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PCP refuses to release client's labs despite signed consent/release

Hello!

Rn/BSN, CDE (cert diabetes educator) here. We offer a diabetes self management education program (for FREE) in our community. Part of our program requires us to have a signed release in order to request labs from our class participants' providers. We send this request immediately after the class completion and again at 6 months to allow another A1c to be run after changes suggested in class have been implemented. This helps to encourage and empower the person with diabetes who made these changes, or, if the A1c shows no change, a little motivational interviewing by phone can guide them to something else to try that they feel empowere and motivated to do.

I have one doctor who refuses to send the labs. Letters (with the signed release enclosed) twice, phone calls, etc, with no success to acquiring the results.

How would you work around this? I do not want to call the client/participant to put them in the middle of this. Is there a clause or section/paragraph/line of the HIPAA law that addresses this? After a few hours of searching, I ask those who probably know.

Joan

I would tell the client the truth. Let them take it up with the Doctor. Many times they can get results where you can't.

Has the Doctor told you why he won't release the results?

The client isn't requesting the results, our diabetes self management education program is.

Also, the doc has not shared his rationale for not sharing.

Frustrating, because we offer this service for FREE in the community, and people benefit from DSME (on average, DSME lowers A1c comparable to introducing one oral med). I guess he must be intimidated that his client could be empowered to care for his own diabetes without additional meds if taking DSME seriously and making changes. We send our participants right back to their own doctor. We are not stealing them, but educating them so their PCP actually looks BETTER in the numbers, and, if paid for performance (BP, A1c, lipids, cholesterol to target), they will make more money.

Just cannot get my head around this one.

llg, PhD, RN

Specializes in Nursing Professional Development.

I think it is a mistake to make assumptions about why the physician doesn't send the lab. There may be other reasons that haven't occurred to you. It may be a problem with his office staff & he may think that labs are being sent. He may be sending the labs to the patient and counting on the patient to share them with you. There could be lots of reasons.

Since you are trying to promote the patient's "self-management," I don't see anything wrong with asking the patient to take responsibility for their own labs. They can send you copies of the results they receive from the doctor. (I've certainly carried my own X-rays and lab reports to consultants before.) But if you have some objection to that, then talk with the doctor. Schedule a meeting (or appointment - and be prepared to pay for his time) and discuss the situation with him. Find out what the real reasons are. Don't be assuming things that you have no evidence of.

As the old saying goes ..."When we a-s-s-u-m-e things, we make an a** of u and me."

I have access to all my lab work online through the lab I use. Perhaps that would be worth looking into?

Send the request with consent to the lab.

Seriously doubt the physician is intimidated or doesn't want the patient educated. Probably too busy to exhale.

I have to get it from the provider.

klone, MSN, RN

Specializes in Women's Health/OB Leadership.

I have to get it from the provider.

Why?

I agree with llg both with not inferring the reason why the physician isn't sending it, and that you should ask the patient to get the labs and bring them to class.

Is the clinic large, small? Do they have a separate medical records department? If so, I would go directly through medical records or the unit secretary, rather than with the physician directly.

Jules A, MSN

Specializes in Family Nurse Practitioner.

I have to get it from the provider.

Really? My secretary gets labs from the lab where it was drawn all the time without even sending consent. Do you have a physician or NP you are affiliated with? I wonder if they might get a more robust response to this request.

I have to get it from the provider.

When we have Dr that do not send things we call the patient and ask that they contact the Dr. It works well with DME I can't see why labs would be different. We only do that after the Dr's office does not respond to requests. We always try direct contact first.

OyWithThePoodles, RN

Specializes in Med-surg, school nursing..

It may be that I am just not reading the question correctly, but does the patient sign this request form that you send to the doctor?

If not, I feel the doctor is very much in the right by not releasing the information. They have to have the patients permission to release records even if it is to another doctors office. So you being a community group, they may just be trying to protect themselves if the patient has not signed anything giving them permission to release the records.

klone, MSN, RN

Specializes in Women's Health/OB Leadership.

They have to have the patients permission to release records even if it is to another doctors office.

Actually, that's not true.

BostonFNP, APRN

Specializes in Adult Internal Medicine.

Are you looking for the PCP to send results? Or are you requesting the PCP to order the labs for you?

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC.

Why?

I agree with llg both with not inferring the reason why the physician isn't sending it, and that you should ask the patient to get the labs and bring them to class.

Is the clinic large, small? Do they have a separate medical records department? If so, I would go directly through medical records or the unit secretary, rather than with the physician directly.

I've never questioned this practice, but many MD offices will only release their own results to a third party. For instance, if a patient had an EKG in the provider's office in 2017 and a previous EKG in 2015 in another provider's office (a copy of which is in the 2nd provider's office), the provider usually is only willing to send the 2017 EKG on a medical records request.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, Elder Care, L&D.

I don't understand - My insurance has electronic medical records and I download my labs and take them to any Dr's that request them. Of Course I have Kaiser and all my doctors are with Kaiser so it makes things simple stupid. But even when I was with another insurance co if a provider needed a copy of a test result - I would just call my doctor and arrange to pick it up then bring it with me on my next appointment.

My Kaiser Dr is great though. If I want a specific lab done out of my own curiosity - like inflammatory markers, or cortisol levels I just send her an e-mail she orders the test and I go by the lab at my convenience.

Hppy

brillohead, ADN, RN

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

Another vote for requesting results directly from the lab.

You have a signed consent form -- just get the lab results from the lab itself, no doctor in the middle.

kkbb, BSN, RN

Specializes in Oncology.

I guess he must be intimidated that his client could be empowered to care for his own diabetes without additional meds if taking DSME seriously and making changes.

Based on my own working experience as a MA and office manager for a PCP I am going to guess that this provider is not intimidated. More than likely, s/he has no idea that you requested lab results. If you sent a letter letting them know that you are working with the patient they most likely just read it and moved on with their day. It is someone else in the practice that forwards medical records to where they need to go.

You have three options at this point: do nothing and keep waiting (not the best choice), let the patient know that you are still waiting for the requested lab results, or call the office and ask to speak to whomever is responsible for medical record requests. I would personally just call the office and go from there.

I would just call. There seems to be a lot of assumptions being made... One, that the pcp has ordered the test. Two, that the pcp is aware of the results requested. Three, that the pcp has a signed consent for the release of information. It's a simple request, but a lot can go awry. Just call.

LessValuableNinja

Specializes in Cardiac (adult), CC, Peds, MH/Substance.

This entire thread hurts my brain.

I do not have enough fingers to count the assumptions being made in a way that is not productive.

I feel like more effort is going into discussing it with randoms on the internet than discussing it with the patient or provider's office.

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