Medical Record Request Rules for Tennessee

Introduction

Tennessee patients seeking copies of their health information face a regulatory framework shaped by both federal HIPAA requirements and state-specific statutes under Tennessee Code Annotated § 63-2-101 and related provisions. The medical record request rules for Tennessee establish distinct timelines, fee caps, and procedural requirements that differ from neighboring states and federal defaults. Understanding these rules matters because healthcare providers in Tennessee must comply with state law when it provides greater patient protections than HIPAA, and patients who know the specific requirements can identify when a provider fails to meet legal obligations. Tennessee law addresses who may access records, what formats are available, maximum allowable charges, and the narrow circumstances under which providers may deny or delay access. The state also imposes specific requirements for mental health records, substance abuse treatment documentation, and records involving minors. Providers who violate these rules face potential licensing board complaints and civil liability. This reference covers the complete framework governing medical record requests in Tennessee, including the practical details needed to submit a compliant request and troubleshoot common obstacles.

TL;DR

Tennessee law requires healthcare providers to respond to medical record requests within 10 business days of receiving a signed authorization. Providers may charge up to $0.25 per page for paper copies, plus reasonable retrieval and postage costs, with a maximum total fee of $25 for records under 100 pages. Patients have the right to receive records in electronic format if maintained electronically, and providers cannot charge more for electronic copies than for paper. Requests must be in writing with proper authorization, and providers can deny access only under limited circumstances such as ongoing litigation or imminent harm concerns.

Who Can Request Medical Records in Tennessee

Tennessee law grants access rights to several categories of requesters. Adult patients (18 and older) have an unconditional right to their own records. For minors, parents or legal guardians generally control access, though Tennessee recognizes exceptions for emancipated minors and certain sensitive services where minors can consent to treatment independently.

Personal representatives of deceased patients may access records with proper documentation of their authority, typically through probate court appointment letters. Healthcare powers of attorney and advance directive agents gain access rights when the patient becomes incapacitated. Third parties, including attorneys, insurance companies, and other providers, require a valid HIPAA-compliant authorization signed by the patient or authorized representative.

Tennessee courts and administrative agencies can compel disclosure through subpoenas, though providers must follow specific procedures before releasing records under subpoena without patient consent.

How to Submit a Medical Record Request in Tennessee

Written requests are required under Tennessee law. Most providers accept requests on their own authorization forms, though patients may submit requests on plain paper if they include all required elements: patient name, date of birth, specific records requested, date range, recipient information, purpose of disclosure, expiration date, and signature with date.

Requests should be submitted directly to the provider's medical records or health information management department. Large hospital systems typically have centralized release of information offices, while smaller practices may handle requests through front desk staff. Fax, mail, and in-person delivery are universally accepted; many providers now also accept requests through patient portals or secure email.

Verbal requests are insufficient for releasing records to third parties but may be honored for patient viewing of their own records at the provider's facility. Keeping a copy of the submitted request with proof of delivery date establishes the timeline for compliance tracking.

Response Timeframes

Tennessee Code Annotated § 63-2-101 establishes a 10-business-day response window from receipt of a proper written request. This timeline applies to the provider's initial response, which must either fulfill the request, provide a written explanation for denial, or request additional time.

Providers may extend the deadline by up to 30 additional days if records are stored off-site or the request is unusually complex, but they must notify the requester in writing within the initial 10-day period. The extension notice must state the reason for delay and the expected completion date.

For requests involving records from multiple treatment episodes or facilities within a health system, each custodian's 10-day clock starts when that specific department receives the request. Patients should submit requests to each relevant department separately to avoid routing delays.

Fees & Costs

Tennessee caps medical record copying fees under T.C.A. § 63-2-102. Providers may charge up to $0.25 per page for paper copies. Search and retrieval fees are limited to $15 for the first 20 pages, with the per-page fee applying thereafter. Postage and delivery costs may be charged at actual cost.

For records under 100 pages, total fees cannot exceed $25 including retrieval and copying. Electronic copies delivered via email, portal, or media cannot be charged at rates higher than paper copies. Many providers charge less for electronic delivery since their actual costs are lower.

Providers cannot require prepayment before processing requests to other healthcare providers for treatment purposes. For patient-directed requests to third parties like attorneys or insurers, providers may require payment before release. Patients receiving records for their own use cannot be denied access solely due to inability to pay, though providers may pursue collection of reasonable fees afterward.

