Medical Record Request Rules for New Hampshire

Introduction

New Hampshire residents seeking access to their health information must navigate a specific set of state regulations that govern how providers handle these requests. The medical record request rules for New Hampshire combine federal HIPAA requirements with state-specific statutes, creating a framework that differs from neighboring states in several meaningful ways. RSA 151:21, the primary state law governing patient access to health records, establishes timelines, fee structures, and procedural requirements that healthcare providers must follow. Understanding these rules matters for patients coordinating care between multiple providers, individuals reviewing records for accuracy, attorneys handling personal injury or malpractice cases, and family members managing healthcare decisions for incapacitated relatives. New Hampshire's approach reflects a balance between patient access rights and practical considerations for healthcare facilities of varying sizes. The state's relatively straightforward fee schedule and defined response windows provide predictable expectations for both requesters and providers, though certain exceptions and edge cases can complicate what initially appears to be a simple process.

TL;DR

New Hampshire law requires healthcare providers to respond to medical record requests within 30 days. Patients may be charged up to $15 for the first 10 pages and $0.25 per page thereafter, with a $15 maximum search and retrieval fee. Requests must be in writing and include proper identification. Mental health records, substance abuse treatment documentation, and records of minors carry additional restrictions. Providers can deliver records in paper or electronic format based on patient preference when technically feasible.

Who Can Request Medical Records in New Hampshire

New Hampshire law grants several categories of individuals the right to request medical records. The patient themselves holds the primary right of access to their own health information. For deceased patients, the executor or administrator of the estate assumes this right, along with next of kin in certain circumstances.

Parents or legal guardians may request records for minor children under 18, though New Hampshire recognizes exceptions for sensitive services where minors have independent consent rights. These include reproductive health services, mental health treatment, and substance abuse counseling. Healthcare providers must evaluate each request involving minors against these carve-outs.

Legal representatives, including attorneys with proper authorization, may request records on behalf of clients. This requires a valid authorization form signed by the patient or their legal decision-maker. Healthcare facilities routinely receive requests from insurance companies, workers' compensation carriers, and other third parties, all of which require documented patient consent.

How to Submit a Medical Record Request in New Hampshire

Written requests remain the standard in New Hampshire. Most healthcare facilities accept requests via mail, fax, or in-person delivery. Some larger health systems now offer electronic submission through patient portals, though this varies by provider.

A complete request should include the patient's full legal name, date of birth, address, and contact information. Specify the date range of records needed and identify whether you want complete records or specific categories such as lab results, imaging reports, or clinical notes. Include a signed authorization form if the request comes from someone other than the patient.

Facilities may require proof of identity before releasing records. Acceptable identification typically includes a government-issued photo ID or, for mail requests, a notarized signature. Requests lacking required elements may be returned, restarting the timeline once corrected documentation arrives.

Response Timeframes

New Hampshire mandates that healthcare providers respond to medical record requests within 30 days of receipt. This timeline applies to most standard requests from patients or their authorized representatives.

Providers may extend this period by an additional 30 days if they notify the requester in writing, explaining the reason for the delay and providing an expected completion date. Valid reasons for extension include requests involving voluminous records, records stored at off-site facilities, or situations requiring legal review before release.

Emergency requests, particularly those needed for ongoing patient care, typically receive expedited handling, though no specific statutory timeline exists for urgent situations. Practically speaking, most providers prioritize care-related requests and can often fulfill them within days rather than weeks.

Fees & Costs

New Hampshire sets specific limits on what providers may charge for medical records. The fee structure under RSA 151:21 permits up to $15 for the first 10 pages and $0.25 for each additional page. Providers may also charge a search and retrieval fee capped at $15.

Electronic copies requested and delivered electronically may be subject to lower fees under HIPAA's reasonable cost-based standard, which some providers interpret as superseding state maximums for digital delivery. Actual postage costs may be added for mailed records.

Providers cannot deny access to records based on outstanding medical bills, though they may charge the statutory fees for the records themselves. Some facilities waive fees for records sent directly to other healthcare providers for continuity of care purposes, though this practice varies and is not legally required.

Delivery Formats

Patients in New Hampshire may request records in paper or electronic format. Under HIPAA's access provisions, providers must accommodate electronic delivery requests when the records exist electronically and the requested format is readily producible.

