Updated state medical records payment rates

Many states have laws that waive or limit the amount medical providers can charge for providing copies of medical records when the request is made in connection with a Social Security disability or SSI claim. Some states have limits that apply to all requests, regardless of purpose, while other states have no limits at all. Below is a summary of the relevant state laws. While we strive to keep this list updated, if you notice a discrepancy between this list and your state’s rules, please send us an email at nosscr@nossrc.org.

Many of the state laws that limit costs exist because NOSSCR members contacted their state representatives and pushed for helpful legislation. If you are interested in contacting your state representative to pass a similar statute, please reach out to NOSSCR for assistance.

Alabama: $1 per page for the first 25 pages, 50¢ per page for each additional page, and a search fee of $5. Reasonable costs also include the actual cost of mailing the records. In addition, the provider may also charge the actual cost of reproducing X-rays and other special medical records. Code of Alabama § 12-21-6.1.

A note on the search fee: if the individual requests their own records, per HIPPA, the search fee must be waived; however, this required waiver applies only to an individual’s request for access to their own records and does not apply to an individual’s request to transmit records to a third party.

Alaska: Although Alaska Statutes § 18.23.005 specifies that “a patient is entitled to inspect and copy any records developed or maintained by a health care provider or other person pertaining to the health care rendered to the patient,” no state law limits the costs of providing copies of medical records.

Arizona: One free copy of a patient’s medical records per calendar year if requested by the patient or the patient’s legal representative “for the purpose of appealing a denial of benefits under the social security act.” Before obtaining a patient’s medical records free of charge, “[a] legal representative must provide an Appointment of Representative Form SSA-1696.” Any additional requests for medical records in the same calendar year are subject to “a reasonable fee” for the production of the records. But no fees may be charged if no medical records are found in response to the request. Arizona Revised Statutes § 12-2295.B.5.

Arkansas: For paper records: 50¢ per page for the first 25 pages, 25¢ per page for each additional page, and a $25 labor charge. The actual cost of any required postage can also be charged. However, these per page limits do not apply to photocopies of x-rays.

For electronic records: $75 and the actual cost of postage, if any postage is required. No other fees may be charged for electronic records. Medical records requested that exist in electronic format shall be produced within 30 days after receipt of the request.

Additional “reasonable fees” can be charged for retrieval of records stored offsite and for narrative medical reports. Arkansas Code § 16-46-106(a).

California: One free copy of a patient’s medical records for “a patient, employee of a nonprofit legal services entity representing the patient, or the personal representative of a patient” if the records are needed to support a claim or appeal regarding eligibility for a public benefit program, which includes Social Security Disability Insurance Benefits and Supplemental Security Income benefits. Notably, the provision granting one free copy of the patient’s medical records does not apply if the patient is represented by a “private attorney,” meaning any attorney not employed by a nonprofit legal services entity, who is paying for the costs related to the patient’s appeal, pending the outcome of that appeal. In that case, the medical provider may charge 25¢ per page for paper copies or 50¢ per page for records that are copied from microfilm, plus the costs of labor, supplies, and postage, if applicable. If the records are requested to support a claim or appeal regarding eligibility for a public benefit program, the medical provider must “ensure that the copies are transmitted within 30 days after receiving the written request.” California Health & Safety Code, Division 106, Chapter 1, § 123110.

Colorado: $18.53 for the first 10 pages, 85¢ per page for the next 30 pages, and 57¢ per page for each additional page. These costs do not apply to medical records that are stored on microfilm, which cost $1.50 per page, or radiographic studies, which cost the actual cost of reproduction for each radiograph copy. Additionally, the medical provider may charge the actual postage and electronic media costs, if applicable, and any applicable taxes as well as a $10 fee for certification of the medical records, if requested. 

However, a third-party entity that is performing duties under the Laura Hershey Disability Support Act, which funds a program that awards contracts to nonprofit organizations “to aid persons with disabilities in accessing disability benefits…,” is entitled to one free copy of a patient’s medical records “when required by the disability benefit administrator.”  Colorado Revised Statutes § 25-1-801. 

Connecticut: No charge for medical records requested by a patient, patient’s attorney or authorized representative “for the purpose of supporting a claim or appeal under any provision of the Social Security Act…” The request must be accompanied by documentation of the claim or appeal. The medical provider must furnish the records within 30 days of the request. Connecticut General Statutes § 20-7c(d).

