Romania: Requirements and procedures for obtaining medical records, within the country as well as from abroad

1. Patient Rights to Obtain Medical Documents

In 2 April 2014 correspondence with the Research Directorate, an official at the Embassy of Romania provided the following information regarding medical records, which the official obtained from the Ministry Health:

In accordance with the national legislation on the health insurance system, physicians are issuing medical letters containing information on the case history, diagnosis, risk factors, clinical and laboratory examinations, treatment which was recommended and pursued; patients discharged from hospital receive a Discharge note with the same contents.

[...]

In accordance with Article 6 of the Law on patients' rights No. 46/2003, the patient has the right to be informed of his condition, the suggested medical interventions, potential risks of each procedure, the alternatives to the proposed procedures, including to be informed about the risk of the failures to pursue treatment or to abide by to the medical recommendations, as well as about data on diagnosis and prognosis.

Also, in accordance with Article 12 of the same law, the patient has the right to request and receive, at discharge, a written summary of the medical investigations, diagnosis, treatment and the care provided during hospitalization. The request shall be addressed to the management of the respective health facility.

Similarly, in correspondence with the Research Directorate, a representative of Transparency International Romania (TI-RO), an NGO that aims to fight corruption at both the national and international levels, said that Article 24 of Law No. 46/2003 affords patients in Romania the right to access their personal medical records (TI-RO 31 Mar. 2014). The same source indicated that, upon discharge, the patient has a right to receive a "synthesis of his case" (ibid.).

In correspondence with the Research Directorate, a program coordinator at the Foundation for an Open Society (Fundația pentru o societate deschisã), an organization based in Bucharest that promotes the development of freedom, responsibility and respect for diversity (Fundația n.d.), said that a patient's medical record is usually given to the patient when he or she leaves the hospital or medical facility (ibid. 27 Mar. 2014).

2. General Procedures for Obtaining Medical Records

According to the Romanian official, medical records can be obtained at a later date "by sending a request or a letter to the respective health facility where the patient received the medical services" (Romania 2 Apr. 2014). The official indicated that there are no specific provisions regarding the cost or length of time to process the request (Romania 2 Apr. 2014).

The Foundation for an Open Society program coordinator stated that, if the patient requires a copy of a medical record at a later time, he or she should contact the doctor, who will direct the request to the administrators of the hospital or medical facility to check the institution's archives (Fundația 27 Mar. 2014). The Program Coordinator recommended contacting both the doctor and the management of the medical institution in these situations (ibid.). The TI-RO representative said that citizens have a right to "petition" authorities for their personal medical records, and that, according to the government ordinance pertaining to this issue, the authorities are obliged to answer the requester within 30 days (31 Mar. 2014). According to the Program Coordinator, the process can take up to a month, and sometimes longer, depending on the institution (Fundația 27 Mar. 2014). The TI-RO representative said that a citizen can make a request to the authorities at the unit where he or she was treated; the communication can be made by e-mail, regular mail or on site at the medical facility (TI-RO 31 Mar. 2014). The TI-RO representative added that the hospital "should" have a special department for handling these requests (ibid.).

The TI-RO representative noted that, according to the legislation, there could be a fee charged for issuing physical copies of the medical documents (ibid.). However, the Foundation for an Open Society Program Coordinator said that a fee is rarely charged for obtaining copies of the medical records (27 Mar. 2014).

Sources indicate that the procedures for obtaining medical records are standard throughout the country (TI-RO 31 Mar. 2014; Fundația 27 Mar. 2014; Romania 2 Apr. 2014).

2.1 Obtaining Medical Records through a Third Party

The Romanian official said that, according to Art. 22 of Law No. 46/2003, information about the patient's health can only be provided to a third party with the "patient's express consent" (ibid.). Both the TI-RO representative (31 Mar. 2014) and the Foundation for an Open Society Program Coordinator (27 Mar. 2014) said that a third party, such as a family member or friend, can obtain medical records on behalf of a person who is abroad, provided that the third-party representative has a notarized letter. The TI-RO representative noted that a family member would not need a notarized letter if the patient were a minor or were not mentally competent (TI-RO 31 Mar. 2014).