Common electronic formats include PDF files delivered via secure email, CD-ROM, or USB drive. Patient portal access represents another delivery method, allowing patients to view and download records directly. Not all providers maintain comprehensive portal systems, particularly smaller practices or specialty facilities.

Paper copies remain available for those who prefer physical documents or lack reliable electronic access. Providers may charge actual shipping costs for paper records, including certified mail fees if requested by the patient.

State-Specific Exceptions or Gotchas

New Hampshire maintains several notable exceptions to standard access rules. Mental health records receive additional protections under RSA 330-A, allowing providers to withhold information if disclosure would be detrimental to the patient's mental health. This determination requires clinical judgment and documentation.

Substance abuse treatment records fall under federal 42 CFR Part 2 regulations, which impose stricter consent requirements than standard HIPAA rules. These records cannot be released without specific authorization that meets Part 2 standards, even to other healthcare providers.

Psychotherapy notes, defined as a provider's personal notes kept separate from the medical record, are explicitly excluded from patient access rights under both federal and state law. Providers are not required to release these notes regardless of who requests them.

Hospital incident reports, peer review documents, and quality assurance materials are generally protected from disclosure under RSA 151:13-a, which shields these documents to encourage candid internal review processes.

Common Problems Patients Encounter

Incomplete requests represent the most frequent obstacle to timely record retrieval. Missing signatures, unclear date ranges, or insufficient identification documentation can delay processing by weeks while facilities request clarification.

Facilities that have closed or merged present particular challenges. Records from defunct practices may transfer to successor organizations, state archives, or designated custodians. Tracking down these records requires research into the facility's closure circumstances, which the New Hampshire Board of Medicine may assist with for physician practices.

Third-party release of information companies handle requests for many healthcare systems. These vendors sometimes introduce additional delays or fees beyond what the original provider would charge. Patients experiencing difficulties with these companies may benefit from contacting the healthcare facility's patient relations department directly.

Records from out-of-state providers who treated New Hampshire residents follow the originating state's rules, not New Hampshire's. This creates complexity for patients assembling comprehensive records from multiple sources.

Disputes over fee calculations occasionally arise, particularly when facilities apply charges inconsistently or exceed statutory limits. Patients may file complaints with the New Hampshire Attorney General's Consumer Protection Bureau for fee-related concerns.

Conclusion

Medical record access in New Hampshire operates under a framework that provides reasonable timelines and capped fees while maintaining necessary protections for sensitive information categories. The 30-day response requirement and structured fee schedule offer predictability for most routine requests. Patients should submit complete, properly documented requests to avoid processing delays and maintain records of all communications with healthcare facilities. For complex situations involving mental health records, substance abuse treatment documentation, or records from closed facilities, additional research or professional assistance may prove necessary. Understanding the specific rules governing medical record requests in New Hampshire helps patients exercise their access rights effectively while setting appropriate expectations for the process.

Frequently Asked Questions

Can a healthcare provider refuse to release my medical records in New Hampshire? Providers may refuse release only in limited circumstances, such as mental health records where disclosure could harm the patient, or when requests lack proper authorization. They cannot withhold records due to unpaid medical bills.

How long must New Hampshire healthcare providers retain medical records? New Hampshire requires retention of adult patient records for at least seven years from the last treatment date. Records for minors must be kept until the patient reaches age 18 plus seven years.

What if a provider charges more than the allowed fees? Patients may file complaints with the New Hampshire Attorney General's Consumer Protection Bureau. Documenting the excessive charges and any communication with the provider strengthens such complaints.

Can I request records for a deceased family member? Executors, administrators of estates, and in some cases next of kin may request records. Documentation of legal authority, such as letters testamentary, is typically required.

Are electronic health record portal downloads subject to fees? Portal access provided as part of standard patient services typically carries no additional charge. Requests for records beyond what the portal offers may incur standard copying fees.

Sources

• New Hampshire RSA 151:21 - Patient Access to Medical Records

• New Hampshire RSA 330-A - Mental Health Practice Act

• 45 CFR Part 164 - HIPAA Privacy Rule

• 42 CFR Part 2 - Confidentiality of Substance Use Disorder Patient Records

• New Hampshire Board of Medicine - Record Retention Guidelines