Medical Records System
HMO providers must maintain a medical records system that is
consistent with professional standards and that:
Permits prompt retrieval of information and provides legible
and timely information, accurately documented, and readily available to members
and/or appropriate or authorized health care practitioners.
Protects the confidentiality of patient records. There are
occasions when Health Options may request to review and/or obtain copies of
medical records from physicians to review quality of care, medical necessity,
appropriateness of service, and/or clarification of treatment. The member’s
enrollment application includes an authorization for the release of information
that allows Health Options to obtain the medical records of the member and/or
eligible spouse and dependents
Records in the medical record a summary of significant
surgical procedures, past and current diagnoses or problems, allergies, and
untoward reactions to drugs and current medications.
Identifies the patient by name, identification number, date
of birth, and sex.