Delaware: $2 per page for the first 10 pages, $1 per page for pages 11-20, 90¢ per page for pages 21-60, and 50¢ per page for pages 61 and above. The actual cost of reproduction may be charged for records unsusceptible to photocopying, such as radiology films, models, photographs or fetal monitoring strips. The medical provider may also charge the actual cost of postage or shipping if the records are mailed.  Advance payment for medical records requested to make or complete an application for a disability benefits program is not required. Delaware Administrative Code, Title 24, Division 1700, § 16.0.

District of Columbia: For electronic copies, medical providers may charge an authorized person 68¢ per page, not to exceed $89.66 total, and a $23.70 search and handling fee (even if no personal medical record is located).

For non-electronic copies, medical providers may charge an authorized person 91¢ per page (with no maximum), a $23.70 search and handling fee (even if no personal medical record is located), and the actual cost for postage and handling.

These fees will be adjusted annually for inflation. The 2024 rates are reflected above and located here.

The medical provider must provide copies of the records within 30 days of receipt of the request. Code of the District of Columbia § 3–1210.12. For requests by a patient or a person with a health care power of attorney for the patient, medical providers may charge “a reasonable fee for copying.” Code of the District of Columbia § 3–1210.11.

Florida: 

Hospitals: $1 per page, plus sales tax and actual postage. Non-paper records (such as microfiche) are subject to a charge not to exceed $2 per page. A fee of up to $1 may be charged for each year of requested records. However, this does not apply to records maintained at any licensed facility that primarily provides psychiatric care, or to records of treatment for any mental or emotional condition, or records of substance abuse. Florida Statutes, Title XXIX, Chapter 395, § 3025.

Doctors: While “the Board of Medicine urges physicians to provide their patients a copy of their medical records, upon request, without cost, especially when the patient is economically disadvantaged,” the doctor is permitted to charge “patients and governmental entities” $1 per page for the first 25 pages and 25¢ for each additional page. For “other entities,” the reasonable costs of reproducing copies of written or typed documents or reports shall not be more than $1.00 per page. The doctor may charge the actual cost of reproduction for x-rays and other special kinds of records. Florida Administrative Code § 64B8-10.003.

Georgia: Per § 31-33-3(a) of the Official Georgia Code Annotated (O.G.C.A.), which sets forth the costs of copying and mailing patient records, these costs “shall not apply to records requested in order to make or complete an application for a disability benefits program.” Notably, according to O.G.C.A. § 31-33-3(c), this Code section does apply to a patient’s psychiatric, psychological, and other mental health records. Official Georgia Code Annotated § 31-33-3. See also Georgia Department of Community Health, Medical Records Retrieval Rates.

Hawaii: “Reasonable costs incurred by a health care provider in making copies of medical records shall be borne by the requesting person.” Hawaii Revised Statutes § 622-57(g). If the patient’s attorney requests the records and “presents a proper authorization from the patient for the release of the information, complete and accurate copies of the records shall be given to the attorney within a reasonable time not to exceed ten working days.” Hawaii Revised Statutes § 622-57(b).

Idaho: No state law limits the costs of providing copies of medical records.

Illinois: Effective January 1, 2022, no charge for “one complete copy of a patient’s records,” which includes any updated medical records not included in the original record, if “the records are being requested by the patient or a person, entity, attorney, registered representative, or organization presenting a valid authorization for the release of records signed by the patient or the patient’s legally authorized representative who has provided documentation of authority to act for the patient… for the purpose of supporting a claim for… federal Social Security or Supplemental Security Income benefits, or both, under any title of the Social Security Act…” See Illinois Compiled Statutes, Chapter 735, § 5/8-2001(h). See also Public Act 102-0183.

Indiana: The Department of Insurance sets the rules for making and providing copies of medical records. Indiana Code, Title 16, Article 39, Chapter 9, § 2. The maximum copying fees are $1 per page for the first 10 pages, 50¢ per page for pages 11-50, and 25¢ per page for pages 51 and higher. Additionally, the medical provider may charge the actual cost of mailing. A $20 labor fee can also be charged; however, if a labor fee is charged, the first 10 pages are free. An expedited processing fee of $10 may be charged if the records are to be provided within two working days. The medical provider may also charge $20 for certified records. Indiana Administrative Code, Title 760, Article 1, Rule 71, § 3.

