity to make decisions about individuals.Enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan or.Medical records and billing records about individuals maintained by or for a covered health care provider.
Individuals have a right to access PHI in a "designated record set." A "designated record set" is defined at 45 CFR 164.501 as a group of records maintained by or for a covered entity that comprises the: Information Included in the Right of Access: The "Designated Record Set" Individuals have a right to access this PHI for as long as the information is maintained by a covered entity, or by a business associate on behalf of a covered entity, regardless of the date the information was created whether the information is maintained in paper or electronic systems onsite, remotely, or is archived or where the PHI originated (e.g., whether the covered entity, another provider, the patient, etc.). This includes the right to inspect or obtain a copy, or both, of the PHI, as well as to direct the covered entity to transmit a copy to a designated person or entity of the individual's choice. The Privacy Rule generally requires HIPAA covered entities (health plans and most health care providers) to provide individuals, upon request, with access to the protected health information (PHI) about them in one or more "designated record sets" maintained by or for the covered entity.
With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans. The regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which protect the privacy and security of individuals' identifiable health information and establish an array of individual rights with respect to health information, have always recognized the importance of providing individuals with the ability to access and obtain a copy of their health information. Putting individuals "in the driver's seat" with respect to their health also is a key component of health reform and the movement to a more patient-centered health care system. With the increasing use of and continued advances in health information technology, individuals have ever expanding and innovative opportunities to access their health information electronically, more quickly and easily, in real time and on demand. For example, individuals with access to their health information are better able to monitor chronic conditions, adhere to treatment plans, find and fix errors in their health records, track progress in wellness or disease management programs, and directly contribute their information to research. Providing individuals with easy access to their health information empowers them to be more in control of decisions regarding their health and well-being. New Clarification – $6.50 Flat Rate Option is Not a Cap on Fees for Copies of PHI Introduction Any provision within this guidance that has been vacated by the Ciox Health decision is rescinded. More information about the order is available at. January 23, 2020), which may be found at. This guidance remains in effect only to the extent that it is consistent with the court's order in Ciox Health, LLC v.
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