Medical Record Request Rules for North Dakota
Introduction
Requesting medical records in North Dakota involves specific statutory requirements that differ from neighboring states and federal baseline rules. The state follows a framework established under North Dakota Century Code Chapter 23-12, which governs health care records alongside HIPAA's federal minimums. Understanding these medical record request rules for North Dakota matters because providers have discretion in several areas where federal law sets only floors, not ceilings.
North Dakota grants patients broad access rights while permitting healthcare facilities to establish reasonable procedures for processing requests. The state lacks a comprehensive patient bill of rights statute, meaning individual facility policies carry significant weight in day-to-day request handling. This creates variability across providers, from critical access hospitals in rural counties to large health systems in Fargo and Bismarck.
The practical implications affect everyone from patients managing chronic conditions across multiple providers to attorneys handling personal injury litigation. Knowing the specific timelines, fee caps, and delivery requirements under North Dakota law prevents unnecessary delays and disputes. The following sections break down each component of the request process with attention to state-specific details that practitioners and patients need.
TL;DR
North Dakota requires providers to respond to medical record requests within a reasonable time, generally interpreted as 30 days consistent with HIPAA. Fees cannot exceed $20 for the first 25 pages plus $0.50 per page thereafter, with a $50 maximum search fee. Patients, authorized representatives, and certain third parties may request records. Electronic delivery must be offered if records are maintained electronically. Mental health and substance abuse records carry additional authorization requirements under state and federal law.
Who Can Request Medical Records in North Dakota
North Dakota law permits several categories of individuals to access medical records. The patient holds primary access rights, with no minimum age specified for accessing one's own records, though minors' access may be limited by parental consent requirements for treatment.
Parents and legal guardians may request records for minor children under age 18. This right transfers to the minor upon reaching majority or upon emancipation. For deceased patients, the personal representative of the estate gains access rights, typically requiring letters testamentary or administration as proof of authority.
Authorized representatives holding valid HIPAA-compliant authorizations may request records on a patient's behalf. North Dakota accepts the standard HIPAA authorization form, though providers may use their own forms provided they contain all required elements. Healthcare powers of attorney grant access during incapacity, while general powers of attorney require specific language regarding medical information access.
How to Submit a Medical Record Request in North Dakota
Requests should be submitted in writing to the healthcare provider's medical records or health information management department. While verbal requests are technically permissible under HIPAA, most North Dakota facilities require written requests for documentation purposes and will provide their own request forms.
A valid request must include the patient's full legal name, date of birth, and date range of records sought. Specific record types should be identified when possible: office notes, laboratory results, imaging reports, or complete records. The request must specify the delivery method and destination.
For third-party requests, a signed authorization must accompany the request. The authorization requires the patient's signature, date, expiration date or event, description of information to be disclosed, and identification of the recipient. Authorizations lacking any required element are invalid, and providers must reject them.
Requests may be submitted by mail, fax, secure electronic portal, or in person. Many North Dakota health systems now accept requests through patient portal messaging, though complex requests may still require formal written submission.
Response Timeframes
North Dakota does not specify a statutory response timeline independent of HIPAA, meaning the federal 30-day standard applies. Providers must act on requests within 30 days of receipt, with a single 30-day extension permitted if the provider notifies the patient in writing of the delay and its reason.
Extensions are appropriate when records are stored offsite, when the request involves unusually large volumes, or when the provider must consult with another entity regarding disclosure. The extension notice must include the expected completion date.
For requests involving records held by multiple entities within a health system, each entity's 30-day clock starts independently upon receiving the request. Patients seeking records from integrated delivery networks should submit requests to each facility separately to avoid delays.
Urgent requests, such as those needed for imminent medical appointments or legal deadlines, may be expedited at provider discretion. North Dakota law does not mandate expedited processing, but many facilities accommodate reasonable urgency requests.
Fees & Costs
North Dakota Century Code Section 23-12-14 establishes maximum fees for medical record copies. Providers may charge up to $20 for the first 25 pages and $0.50 for each additional page. A search fee not exceeding $50 may be added for requests requiring extensive retrieval efforts.
These caps apply to paper copies. Electronic copies delivered via email, portal, or electronic media may be subject to different fee structures, though HIPAA requires that electronic copy fees be limited to labor costs for copying. Many North Dakota providers charge $6.50 for electronic copies, reflecting the HIPAA cost-based approach.
Patients requesting records for continuing care purposes, where records transfer directly to another treating provider, often receive copies at reduced or no cost. This practice varies by facility policy rather than statutory mandate.