Iowa: Medical providers may charge “the actual cost of production” for producing patient records or images. If the properly submitted request is for “all of the patient’s records for the requested time period, including records relating to the patient’s mental health, substance use disorder, and acquired immune deficiency syndrome-related conditions, the amount charged shall not exceed the rates established by the workers’ compensation commissioner for copies of records in workers’ compensation cases.” The workers’ compensation rates are $20 for pages 1-20, $1 per page for pages 21-30, 50¢ per page for pages 31 to 100, 25¢ per page for pages 101-200, 10¢ per page for more than 200 pages, plus the actual expense of postage. Iowa Admin. Code r. 876-8.10(85,86)

The records and images must be provided within 30 days of receipt of the written request. The medical provider may also charge $10 for certified records. Iowa Code § 622.10(6). 

Kansas: No state law limits the costs of providing copies of medical records since Kansas Statutes Annotated § 65-4971(b) was repealed by the 2011 Kansas Legislature. Thus, the HIPAA language governs, allowing for “reasonable” cost-based fees. Copies of the records shall be furnished within 30 days of the receipt of the authorization. K.S.A. § 65-6836.

Kentucky: One free copy of a patient’s medical records upon the patient’s written request. A copying fee of $1 per page may be charged “for furnishing a second copy of the patient’s medical record upon request either by the patient or the patient’s attorney or the patient’s authorized representative.” Kentucky Revised Statutes § 422.317.

Louisiana: 50¢ per page for the first 5 pages and 25¢ for each additional page for “any records that are necessary to support [a patient’s] filing for Social Security disability benefits or Supplemental Security Income benefits under any provision of the Social Security Act.” The statute also stipulates that “the amount due shall not be less than the amount paid by the Department of Children and Family Services [DCFS] for such copies,” but unfortunately, the DCFS rate is not publicly available. Records should be provided in “a reasonable period of time, not to exceed fifteen days following the receipt of the request and written authorization.” Louisiana Revised Statutes § 46:18.

Maine: 

Hospitals: For paper copies, $5 for the first page and 45¢ for each additional page, up to a maximum of $250 for the entire medical record. “The hospital may require payment prior to responding to the request.” For electronic copies, the hospital may charge “reasonable actual costs of staff time to create or copy the medical record and the costs of necessary supplies and postage,” not to exceed $150. “Actual costs may not include a retrieval fee or the costs of new technology, maintenance of the electronic record system, data access or storage infrastructure.” Maine Revised Statutes, Title 22, Subtitle 2, Part 4, Chapter 401, § 1711.

Doctors: For paper copies, $5 for the first page and 45¢ for each additional page, up to a maximum of $250 for the entire treatment record or medical report. For electronic copies, the doctor may charge “reasonable actual costs of staff time to create or copy the treatment record or medical report and the costs of necessary supplies and postage,” not to exceed $150. “Actual costs may not include a retrieval fee or the costs of new technology, maintenance of the electronic record system, data access or storage infrastructure.” Maine Revised Statutes, Title 22, Subtitle 2, Part 4, Chapter 401, § 1711-A.

Maryland: No charge for medical records “that will be used for the purpose of filing a claim regarding or appealing a denial of Social Security Disability Income or Social Security Benefits under Title II or Title XVI of the Social Security Act” when requested by the patient, the patient’s personal representative, or “an employee or other representative of a nonprofit legal services entity or other volunteer or nonprofit program representing the patient.” Code of Maryland, Health–General § 4-304(c)(5).

For all other requests, paper copies will cost 76¢ per page plus the actual cost for postage and handling. Additionally, a medical provider may charge a $22.88 retrieval and preparation fee (unless the records are provided directly to the patient per federal HIPAA regulations). For electronic copies, 57¢ per page (75% of the per page charge for paper copies), not to exceed $80, plus the actual cost for postage and handling. Additionally, a medical provider may charge a $22.88 retrieval and preparation fee (unless the records are provided directly to the patient per federal HIPAA regulations). Code of Maryland, Health–General § 4-304(c)(3).

Massachusetts: 

Hospitals & Clinics: No charge for medical records requested by “any applicant, beneficiary or individual representing said applicant or beneficiary… for the purpose of supporting a claim or appeal under any provision of the Social Security Act,” upon presentation of “reasonable documentation” showing that the records are being requested for this purpose. The hospital or clinic must furnish the records within 30 days. Massachusetts General Laws, Chapter 111, § 70.