According to the TI-RO representative, permission for another person to access medical records can be arranged in one of two ways: through the Romanian consul's office abroad or through a notary (ibid.). The representative said that if the notarized letter is from a notary abroad, it would need to be translated and "legalized" in Romania (ibid.).

The official at the Embassy of Romania in Ottawa said the Embassy in Ottawa or the Consulates General of Romania in Montreal, Toronto or Vancouver can authenticate a power of attorney to authorize someone in Romania to access documents, such as medical records, on behalf of someone else (Romania 2 Apr. 2014). According to the official, a power of attorney can be authenticated on site when the person comes to the embassy or consulate, and the fee is approximately C$90 (ibid.). In terms of the requirements, the official said that the person arranging the power of attorney must have a valid identity document, such as a passport or ID card, to authenticate his or her identity (ibid.). The official also stated that it is necessary to have the particulars of the person in Romania being authorized to access the documents, such as the person's name, address, passport or ID number, and/or personal data (such as birth date or "Personal Number Code") (ibid.).

3. Challenges in Obtaining Medical Records

According to the Foundation for an Open Society Program Coordinator, the biggest challenge for someone to obtain a copy of their medical records is the poor management of the archives at the medical institutions and the long duration of the process (27 Mar. 2014). The TI-RO representative said that the lack of a centralized system of medical records poses a challenge because the person may need to address multiple medical units to obtain all the information needed (31 Mar. 2014).

4. Electronic Medical Records

In 2011, Romanian media sources reported that Romania's National Health Insurance House [Casa Nationala de Asigurari de Sanatate (Romania n.d.)], the CNAS, was in the process of creating a computerized system to manage patients' medical records electronically (Mediafax 11 Nov. 2011; Rompres 30 Aug. 2011). Information about the availability of electronic medical records through the CNAS could not be found among the sources consulted by the Research Directorate within the time constraints of this Response. However, the Foundation for an Open Society Program Coordinator said that the CNAS may be of assistance to patients who experience challenges accessing medical records (27 Mar. 2014).

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of sources consulted in researching this Information Request.

References

Fundația pentru o societate deschisă. 27 March 2014. Correspondence from a program coordinator to the Research Directorate.

_____. N.d. "About Us." [Accessed 1 Apr. 2014]

Mediafax. 11 November 2011. "Health Insurance-IT System-Medical Records / Romanian Health Insurance House Resumes Auction to Award IT System Contract." (Factiva)

Romania. 2 April 2014. Embassy of Romania in Ottawa. Correspondence from an official.

_____ .N.d. Casa Nationala de Asigurari de Sanatate (CNAS). [Accessed 2 Apr. 2014]

Rompres. 30 August 2011. "Health Ministry to Continue Paring Down Hospital Beds." (Factiva)

Transparency International Romania (TI-RO). 31 March 2014. Correspondence with a representative.

Additional Sources Consulted

Oral sources: Attempts to contact representatives of the following organizations were unsuccessful within the time constraints of this Response: Associatia Pro Democratia; Association for the Defence of Human Rights in Romania - the Helsinki Committee; Canada - Embassy in Bucharest; Romania - Ministry of Health; lawyers and nine hospitals in Romania. Two lawyers in Romania were unable to provide information.

Internet sites, including: Associatia Pro Democratia; Association for the Defence of Human Rights in Romania - the Helsinki Committee; Brasoc County Emergency Clinical Hospital; ecoi.net; Emergency Hospital Floreasca; legislationline.org; Romania - Embassy of Romania in Washington, DC, Ministry of Health, National Health Insurance House; United Nations - Refworld; United States - Bureau of Consular Affairs, Department of State.