Delivery Formats

Tennessee patients may specify their preferred format, and providers must accommodate reasonable requests when technically feasible. Options include paper copies via mail or pickup, electronic copies via secure email or encrypted media, access through patient portals, and in-person inspection at the provider's facility.

For records maintained electronically, patients have the right to receive electronic copies in a readily producible format. Providers are not required to purchase new software to accommodate unusual format requests, but they must provide records in at least one electronic format if they maintain an EHR system.

Certified copies with attestation statements carry additional fees, typically $5-15 beyond standard copying charges. These are generally only necessary for court filings or official proceedings. Standard copies suffice for personal review, second opinions, or transfer to new providers.

State-Specific Exceptions or Gotchas

Tennessee imposes special handling requirements for certain record categories. Mental health records maintained by licensed mental health professionals may be withheld if disclosure would cause substantial harm to the patient, though this exception is narrowly construed and requires documented clinical justification.

Substance abuse treatment records from federally funded programs fall under 42 CFR Part 2, which requires specific consent language beyond standard HIPAA authorization. Generic release forms are insufficient for these records.

Records involving minors who received treatment for sexually transmitted infections, pregnancy, or substance abuse without parental consent present complications. Tennessee allows minors to consent to these services independently, and providers may withhold these specific records from parents to protect minor confidentiality.

Psychotherapy notes, meaning a therapist's personal session notes kept separate from the medical record, are excluded from standard access rights under both HIPAA and Tennessee law. Providers may decline to release these even to the patient.

Common Problems Patients Encounter

Excessive fee demands represent the most frequent violation. Some providers, particularly those using third-party release of information vendors, attempt to charge per-page rates exceeding statutory limits or add unauthorized "processing" fees. Patients should cite T.C.A. § 63-2-102 and request itemized fee breakdowns.

Improper denial reasons also occur regularly. Providers sometimes claim they cannot release records due to outstanding balances, pending litigation, or vague "policy" restrictions. Outstanding medical bills do not justify withholding records from patients. Pending litigation requires specific court orders, not blanket denials.

Delays beyond statutory timeframes happen when requests are misrouted internally or staff are unfamiliar with legal requirements. Sending requests via certified mail and following up in writing at day 8 creates a paper trail for escalation.

Incomplete responses, where providers release only portions of requested records without explanation, require written follow-up specifying which records are missing. Providers must identify any withheld records and provide the legal basis for withholding.

Conclusion

Medical record request rules for Tennessee establish clear obligations that favor patient access. The 10-business-day response requirement, $0.25 per-page cap, and $25 maximum for smaller record sets provide concrete standards against which provider compliance can be measured. Patients who submit proper written requests with all required authorization elements and maintain documentation of submission dates hold significant leverage when providers fail to comply. The Tennessee Department of Health and relevant professional licensing boards accept complaints regarding record access violations, and documented patterns of noncompliance can result in disciplinary action. For records involving mental health treatment, substance abuse, or minors, additional authorization language and awareness of applicable exceptions prevents delays. Most access problems resolve quickly when patients demonstrate familiarity with specific statutory requirements.

Frequently Asked Questions

Can a Tennessee provider charge more than $25 for medical records? Yes, but only when records exceed 100 pages. For larger record sets, the $0.25 per-page rate applies beyond the first 100 pages, plus actual postage costs. Providers cannot add administrative fees beyond what T.C.A. § 63-2-102 authorizes.

What if a provider misses the 10-day deadline? Send a written follow-up citing T.C.A. § 63-2-101 and the original request date. If noncompliance continues, file a complaint with the Tennessee Department of Health or the provider's licensing board. Document all communications.

Can I get records from a deceased family member? Yes, if you are the appointed personal representative of the estate or hold healthcare power of attorney. Provide documentation of your legal authority with the request. Surviving spouses and next of kin without formal appointment may face additional requirements.

Do providers have to give me electronic copies? If the provider maintains records electronically, they must provide electronic copies upon request in a readily producible format. They cannot charge more for electronic copies than for paper.

Sources

• Tennessee Code Annotated § 63-2-101 (Medical Records Access)
• Tennessee Code Annotated § 63-2-102 (Copying Fees)
• 45 CFR § 164.524 (HIPAA Access Rights)
• 42 CFR Part 2 (Substance Abuse Records)
• Tennessee Department of Health Administrative Rules