Doctors: No charge for medical records requested by “any applicant, beneficiary or individual representing said applicant or beneficiary if the record is requested for the purpose of supporting a claim or appeal under any provision of the Social Security Act,” upon presentation of “reasonable documentation” showing that the records are being requested for this purpose. Code of Massachusetts Regulations, Title 243, § 2.07(13)(d). 

Michigan: One free copy of a patient’s medical records for “a medically indigent individual.” Any additional or other requests are subject to an initial fee of $30.60 per request, plus $1.53 per page for the first 20 pages, 77¢ per page for pages 21-50, and 31¢ per page for pages 51+. A medical provider cannot charge a patient the “initial fee” for his/her own medical records. Michigan Compiled Laws § 333.26269. See also State of Michigan Department of Health and Human Services, 2023 MEDICAL RECORDS ACCESS ACT FEES (In Accordance with the Consumer Price Index). 

Minnesota: A $10 retrieval fee (and no per page fee) for “copies of records requested by a patient or the patient’s authorized representative if the request for copies of records is for purposes of appealing a denial of Social Security disability income or Social Security disability benefits under title II or title XVI of the Social Security Act.” But a medical provider cannot even charge the $10 retrieval fee “to a person who is receiving public assistance, who is represented by an attorney on behalf of a civil legal services program or a volunteer attorney program based on indigency.” For further appeals, “a patient may receive no more than two medical record updates without charge, but only for medical record information previously not provided.” Minnesota Statutes § 144.292, subdivision 6, paragraph (d).

Mississippi: $20 total for pages 1-20, $1 per page for the next 80 pages, and 50¢ per page for any additional pages. A medical provider may add 10% of the total charges for postage and handling. Also, an extra $15 can be charged for retrieval of records stored offsite. Mississippi Code Annotated § 11-1-52(1). 

Missouri: For paper copies, a $28.70 search and retrieval fee, plus 66¢ per page. An extra $26.87 can be charged for retrieval of records stored offsite. For electronic copies, a $28.70 search and retrieval fee, plus 66¢ per page, or $125.78 total, whichever is less. Additionally, a medical provider may charge postage, to include packaging and delivery cost, and a $2 notary fee, if requested. Missouri Revised Statutes § 191.227. See also Missouri Department of Health and Senior Services, Fees for Medical Records.

Montana: $15 administrative fee for searching and handling, plus 50¢ per page for paper copies. Montana Code Annotated § 50-16-540.

Nebraska: No charge for medical records requested by a patient for use in supporting an application for disability benefits or an appeal relating to the denial of such benefits under Title II, Title XVI, or Title XVIII of the Social Security Act. The request must also include a statement or document from the Social Security Administration that confirms the application or appeal. Nebraska Revised Statute § 71-8405.

Nevada: One free copy of a patient’s medical records “necessary to support a claim or appeal under any provision of the Social Security Act… if the request is accompanied by documentation of the claim or appeal.” A copying fee of 60¢ per page plus “a reasonable cost for copies of x-ray photographs and other health care records produced by similar processes” may be charged for furnishing a second copy of the patient’s records to support the same claim or appeal. “No administrative fee or additional service fee of any kind may be charged for furnishing such a copy.” Notably, a medical provider cannot deny furnishing a copy of the records “solely because the patient is unable to pay the [applicable] fees.” The records must be provided within 30 days of receipt of the request. Nevada Revised Statutes § 629.061(5).

New Hampshire: $15 total for the first 30 pages or 50¢ per page, whichever is greater. However, a medical provider may charge a “reasonable cost” for providing copies of “filmed records,” including radiograms, x-rays, and sonograms. New Hampshire Revised Statutes, Title XXX, § 332-I:1. 

New Jersey: No charge for medical records requested by a patient or an attorney representing a patient who has a pending application for, or is currently receiving, Social Security disability benefits provided under Title II or Title XVI of the Social Security Act. The records must be delivered in the manner specified by the requestor within 30 days of the request. New Jersey Revised Statutes § 26:2H-5n and New Jersey Revised Statutes § 45:9-22.27.

New Mexico: $2 per page for the first 10 (one-sided) pages, 20¢ per page for each additional page. All requests for medical records needed to support a Social Security disability application or appeal must be accompanied by a written verification of the application or appeal. Regardless of whether the applicable fees have been paid, the medical provider must produce the records within 30 days of receipt of the written request. New Mexico Administrative Code § 7.1.10.8B-10.

