Step 1: Obtain Medical Records

There are many reasons why medical records are of value to a parent; they help parents keep track of a child’s various medical treatments and therapies. The records can also be instrumental during the case evaluation and litigation process.

As you enter the litigation process, your attorney will guide you through each step, including how to obtain medical records. For a free review of your case, please call Stern Law, PLLC at (800) 462-5772 today.

Reasons to obtain medical records include:

For general use

As a general rule, parents should maintain their child’s medical records to record immunization, growth milestones, illness, surgery, and medical complications. Of course, for parents of a child with a birth injury, keeping track of all the records and documenting challenges becomes critical.

Medical professionals are only obligated to keep a child’s medical records for a designated period of time. There are many times in the child’s life, especially if the child has a birth injury, when it will be important to have a copy of the child’s medical records.

For documentation of diagnosis

For children with a birth injury, medical records can be extremely valuable in many ways. There is no single test that will conclusively diagnose a birth injury. Some severe cases of birth injury may be diagnosed at the time of birth or the infliction of the trauma in situations involving obvious physical injury to the baby.

However, for a birth injury that does not present with obvious harm to the child, the diagnosis may involve a process by which other conditions first need to be ruled out. As parents begin to seek answers regarding why their child is behind in meeting the established growth milestones, medical history information and test results are reviewed over a period of time, usually during the first three to five years of a child’s life.

What Can You Do If Your Child’s Medical Records Are Missing Or Altered? from The CP Lawyer | Stern Law, PLLC on Vimeo.

For medical management

After receiving a diagnosis of a birth injury, parents who maintain medical records for their child will find it easier to provide various medical professionals with the information they may require. Medical records, including test results and formal diagnosis, can indicate the extent, location, and severity of the child’s impairment or restrictions and how much the devastating situation has impacted the child and his family.

Providing medical documentation at the time of the initial consultation to each and every medical professional to whom the child is referred leads to efficiency in care since pertinent diagnosis history and tests are made immediately available, eliminating the need for the medical professional to request and await the same information through a medical release and record gathering. It also ensures every medical professional has access to the same information a parent has on file.

For educational purposes

Children with a birth injury often are evaluated for special needs while attending school. Individualized Education Plan reviews often require a team of professionals to meet with the family, review pertinent medical records, the child’s home life, the child’s ability to provide self-care, and the child’s ability to perform daily activities. The medical records will be extremely helpful in assisting the school to determine what options are available for the child’s educational experience.

As a right mandated by HIPAA

Federal law mandates that patients have access to most of their medical records. The Health Information Portability Accountability Act, or HIPAA, protects patient privacy when it comes to health information and provides a degree of access to medical records. According to HIPAA, the person requesting the medical records must be a patient, parent, or legal guardian. As an alternative, the patient can provide written permission that allows a medical facility to release a copy of the medical records for review. Often medical offices will utilize medical release forms for such purposes.

For convenience

It can be most efficient, and less costly, to request medical records at the time a doctor is providing diagnosis or sharing test results, as opposed to asking for records after some time has elapsed. Over time, the patient risks the chance that the records are lost or destroyed, especially in instances when medical facilities have closed, changed ownership, or the period of time facilities are required to maintain patient files has elapsed.

When discussing test results, or similar situations, asking for a copy may be all that is necessary. A short one to two week waiting period is not uncommon when requesting certain records. Doctors or other medical professionals are able to charge an administration fee for providing records upon request at a later date. The charge covers copy charges, postage, storage retrieval fees, and staff time to retrieve data from client files.

For Lifetime Benefits consideration

If a parent wishes to pursue Lifetime Benefits for a child, a medical malpractice attorney likely will request that the mother be available for questions and the child’s medical records be obtained, if at all possible. The mother will be able to relay specific pregnancy and birth-related experiences, which is critical to demonstrating that the mother did nothing to cause the injury to her child and in fact did everything she could to bring a healthy baby into the world.

The medical records may prove beneficial in determining whether or not there is a reasonable basis to believe that the child’s injury was the result of the negligence caused by a doctor or other medical professional, or a healthcare entity. It is not mandatory that records are provided at time of legal consultation, but it is helpful. If records are not provided, but the attorney believes there may be evidence that a child was denied a life without impairment, the attorney may request a medical release form be signed to obtain the complete records.

What Are Some Things We Look For In Medical Records To Prove That Cerebral Palsy Was Preventable? from The CP Lawyer | Stern Law, PLLC on Vimeo.

For government assistance

Parents applying for government assistance often report that they are initially denied benefits. To qualify for government support, it is often essential that the applicant is able to prove they are eligible under the program’s guidelines. Immediate access to medical records allows an applicant to conveniently provide the necessary proof at the time of application.

The litigation process can be complex, which is why it’s critical to seek qualified legal guidance in your birth injury case. Contact Stern Law, PLLC by calling (800) 462-5772 today to discuss your case for free.

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