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Indian Health Service The Federal Health Program for American Indians and Alaska Natives


     Indian Health Manual
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Part 2, Chapter 7:  Manual Exhibit 2-7-E

Policy and Procedure for Request for Correction/Amendment of
Protected Health Information


  1. PURPOSE.  To establish the policy and procedures for receiving and processing requests for correction/amendment of protected health information (PHI).

  2. AUTHORITY.

    1. 45 Code of Federal Regulations (CFR) 164.526

    2. 5 United States Code (U.S.C.) §552a(d)

  3. POLICY.  Pursuant to the requirements set forth in the Privacy Act as amended, 5 U.S.C. §552a and the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, 45 CFR Parts 160 and 164, every patient receiving healthcare services at an Indian Health Service (IHS) facility has the right to request corrections or amendments to his or her PHI contained in the IHS Privacy Act System of Records (IHS Medical, Health, and Billing Records System Number 09-17-0001) that was created or received by the IHS.

  4. REQUEST FOR CORRECTION/AMENDMENT OF PHI.  A patient who believes that his or her health information is inaccurate or incomplete may submit a request to the Chief Executive Officer (CEO) or his or her designee for correction/amendment of the record in question.  (For Areas that provide contract health services directly through the Area Office, references to the CEO should be considered references to the Area Director’s designee, as applicable, throughout this Exhibit and the Appendix that follow.)

    1. The patient must complete the form IHS-917, Request for Correction/Amendment of Protected Health Information, found at Appendix 1 to this Exhibit.  Instructions for completing form IHS-917 are found in Appendix 2 to this Exhibit.

    2. The CEO or designee receiving the written request will date the form IHS-917.

    3. The patient must receive a date stamped copy of the completed form IHS-197 as an acknowledgment of the receipt of the request within 10 working days.

    4. If a decision on the request for correction/amendment can be made within 10 working days of the IHS’ receipt of the request, then the IHS will simultaneously notify the patient of the receipt of the patient’s correction/amendment request and of its decision within that 10-day period.

    5. The CEO or designee in consultation with the appropriate staff member will review the request for correction/amendment and will inform the patient in writing within 60 days after receipt of the request, of approval or denial of the request for correction/amendment.  The IHS may extend the time frame one time only for no more than 30 days if it informs the patient in writing prior to the expiration of the initial 60 day time frame of the reasons for the delay and the date by which the IHS will act on the request.  Approvals shall be processed in accordance with the procedures set forth in Section 5 below. Denials shall be processed in accordance with the procedures set forth in Sections 6 and 7 below.

    6. The form IHS-917 will be filed at the site of the contested entry in the medical record and maintained for the life of the medical record.

  5. APPROVAL OF REQUEST FOR CORRECTION/AMENDMENT OF PHI.

    1. Approved Correction.  If the request for correction is approved, the health information will be corrected as follows:

      1. No erasure or other obliteration shall be made.

      2. Incorrect data shall be lined out with a single line.

      3. The date of correction, the signature of the person making the correction, the corrected information, and the reason for the correction shall be added.

      4. The above is also required for preservation of the health record to meet retention guidelines.

    2. Individual Agreement.  Subject to the patient’s prior agreement, IHS shall make reasonable efforts to inform and provide the corrected/amended information within a reasonable time:

      1. to persons/organizations that the IHS knows received the information in the past and who may have relied or may foreseeably rely on such information to the detriment of the patient; and

      2. to those persons/organizations identified by the patient as having received the health information and needing the correction/amendment.

      3. When such information is sent, it should be accompanied by a statement, “This is a correction/amendment to the information that was previously sent on ___________ date.”

    3. Documentation.  Disclosure of the corrected/amended health information will be documented on the form IHS-505, “Disclosure Accounting Record or the Resource and Patient Management System (RPMS) Release of Information (ROI) software application.”

    4. Notification.  The patient will be notified in writing that the request for correction/amendment of the health information has been approved.

  6. DENIAL OF CORRECTION/AMENDMENT OF PHI.

    If the request for correction/amendment is denied, in whole or in part, the CEO or designee will document the denial on the form IHS-917 and a copy of the form will be sent to the patient within the time period set forth in Section 4E above.  The original form will be filed in the patient’s medical record.  The IHS will only deny a request for correction/amendment for the following reasons:

    1. The health information is not part of the patient’s designated record set.

    2. The IHS did not create the record.

      [However, this fact shall not form the basis of a denial if the patient provides a reasonable basis to believe that the originator of the PHI is no longer available to make the correction/amendment itself (for example, if the PHI received from a physician who is no longer in practice)].

    3. The record is not available to the patient for inspection under applicable Federal law.

    4. The record is accurate and complete.

      When the patient is notified of the denial of his or her request, he or she also will be notified of applicable appeal rights, as described below.

  7. APPEAL RIGHTS.

    1. For Patients Who Are Not U.S. Citizens or are Aliens Admitted for Permanent Residence.  If the patient is not a U.S. citizen or an alien admitted for permanent residence and the request for correction/amendment is denied, he or she may submit to the CEO or designee a written statement disagreeing with the denial and the basis of such disagreement within 30 days of the denial.  The law does not allow any further appeal.

      1. The IHS has the right to prepare a written rebuttal to any statement of disagreement and provide a copy of any rebuttal statement to the patient.  Any written rebuttal prepared by the IHS is not subject to correction or amendment.

      2. If the patient has submitted a statement of disagreement, the IHS must include such statement or an accurate summary thereof with any subsequent disclosure of the health information to which the disagreement relates.

      3. If the patient has not submitted a written statement of disagreement, the IHS must include the patient's request for correction/amendment and its denial, or any accurate summary of such information, with any subsequent disclosure of the health information only if the patient has requested such action.