New York: No charge for medical records if requested “for the purpose of supporting an application, claim or appeal for any government benefit or program…” If the medical provider maintains records in electronic format, it will provide copies “in either electronic or paper form, as required by the government benefit or program, or at the patient’s request.” New York Public Health Law § 17. 

North Carolina: 75¢ per page for the first 25 pages, 50¢ per page for pages 26-100, and 25¢ per page for each page over 100, with a minimum fee of $10. North Carolina General Statutes § 90-411.

North Dakota: For paper copies, $20 total for the first 25 pages, plus 75¢ per page for each additional page. For electronic copies, $30 total for the first 25 pages, plus 25¢ per page for each additional page. North Dakota Century Code § 23-12-14.2.

Ohio: One free copy of a patient’s medical records, plus one free copy of any updated records (excluding copies of records already provided), to a patient or his/her personal representative or authorized person “if the medical record is necessary to support a claim under Title II or Title XVI of the Social Security Act.” The request must be accompanied by documentation that a disability claim has been filed. Ohio Revised Code § 3701.741(C)(1)(e).

Oklahoma: For paper copies, 50¢ per page. For electronic copies, 30¢ per page plus delivery fees, not to exceed a combined total of $200. If an attorney requests the records, the medical provider may charge an additional $20 base fee (even if the search yields no records), plus postage or delivery fees. Each printed x-ray, other photograph, or image costs $15 plus $20 per CD/DVD or other electronic media that it is provided on. The medical provider may also charge $15 for certified records. However, a medical provider cannot charge a patient requesting his/her own records any fees for “searching, retrieving, reviewing, and preparing medical records.” Oklahoma Statutes § 76-19(A)(2).

Oregon: One free copy of a patient’s medical records for the period from the date of the alleged onset of disability to the date of the administrative hearing to support an appeal of the denial of Social Security disability benefits to the claimant or his/her personal representative in either paper or electronic format. Oregon Revised Statutes § 192.576. 

Pennsylvania: A flat fee of $35.50 plus the actual cost of postage, shipping or delivery for the production of records “requested for the purpose of supporting a claim or appeal under any provision of the Social Security Act.” The medical provider must be given “clear and convincing documentation” that the records are necessary to support a Social Security claim or appeal. Pennsylvania Consolidated Statutes, Title 42, Chapter 61, § 6152.1. See also Amendments to Charges for Medical Records.

Puerto Rico: Every provider shall provide all patients “with a speedy access to their files and records. Patients are entitled to receive a copy of their medical record.” There is no further law limiting the costs of providing copies of medical records, except that “whenever any of the parties, to wit the medical services provider or the patient, concludes the physician-patient relationship, said medical record shall be furnished to the patient, father, mother, or custodian free of charge, within a term that shall not exceed five (5) working days. The fact that an outstanding debt exists between the physician and the patient shall not be an impediment for the patient to obtain his/her medical record.” P.R. Laws tit. 24, §3049.

Rhode Island: No charge for medical records furnished to a patient or his/her attorney or representative if “necessary for the purposes of supporting an appeal under any provision of the Social Security Act,” and the request is accompanied by documentation of the appeal. The medical provider must furnish the records within 30 days of receipt of the request. Rhode Island General Laws § 23-17-19.1(16).

South Carolina: For paper and electronic copies, 83¢ per page for the first 30 pages, 63¢ per page for each additional page, plus a $32.06 clerical fee. For paper copies, altogether these fees cannot exceed $256.58, and for electronic records, these combined fees cannot exceed $192.44. Actual postage and applicable sales tax may also be charged. The search and handling fees are permitted even when no medical record is found as a result of the search, except where the request is made by the patient.

For copies of x-rays, the hospital may charge the actual cost of reproduction, including the cost of materials and supplies used to duplicate the x-ray and the labor and overhead costs associated with the duplication. The provider must furnish the records no later than 45 days after the patient’s discharge or 45 days after the request is received, whichever is later. South Carolina Code of Laws § 44-7-325 and South Carolina Code of Laws § 44-115-80; see also The Department of Health and Environmental Control (DHEC), ANNUAL ADJUSTMENT TO THE FEE FOR SEARCH AND DUPLICATION OF A MEDICAL RECORD.

