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NY state here.

If I go to get a second opinion from a physician other than my primary, are there any regulations (HIPAA or otherwise) that require that 2nd physician to share consultation notes/lab results with my primary?

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    Required on whose request? Yours, the 1st doctor's, the 2nd doctor's, another party's, or some combination thereof? – Burned Sep 1 '16 at 21:09
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HHS answers FAQ 481:

Does the HIPAA Privacy Rule permit doctors, nurses, and other health care providers to share patient health information for treatment purposes without the patient’s authorization?

with:

Yes. The Privacy Rule allows those doctors, nurses, hospitals, laboratory technicians, and other health care providers that are covered entities to use or disclose protected health information, such as X-rays, laboratory and pathology reports, diagnoses, and other medical information for treatment purposes without the patient’s authorization. This includes sharing the information to consult with other providers, including providers who are not covered entities, to treat a different patient, or to refer the patient. See 45 CFR 164.506.

This implies that if Doctor 1 requests your records from Doctor 2 for treatment purposes, Doctor 2 may provide them. Reciprocal practices in the medical field may make such requests required in practice, if anyone at Doctor 2's practice might in the future want to request records/cooperation from any practice in Doctor 1's network.

This rule also implies that if Doctor 2 believes that sharing the information with Doctor 1 will be helpful for treatment purposes, Doctor 2 can do that without a request from Doctor 1, and depending on the situation may be ethically required to do so if Doctor 2 believes it's critical for Doctor 1 to get this information.


If you are requesting that Doctor 2 share the information with Doctor 1, and Doctor 2 is refusing, you can get a copy of your record and give it to Doctor 1. User Nate Eldredge has pointed out in his subsequent answer that 45 CFR 164.524 (c)(3)(ii) permits you to skip a step and direct Doctor 2 to transmit the health records directly to Doctor 1 instead of going through you directly, but from a legal perspective it's basically the same. Doctor 2 can charge a fee for this.


Absent any obvious reason why Doctor 2 would feel ethically obliged to inform Doctor 1 about without treating/taking care of that reason directly, and absent any request for the information to be shared (the question as stated at time of answering does not indicate that any request has been made by anybody for the information to be shared), there is no law requiring Doctor 2 to send the report to anybody.

This answer assumes that Doctor 1 and Doctor 2 work for different healthcare systems, such that Doctor's 2 entry of your record which may automatically go to his/her employer (by contract law) does not therefore also reach the same system Doctor 1 accesses when looking up your record, automatically.

  • "Reciprocal practices in the medical field may make such requests required in practice": does that mean that they are legally required to share, or not legally required to share, which is the question. Note the wording "regulations... that require". – user6726 Sep 1 '16 at 21:43
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    @user6726: Not legally required to share. I think Burned is trying to be helpful by giving additional information, suggesting reasons that they might want to share, although it is not legally required. – Nate Eldredge Sep 2 '16 at 2:15
  • I think it depends on your definition of "legally required" (and am not completely sure the legal/practical distinction matters). If Doctor 1 wanted the records for treatment purposes and Doctor 2 refused, it would be legal for Doctor 1 to punish Doctor 2 through future non-cooperation. Depending on power balance this could really hurt Doctor 2 and the presence of these legal penalties (i.e. penalties which are legal) could mean that Doctor 2 is in practice required to share. Since that effective requirement is legal, one could call it a "legal requirement" or say "Dr. 2 is legally required." – Burned Sep 2 '16 at 2:23
  • Actually, 45 CFR 164.524 (c)(3)(ii) requires the doctor to send the records to the other doctor if the patient requests them to do so, and submits the request properly and pays a fee. But I am not clear if that is what @user6726 is asking, or if they want to know if they might be required to send the records even against the patient's wishes. – Nate Eldredge Sep 2 '16 at 2:51
  • This is basically the equivalent of what I've got between the two horizontal lines, which I expanded to incorporate your comment. I agree the question is unclear regarding who if anyone is making a request here, and have posted a comment on the question seeking clarification, but am answering the question as posted. – Burned Sep 2 '16 at 4:21

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