Transferring Records for a Second Opinion

This page is educational and not legal advice. Federal rules are summarized here; states may add protections.

The hard part of a second opinion is almost never finding the doctor. It is getting your material into that doctor's hands before your appointment. Cancer second opinions get canceled or downgraded to a chat because a box of glass slides did not arrive.

So treat this as three separate shipments, each with its own owner and its own delay.

This is the part most people picture. Clinic notes, the operative report, discharge summaries, lab results, the medication list, and any genetic or biomarker reports.

Most of it now moves electronically. Ask the receiving center whether it accepts a portal share, a secure electronic transfer, or an uploaded PDF bundle. Then ask who at that center confirms receipt, and get that person's direct line.

The reviewing radiologist needs the actual image files, not the report about them. That means the DICOM data, which is the standard file format for medical images, sent on a disc, a USB drive, or through an image-sharing network.

Ask for the studies by date and body part, not by the word "recent." Also ask whether the outside center will formally re-read the images, or just glance at them. A re-read is a service that gets billed and documented. Knowing which one you are getting changes what the visit is worth.

This is the shipment that gets forgotten, and it is often the one that changes the answer.

The National Cancer Institute (NCI) states that for a pathology second opinion, "they will need to obtain the slides and/or paraffin block from the pathologist who examined the sample or from the hospital where the biopsy or surgery was done." NCI notes that "many institutions provide second opinions on pathology specimens."

Two physical objects exist. Slides are the stained glass a pathologist looks at. The paraffin block is the wax cube holding the rest of your tissue. If new tests are needed, such as extra stains or a molecular panel, they usually have to come off the block. Ask the second-opinion center whether it wants slides only, or slides plus the block.

NCI also describes what a full pathology report should contain: identifying information, "a gross description (a visual description of the specimen as seen by the naked eye), a microscopic description, and a final diagnosis," plus grade, lymph node status, margin status, stage, biomarker results where relevant, and a comments section. Check that the copy you send has all of it, including any addendum.

Your right to your own records is written in 45 CFR 164.524. Five parts of it are worth knowing by heart.

Speed. A provider "must act on a request for access no later than 30 days after receipt." It may take one extension of "no more than 30 days," and only if it gives you "a written statement of the reasons for the delay." One extension. Not two.

Format. The provider "must provide the individual with access to the protected health information in the form and format requested by the individual, if it is readily producible." If you ask for an electronic copy, it must be electronic when that is readily producible. You do not have to accept a printed stack.

Direct delivery. This is the clause that saves weeks. "If an individual's request for access directs the covered entity to transmit the copy of protected health information directly to another person designated by the individual, the covered entity must provide the copy to the person designated." You can order your records sent straight to the second-opinion center. You are not the mail carrier.

Fees. The regulation limits charges to labor for copying, supplies for creating the copy or media, postage when you ask for mailing, and preparing an explanation or summary if you agreed to one. The Department of Health and Human Services (HHS) is blunter for patients: a provider may "charge for the reasonable costs for copying and mailing the records" but cannot charge for searching for or retrieving them. HHS adds a line worth repeating at the desk: "a provider cannot deny you a copy of your records because you have not paid for the services."

Limits. The right does not cover psychotherapy notes, or "information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding."

If a records office simply stalls, there is a second law behind you. Under the 21st Century Cures Act, information blocking is "a practice by an 'actor' that is likely to interfere with the access, exchange, or use of electronic health information (EHI), except as required by law or specified in an information blocking exception." The definition sits at 45 CFR 171.103.

It binds three groups: health care providers, developers of certified health IT, and health information exchanges and networks. There are ten exceptions in 45 CFR Part 171, so not every delay counts. But patients can file a claim through the federal Report Information Blocking Portal, and the HHS Office of Inspector General investigates.

You rarely need to file. Saying the words "information blocking" to a records supervisor tends to move things, because health systems track these complaints.

Put it in writing, keep a copy, and be specific. A workable request names five things:

1. Exactly what you want. Date ranges, study names, report types, and the words "slides and paraffin block" if pathology is included.
2. The format. Electronic where possible, DICOM for images.
3. Where it goes. Full name, department, address, fax, and phone of the receiving center, with the instruction to send it directly there.
4. Your deadline, tied to your appointment date.
5. Your signature, date, and a callback number.

Then call three days later. Ask one question: "Has it been sent, and to whom?" Track each of the three shipments separately, because they leave from three different departments.

Work backward from the appointment. Records offices may lawfully take 30 days, plus one 30-day extension. Pathology departments often need a week or more to pull and package glass. Shipping adds days.

So a second opinion booked three weeks out is a race. If your appointment is sooner than that, tell both offices the date in writing, and ask the second-opinion center whether it can request the material directly. Centers with an established review service often move faster than a patient can.

Finally, use your own oncologist. NCI's list of questions to ask includes a direct one: "Will you help me find a doctor for a second opinion on the best treatment plan for me?" Asking it is normal, and most oncologists expect it.

See also Getting a Second Opinion, Understanding Your Pathology Report, and Understanding Your Health Insurance.

• https://www.hhs.gov/hipaa/for-individuals/medical-records/index.html
• https://www.ecfr.gov/current/title-45/section-164.524
• https://www.healthit.gov/topic/information-blocking
• https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/pathology-reports-fact-sheet
• https://www.cancer.gov/about-cancer/treatment/questions