South Dakota: For paper copies, $10 for the first 10 pages and 33¢ for each additional page. For electronic copies, 25¢ per page. For a printed copy of an x-ray, MRI, or other form of medical imaging, a fee not to exceed $10, and for an electronic copy of the same, a fee not to exceed $15. The provider may also charge the cost of postage, shipping, and any applicable tax. South Dakota Codified Laws §36-2-16.4.

Tennessee: 

Hospitals: No charge for medical records for an “indigent person” to support a claim or appeal under any provision of the Social Security Act, if the request is accompanied by a copy of a recent application for or decision denying Social Security benefits. “Patients being represented by organizations whose purpose is to provide legal assistance to the indigent, or represented by attorneys with an affiliated pro bono program, shall be presumed indigent.” Those represented by others may be required to provide proof of indigency, which can be done with this form. The hospital must furnish the records within 30 days of the request.

For non-indigent patients, the hospital may charge an $18 fee, which includes the first 5 pages, and a per page charge of 85¢ for pages 6-50, 60¢ per page for pages 51-250, and 35¢ per page for each page after that. The hospital may also charge $20 for each certified record. Tennessee Code Annotated § 68-11-304.

Doctors: $20 total for records 5 pages or less and 50¢ per page for each page over the first 5 pages, plus the actual cost of mailing. The doctor may also charge $20 for certified records. Tennessee Code Annotated § 63-2-102.

Texas: One free copy of a patient’s medical records, including mental health records, requested by a patient, former patient, or his/her attorney or “other authorized representative” for use in supporting an application for or appeal of disability benefits under Title II, Title XVI, or Title XVIII of the Social Security Act. If additional information is added to the patient or former patient’s record, upon request, the provider will supplement the record provided free of charge. The request must also include documentation from the Social Security Administration confirming the application or appeal. Texas Health & Safety Code § 161.202. See also Texas Administrative Code Rule §165.2(k).

Utah: One free copy of a patient’s medical records if the request “is accompanied by documentation of a qualified claim or appeal” for benefits under any provision of the Social Security Act. “[F]or a second or subsequent copy in a calendar year of a date of service that is necessary to support the qualified claim or appeal,” the medical provider may charge 60¢ per page for paper copies and no more than the allowable amount in Subsection (8)(c) for electronic copies (maximum of $150). The records must be provided within 30 days of receipt of the request. Utah Code § 78B-5-618(10). 

Vermont: No charge for medical records “requested to support a claim or an appeal under any provision of the Social Security Act.” Vermont Statutes Annotated, Title 18, § 9419(a).

Virginia: If a patient requests a copy of his/her own records, a medical provider may charge a “reasonable cost-based fee,” which can only include the cost of supplies for and labor of copying the requested information, postage, and preparation of an explanation or summary of such information as agreed to by the patient. Code of Virginia § 32.1-127.1:03(J).

If an attorney requests a copy of the patient’s records, for paper copies, a medical provider may charge 50¢ per page up to 50 pages and 25¢ per page for each additional page, plus a $20 search and handling fee and all postage and shipping costs. These costs do not apply to hard copies from microfilm or other micrographic process, which cost $1 per page. For electronic copies, a medical provider may charge 37¢ per page up to 50 pages and 18¢ per page for each additional page, plus a $20 search and handling fee and all postage and shipping costs, not to exceed a total of $160. These costs do not apply to electronic copies of x-rays, which cost a “reasonable fee” of $25 per x-ray, plus a search and handling fee of $10 and all postage and shipping costs. The patient’s attorney must provide the medical provider with a written confirmation signed by the patient confirming the attorney’s authority to make the request (a photocopy, facsimile or other copy of the original signed by the patient is acceptable). The medical provider must furnish the records within 30 days of receipt of the request and production of the records cannot be withheld or delayed solely on the grounds of nonpayment. Code of Virginia § 8.01-413(B).

Washington: One free copy of a patient’s medical records every two years “if the patient is appealing the denial of” SSI or Social Security disability benefits and the request is made by a patient or his/her “personal representative.” Beyond the free copy, a provider may charge a “reasonable fee.” Revised Code of Washington § 70.02.030(2)(b).

