Appendix D: Sample Contractual Terms

The Physician’s Control of the Patient’s Medical Record

1. The Parties acknowledge and agree that in order to ensure clarity in respect of the rights, responsibilities, and management of Medical Records, it is necessary to designate a Responsible Physician for each Patient. The Parties will cooperate in determining who shall be so designated. No Party may be so designated without their own prior knowledge and consent [and the Patient’s prior knowledge and consent].
2. A Party is designated in the Patient’s Medical Record as the Responsible Physician for any Patient who that Party brings with him or her upon joining the Practice, unless otherwise instructed by the Patient.
3. For new Patients, a Party shall be designated as a Patient’s Responsible Physician in accordance with the Patient’s consent indicated on the [as appropriate: Intake form or Patient file Opening form or in accordance with the Responsible Physician Policy attached as Schedule to the Agreement].
4. The Responsible Physician has the right:
   1. to access to the Medical Record at any time;
   2. to authorize or refuse to authorize who may access their Patient’s Patient Information;
   3. to be given notice of any access, use, or disclosure of any Patient Information held by the Practice in any form whether in the Medical Record or otherwise, upon request;
   4. to require the Practice to transfer a complete copy of the Medical Record into the custody of the Responsible Physician, or to the custody of any third party as directed by the Responsible Physician; and
   5. [insert any other right as agreed ]
5. The Responsible Physician shall cooperate with the Practice in promptly responding to a Patient’s request:
   1. for access to his or her Medical Record;
   2. for correction or notation of his or her Medical Record;
   3. for provision of a copy of the Medical Record or portion thereof to any third party;
   4. to designate another physician within the Practice as Responsible Physician for that Patient; or
   5. to transfer his or her Medical Record to another physician or clinic.
6. In the event that a Party wishes terminate his or her designation as the Responsible Physician in respect of a Patient, he or she shall notify the Patient and provide the Practice [# days] written notice.
7. In the event that a Party is unable to fulfill the obligations of the Responsible Physician due to illness, disability, or death, he or she shall, if reasonably possible, cooperate with the Practice and the other Parties to facilitate transfer of his Patients to his or her designated successor.