Fees must be disclosed to the patient before processing. Providers may require prepayment before releasing records, though this must be communicated clearly. Inability to pay does not eliminate access rights, but providers may delay release until payment arrangements are made.
Delivery Formats
North Dakota providers maintaining electronic health records must offer electronic delivery when patients request it. Acceptable electronic formats include PDF documents delivered via secure email, download through patient portals, or transfer on encrypted USB drives.
Paper copies remain available for patients who prefer physical documents or lack electronic access. Certified copies, sometimes required for legal proceedings, carry additional notarization fees beyond standard copy charges.
Direct transmission to third parties, including other healthcare providers, attorneys, or insurance companies, follows the same format options. The patient's authorization should specify the preferred delivery method. Providers must accommodate reasonable format requests but are not required to create records in formats they do not maintain.
Fax transmission remains common in North Dakota, particularly for rural providers and time-sensitive requests. Providers may charge per-page fees for faxed records consistent with the statutory maximums.
State-Specific Exceptions or Gotchas
Mental health records in North Dakota carry additional protections under Chapter 25-03.1, requiring specific authorization language for release. A general medical records authorization does not automatically cover mental health treatment notes. Psychotherapy notes, defined as a therapist's personal session notes kept separate from the medical record, require separate authorization even within mental health contexts.
Substance abuse treatment records maintained by federally assisted programs fall under 42 CFR Part 2, which imposes stricter requirements than standard HIPAA rules. These records require specific Part 2-compliant authorization language and cannot be redisclosed without additional patient consent.
Minors' records present complexity when the minor consented to treatment independently, as permitted for certain services under North Dakota law. In such cases, the minor controls access to those specific records, and parental requests may be denied.
North Dakota lacks a specific statute addressing patient access to billing records, meaning standard HIPAA access rules apply. Itemized billing statements are generally available upon request through the facility's business office rather than medical records department.
Common Problems Patients Encounter
Requests frequently stall when authorization forms contain deficiencies. Missing expiration dates, unsigned forms, or vague descriptions of requested information cause rejections that restart the timeline. Using provider-specific forms rather than generic authorizations reduces rejection rates.
Multi-provider requests create confusion when patients assume a single request covers all facilities within a health system. Each separately licensed facility maintains its own records and requires individual requests. A request to a hospital does not automatically include affiliated clinics or physician practices.
Fee disputes arise when patients receive bills exceeding statutory caps. Some providers mistakenly apply per-page charges from the first page rather than the discounted first-25-page rate. Patients should reference N.D.C.C. 23-12-14 when challenging excessive charges.
Delays beyond 30 days without proper extension notices violate HIPAA. Patients may file complaints with the North Dakota Department of Health or the federal Office for Civil Rights when providers fail to meet response deadlines.
Conclusion
Medical record request rules for North Dakota combine HIPAA's federal framework with state-specific fee caps and procedural requirements. The $20 base fee, $0.50 per-page rate, and $50 search fee maximum provide cost predictability that some states lack. Response timelines follow the federal 30-day standard, with proper extension procedures required for delays.
Successful requests depend on complete authorizations, clear identification of desired records, and submission to the correct facility within multi-provider systems. Mental health and substance abuse records require heightened attention to authorization specifics. Patients encountering non-compliance have recourse through state and federal complaint mechanisms.
The variability in facility-level policies across North Dakota makes direct communication with provider health information departments valuable for complex requests. Understanding both the statutory framework and practical implementation helps ensure timely access to medical records.
Frequently Asked Questions
How long does a provider have to respond to a medical record request in North Dakota? Providers must respond within 30 days of receiving the request, with one permitted 30-day extension if written notice explains the delay.
What is the maximum fee for medical records in North Dakota? The statutory maximum is $20 for the first 25 pages, $0.50 per additional page, plus up to $50 for search fees.
Can a parent access their minor child's medical records? Generally yes, but records related to treatment the minor consented to independently may be restricted from parental access.
Are electronic copies required to be provided? Yes, if the provider maintains electronic records and the patient requests electronic delivery, the provider must accommodate this request.
Sources
- North Dakota Century Code Chapter 23-12: Health Care Records
- North Dakota Century Code Section 23-12-14: Charges for Copies
- North Dakota Century Code Chapter 25-03.1: Mental Health Treatment
- 45 CFR Part 164: HIPAA Privacy Rule
- 42 CFR Part 2: Confidentiality of Substance Use Disorder Patient Records