    2. For Patients Who Are U.S. Citizens or are Aliens Admitted for Permanent Residence.  If the patient is a U.S. citizen or an alien admitted for permanent residence, he or she may appeal the denial to amend the requested information to the Area Director within 30 days of the denial.

      1. The Area Director must act on the appeal within 30 working days of the patient's appeal, unless the Area Director extends the period for up to an additional 30 working days for good cause.  The Area Director will inform the patient in writing of any extension of the appeal period and the reason(s) for the delay.

      2. When an appeal is denied, the Area Director will inform the patient in writing of the reasons for the denial, and advise the patient of his or her rights to submit a written statement of disagreement and to seek judicial review of the denial.

      3. If the patient elects not to appeal, he or she may submit a statement of disagreement.

      4. If the patient submits a written statement of disagreement, such statement, along with a statement of the IHS Area Director’s reasons for denying the appeal (if an appeal was filed) will be provided to previous recipients of the disputed record where an accounting of the previous disclosure was made.

  8. PERMANENT RECORD.  Any written statement or statement of disagreement by the patient, any response by IHS, and any other document pertaining to the appeal will become part of the patient’s permanent medical record.

  9. COMPLAINTS.  If the patient has a complaint about the IHS policies and procedures regarding health information, he or she may file such a complaint with the CEO or his or her designee or with the Secretary, HHS Washington, D.C. 20201.

    (Insert Service Unit address, CEO's name, Title and Telephone #)

  10. FORMS. The form IHS-917 is available at:

(For Public and Federal access) http://www.forms.gov/ or http://www.ihs.gov/CIO/puf/

(For IHS staff only) http://intranet.hhs.gov/forms


Manual Exhibit 2-7-E
Appendix 1 and 2

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For a copy of this Appendix:

Adobe Acorbat PDF Document


Manual Exhibit 2-7-E
Appendix 3

Model Letter of Acknowledgement of Receipt of Request for Correction/Amendment
Service Unit Letterhead and Address

Date:

Jane Doe
1234 Main Street
Main, AZ 12341

Dear Ms Doe,

This is to acknowledge receipt of your request for correction/amendment of your health information.

  1. ______Your request is being reviewed and a decision will be made and sent to you within 60 days from the date of this letter.

  2. ______We are currently unable to make a decision on your request for correction/amendment of your health information within 60 days for the following reason(s):  [INSERT REASON(S) therefore, we are extending this period up to an additional 30 days.

  3. ______The record requested is maintained by another government agency; therefore, your request has been forwarded to the agency responsible for your request.  Please contact the agency at the address below for all future inquiries regarding this request:

(Insert name and address of the agency)

Thank you.

Signature of Chief Executive Officer or his or her designee


Manual Exhibit 2-7-E
Appendix 4

Model Letter Approving Request for Correction/Amendment
Service Unit Letterhead and Address

Date:

Jane Doe
1234 Main Street
Main, AZ 12341

Dear Ms Doe,

After reviewing your letter requesting correction/amendment of your health information, I am pleased to inform you that your requested correction/amendment has been approved.  Your record now reflects the correction/amendment requested.

Thank you for allowing us to continue to serve you.

Signature of Chief Executive Officer or his or her designee


Manual Exhibit 2-7-E
Appendix 5

Model Letter Denying Request for Correction/Amendment
Service Unit Letterhead and Address

Date:

Jane Doe
1234 Main Street
Main, AZ 12341

Dear Ms. Doe,

After reviewing your request for the correction/amendment of your health information, I regret to inform you that your request is denied for the reason(s) specified below:

  1. ______Your information is not part of the designated record set.

  2. ______The Indian Health Service (IHS) did not create the record.

  3. ______Your record is not available for inspection under applicable Federal law.

  4. ______Your record is accurate and complete.

Since your request is denied, you may do the following:

  1. If you are a United States citizen or alien lawfully admitted for permanent resident, you may submit to the Area Director a written statement disagreeing with the denial and the reason of such disagreement within 30 days of the denial.  The IHS has the right to prepare a written rebuttal to any statement of disagreement.  You will be provided a copy of any rebuttal statement.

  2. If you do not submit a statement of disagreement, you may request in writing that the IHS provide this request for correction/amendment (or summary) and the denial with any future disclosures.

  3. If you are not a U.S. citizen or alien lawfully admitted to permanent residence, you may do the following:

    1. Submit to the Service Unit Chief Executive Officer (CEO) a one page written statement disagreeing with the denial and the basis of such disagreement;

    2. If you do not submit a statement of disagreement, you may request that IHS provide this request for correction or amendment (or summary) and the denial with any future disclosures;

    3. IHS has the right to prepare a written rebuttal to any statement of disagreement.  You will be provided a copy of any rebuttal statement.  Any written rebuttal prepared by IHS is not subject to correction or amendment.

If the IHS did not create the information and the originator (healthcare provider/facility) is no longer available to act on your correction/amendment and is the basis for this denial, you may submit to the CEO in writing evidence of the originator's unavailability and request a supplemental review of IHS decision.

If you are a United States citizen or alien lawfully admitted for permanent residence, you may also appeal the denial to amend the requested information to the Area Director at the following address:

(Insert address of Area Director)

In the event your appeal is ultimately denied, or if you elect not to appeal, you may submit a statement of disagreement as described above.  If you appeal and your appeal is denied, you may also seek judicial review of the denial.

If you have complaints about the IHS' policies and procedures regarding health information, you may file such complaint with the CEO or designee or with the Secretary, HHS, Washington, D.C., 20201.

(Insert address of Service Unit)

Thank you.

Signature of CEO or his or her designee


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