2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9237 - Right to access protected health information

(a) Subject to the exceptions listed in subsection (b)(3) of this section, an individual who is the subject of the protected health information has the right to examine or receive a copy of the protected health information that is in the possession of the health insurance organization or issuer.
(b) An individual who is the subject of protected health information may request access to such information in writing to the health insurance organization or issuer. Not later than thirty (30) working days after receipt of such written request, a health insurance organization or issuer shall do one of the following: If it needs additional time to make the report, the health service organization or issuer shall have an additional term of thirty (30) calendar days to respond to the individual that made the request. Such additional term shall be notified to the individual that made the request prior to the expiration of the initial term, explaining the reasons therefor:
(1) Provide a copy of the protected health information requested to the individual or if providing a copy is not possible, permit the individual to examine the protected health information during regular business hours;
(2) notify the individual that it does not have the protected health information and, if known, inform the individual of the name and address of the person who has the protected health information requested, or
(3) deny the request in whole or in part if the health insurance organization or issuer determines any of the following:
(A) Knowledge of the protected health information would reasonably be expected to identify a confidential source who provided the same in conjunction with a lawfully conducted investigation or court proceeding;
(B) the protected health information was compiled in preparation for litigation, law enforcement or fraud investigation, or quality assurance purposes;
(C) the protected health information is the original work product of the health insurance organization or issuer, which would include but not be limited to interpretation, mental impressions, instructions and other original product of the health insurance organization or issuer, its employees and agents;
(D) the requester is a party to a legal proceeding involving the health insurance organization or issuer where the health condition of the requester is at issue, subject to the provisions of the Rules of Civil or Criminal Procedure or of Evidence in effect related to discovery in tort claims involving medical malpractice. However, once a legal proceeding is resolved, the individual's right to access protected health information shall be restored, or
(E) Disclosure of the protected health information to the individual who is the subject of the protected health information is otherwise prohibited by law.
(c) If a request to examine or copy protected health information is denied in whole or in part, the health insurance organization or issuer shall notify the individual the reasons for the denial in writing. When the protected health information was compiled in preparation for litigation, or as part of an investigation, the health insurance organization or issuer is not required to notify the individual of the reasons for the denial.
(d) A health insurance organizations or issuer is not required to create a new record in order to meet a request for protected health information.
(e) The health insurance organization or issuer may charge a reasonable fee for providing the protected health information requested and shall provide a detailed bill accounting for the charges. No charge shall be made for reproduction of protected health information requested for the purpose of supporting a claim or an appeal, or accessing any federal or Commonwealth sponsored or operated health benefit program.
History —Aug. 29, 2011, No. 194, added as § 14.070 on Aug. 23, 2012, No. 203, § 1, eff. 90 days after Aug. 23, 2012.