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examination or treatment... (other than AIDS, mental, and substance abuse records)," although a psychiatrist or psychologist may substitute a report of the examination in lieu of the medical record. Section 456.057(6), Florida Statutes.If a patient requests a copy of his/her medical records, it is very important that the physician provide the patient with a complete copy of all the records, which would include, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient, even those records obtained from another physician. Section 456.057(6) and (14), Florida Statutes, Rule 64B8-9.003(3), Florida Administrative Code. Failure to do so may subject the physician to disciplinary action.Moreover, a physician must release copies of the medical record to parties authorized by the patient, and the physician must release copies of the record, even if not authorized to do so by the patient, if the records have been subpoenaed for a deposition, evidentiary hearing, or trial. Section 456.057(7), Florida Statutes.It should be pointed out, however, that HIV/AIDS records, sexually transmissible disease records, alcoholic drug abuse records, and psychiatric and psychotherapeutic records are extremely confidential medical records and are not to be disclosed pursuant to a general release. The disclosure of these types of records requires a written release by the patient identifying the specific records to be released or a court order to the same effect. Even a subpoena signed by an attorney is ineffective to release these super confidential records. In maintaining a patient's medical records, it is a good idea to clearly indicate a presence of super confidential materials to avoid inadvertent disclosure.Physicians are required to keep a record of all disclosures of information contained in the medical records to third parties, including the purpose of the disclosure. Physicians must maintain the record of the disclosure in the patient’s medical records. The party to whom the physician disclosed the information may not disclose the patient’s medical information without the expressed written consent of the patient or the patient’s legal representative. Section 456.057(11), Florida Statutes.The Board of Medicine through Rule 64B8-10.003, Florida Administrative Code, governs the costs of reproducing medical records. The rule encourages physicians to provide patients with a free copy of their records, especially when the patient is economically disadvantaged. This is not a requirement, however. A physician required to provide copies of medical records to a requesting party may charge only for the “reasonable costs” of reproducing the records, which is defined as follows:• For patients and governmental entities, a physician can charge no more than $1 per page for the first 25 pages, and 25 cents for every page thereafter.• For other entities, the reasonable costs shall be no more than $1.00 per page.• The reasonable costs of reproducing x-rays and other kinds of special records shall be the actual costs, which mean the cost of material supplies as well as labor and overhead costs.While a physician can condition the release of medical records upon payment of the copying costs, the release cannot be conditioned on payment of the physician's bill for services rendered. Upon the receipt of a written request, the physician must provide the patient with a copy of his medical records within a reasonable time, regardless of whether or not he has outstanding charges due on his account.As has been shown above, medical records certainly are subject to a variety of federal and state statutes and regulations, all of which the physician must be aware of in order to avoid potentially drastic state action. In order to minimize this risk, it is recommended that the physician's medical record procedures be reviewed for compliance with the aforementioned laws. The physician may wish to enlist the aid of a qualified health care attorney in this endeavor, as the input of informed legal advice may well aid the physician in the development of a medical record program which is workable and in compliance with state mandates.According to Section 458.331(1)(m), Florida Statutes, a physician may be disciplined for "[f]ailing to keep written medical records justifying the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered, and reports of consultations and hospitalizations." Moreover, Rule 64B8-9.003, Florida Administrative Code, in addition to the above, mandates that the records be legible and contain sufficient information to "identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately..." Finally, the physician should be aware that failure to keep written medical records could subject the physician to penalties ranging from a mere reprimand to a combination of a two-year suspension, followed by probation and a $5,000 fine. Section 456.057(15), Florida Statutes.This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: November 2013 MEDICARE CONTRACTUAL OPTIONS There are three Medicare contractual options for physicians. Physicians may sign a PAR agreement and accept Medicare’s allowed charge as payment in full for all of their Medicare patients. They may elect to be a non-PAR physician, which permits them to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims. Lastly, they may become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves.Physicians who wish to change their status from PAR to non-PAR or vice versa are required to do so before Dec. 31, 2009. Once made, the decision is binding throughout calendar year 2010 except where the physician’s practice situation has changed significantly, such as relocation to a different geographic area or a different group practice. To become a private contractor, physicians must give 30 days' notice before the first day of the quarter the contract takes effect. Those considering a change in status should first determine that they are not bound by any contractual arrangements with hospitals, health plans or other entities that require them to be PAR physicians. In addition, some states have enacted laws that prohibit physicians from balance billing their patients.Both First Coast and the AMA have information on their websites. The AMA information is from 2008 for 2009 options. They have not put out the 2010 as yet. My guess is it will be out shortly since physicians need to make this decision between mid-November and December 31st. The information has not changed and is an excellent explanation of the participation options available. The file is attached. In addition, First Coast has information on how to "Opt out" of Medicare on their site. http://medicare.fcso.com/Opt_out/138524.asp. If they are a PAR provider, they would not need to do anything to remain as a PAR provider. If they are a PAR provider and want to change to a non-PAR provider, they would have to contact First Coast to see what they would need to fill out (see attached file from CMS on what to do.) First Coast contact information is http://medicare.fcso.com/Contacts/156290.asp.This article is presented for educational purposes