West Virginia: One free copy of a patient’s medical records for an “indigent person” if necessary to support a claim or appeal under any provisions of the Social Security Act. Patients are considered indigent if they are “represented by an organization or affiliated pro bono program that provides legal assistance to indigents; or verifies on a medical records request and release form that the records are requested for purposes of supporting a Social Security claim or appeal and submits with the release form reasonable proof that the person is financially unable to pay full copying charges by reason of unemployment, disability, income below the federal poverty level, or receipt of state or federal income assistance.”

For non-indigent patients or additional patient requests from the same medical provider, the medical provider may charge “a fee consistent with HIPAA” not to exceed 40¢ per page, a $20 search and handling fee, and any actual mailing costs and applicable taxes. For electronic records, the fees cannot exceed $150, inclusive of all fees, except for applicable taxes. A provider can charge $10 if a certified copy is requested. West Virginia Code § 16-29-2. 

Wisconsin: If a patient or his/her authorized representative requests medical records for use in appealing the denial of a Social Security disability insurance or Supplemental Security Income claim, the medical provider cannot charge “more than the amount that the federal Social Security Administration reimburses the department for copies of patient health care records.” Wisconsin Statutes § 146.83(1f)(am). See also 20 C.F.R § 401.95, showing a current SSA reimbursement rate of 10¢ per page, with the caveat that there is no charge if the total amount of copying does not exceed $25.

Wyoming: A medical provider may charge “reasonable charges, and charge a patient for the actual costs incurred in responding to a patient’s request” for medical records, including “the cost of copies, clerical staff time and the physician’s time in reviewing and summarizing the records and/or x-rays and diagnostic records, if necessary.” However, a medical provider cannot deny a patient a summary or copy of his/her medical records because of an inability to pay. Wyoming Administrative Rules, Board of Medicine, Chapter 3: Practice of Medicine, § 4(e).

HIPAA: The Privacy Rule permits a medical provider to impose a “reasonable, cost-based fee,” which may include only the cost of labor for copying the requested records, whether in paper or electronic form; supplies for creating the paper copy or electronic media (e.g., CD or USB drive); postage, when records are requested to be mailed; and preparation of an explanation or summary of the medical records, if agreed to by the patient. 45 CFR § 164.524(c)(4). The fee may not include costs associated with verification, documentation, search and retrieval, maintaining systems, recouping capital for data access, storage, or infrastructure, or other costs not listed above, even if such costs are authorized by state law. See also U.S. Department of Health & Human Services, Individuals’ Right under HIPAA to Access their Health Information 45 CFR § 164.524. However, “the fee limitation set forth at 45 C.F.R. § 164.524(c)(4) apply only to an individual’s request for access to their own records, and does not apply to an individual’s request to transmit records to a third party.” U.S. Department of Health & Human Services, Important Notice Regarding Individuals’ Right of Access to Health Records.

HITECH Act: Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, health care providers that maintain electronic medical records, excluding psychotherapy records, are required to provide them to the patient for the actual cost of production within 30 days of the written request. The request must be signed by the patient indicating that it is a patient’s request for medical records. After the U.S. District Court for the District of Columbia found that the “Patient Rate” is not applicable to an individual’s request for his/her medical records to be sent to a third party in Ciox Health, LLC v. Azar, et al., No. 18-cv-0040 (D.D.C. January 23, 2020), HHS issued an “Important Notice Regarding Individuals’ Right of Access to Health Records” explaining that the fee limitations “will apply only to an individual’s request for access to their own records, and does not apply to an individual’s request to transmit records to a third party.”

21^st Century Cures Act: The Interoperability, Information Blocking, and the ONC Health IT Certification Program final rule implements certain provisions of the 21st Century Cures Act. 85 Fed. Reg. 25642 (May 1, 2020). The regulations, specifically 45 CFR § 171.302, explain when a medical provider may still charge for “accessing, exchanging, or using” electronic health information (EHI) and make clear that providers cannot charge “[a] fee based in any part on the electronic access of an individual’s EHI by the individual, their personal representative, or another person or entity designated by the individual [emphasis added].” See § 171.302(b)(2). However, the regulation defines “electronic access” as an “internet-based method that makes electronic health information available at the time the electronic health information is requested and where no manual effort is required to fulfill the request [emphasis added].” See § 171.302(d). See also www.healthit.gov/curesrule/faq/if-individual-asks-actor-provide-copy-individuals-electronic-health-information-ehi-some-form. These rules, specifically 45 CFR § 171.102, exclude psychotherapy notes and “[i]nformation compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding” from the definition of EHI.