1. The care provider shall keep a file relating to the treatment of the patient. He shall use the file to record data concerning the health of the patient and the procedures performed on the latter. The care provider shall also include other documents containing such information as is necessary for the purpose of providing the patient with the proper standard of care.
   The care provider shall if requested add to the file a statement made by the patient with regard to the documents included therein.
2. The care provider shall keep the documents for fifteen years from the date on which they were produced or for as long after the expiry of this period as is reasonable in order to provide the proper standard of care.
3. The care provider shall destroy the documents in his keeping within three months of receiving a request to this effect from the patient.
   This shall not apply in so far as the request concerns documents whose retention may reasonably be assumed to be of considerable importance to a person other than the patient. Nor shall it apply in so far as their destruction conflicts with provisions laid down by or pursuant to Act of Parliament.
4. The care provider shall if requested provide the patient with access to and copies of the medical file. Access to and copies of the documents shall not be provided in so far as this is necessary to protect the privacy of person other than the patient. The care provider may charge a reasonable fee for providing the copies.
5. The care provider shall ensure that persons other than the patient are not provided with information about the patient or with access to or copies of the documents without the consent of the patient. Information or access to and copies of documents shall be provided only in so far as no other person's privacy is thereby infringed. Information or access to and copies of documents may be provided regardless of the restrictions referred to in the preceding sentences if provisions laid down by or pursuant to Act of Parliament so require.
   Persons other than the patient shall not include those who are directly involved in the implementation of the treatment contract or a person who acts as locum for the care provider, in so far as the provision of information or access to or copies of documents is necessary for the activities to be performed by them in that context.
   Nor shall they include those whose consent in connection with the implementation of the treatment contract is required pursuant to articles 450 and 465 (legal representatives). If by providing information or access to or copies of documents, the care provider cannot be deemed to be acting in accordance with what is required of a competent care provider, he shall refrain from doing so.
6. The right of access to medical records is derived straight from the right of privacy, which is practically without clauses. Access may be denied only if the granting would result in injuring the privacy of a third party. Even if a medical practitioner fears a patient may be damaged by the information about him contained in his medical records, he is not justified in denying access. On the patient's request access is granted at the earliest opportunity as well as a copy of the medical record. The right of access to medical records is of major importance whenever a patient considers taking legal action against a doctor or an institution. The patient must allege and prove, according to the main rule of Article 177, Civil Legal Procedure Code, unless any other regulation or reasonableness and fairness demand a different partitioning of the burden of proof. Not accessible are the doctor's personal worknotes, that is, notes outside the scope of communication. The doctor can charge the patient for a copy of his medical records. The doctor will keep the records for at least ten years from the time they were made. They may be kept for a longer period, if, in reason, the care extended by, a good medical practitioner requires this.

Top