Do I need my old records before a new doctor can order a test?

No, you do not need your old records before a new doctor can order a test. A physician orders based on the current evaluation: your history, your exam, and the clinical question in front of them today. Prior records make the interpretation better and prevent repeat testing, and they are a help rather than a requirement for getting started, so the appointment does not need to wait on the file.

When Your Doctor's Office Stops Calling Back | Philadelphia

TL;DR30-second take

Under the HIPAA right of access, a medical practice must act on your request for your own records within 30 calendar days, and cannot hold them back over an unpaid bill. Ask the imaging center directly for your scan images, since it holds them. If a finding is active, get seen while the records request is still moving.

TL;DR: If your doctor's office has stopped answering, you can still get things moving. Your records belong to you, and federal law gives you the right to a copy. Send a written request that lists what you want and says where to send it, and keep a dated copy of what you sent. Ask the imaging center for your scan pictures yourself, because they are the ones who have them. A new doctor can order your next test without redoing your whole workup. And if something is growing, changing, or already being watched, book the visit now and let the paperwork catch up.

Calling an office that does not call back is its own kind of tired. You leave the message, you wait, you tell yourself you will try again Monday, and somewhere in all that waiting the question you called about starts to feel like a thing you are supposed to solve by yourself. You are not, and none of this means you failed to push hard enough.

Practices go quiet for ordinary reasons. A front desk turns over, a physician leaves, a records department runs on a fax machine and a long queue, or the office is winding down and nobody has said so out loud yet. Whatever the reason on their end, the effect on your end is the same: your history is sitting somewhere you cannot get to, and your next step is stuck behind it. What follows is how to get both moving again, and how to tell when the medical question should not wait for the paperwork at all.

What should you do first when your doctor's office stops calling back?

When a practice stops calling back, the first move is to split the problem into 2 tracks and run them at the same time. The first track is paperwork: getting your records, your imaging, and your open orders out of that office and into your hands. The second track is medicine: whatever question you were calling about in the first place.

Those 2 tracks run on different clocks. Records move on a legal timeline measured in weeks, and there is a rule behind it that you can hold a practice to. A lump, a symptom that keeps getting worse, or a follow-up scan that was due 3 months ago runs on a clinical timeline, and that clock keeps going while a fax sits in somebody's queue. Keeping the 2 tracks separate is what stops a slow records department from turning into a delayed diagnosis.

Do you have a legal right to your own medical records?

Yes. Under the HIPAA Privacy Rule you have a right to see and get a copy of the health information a practice keeps about you, the practice has to act on your request inside a set window, and the U.S. Department of Health and Human Services Office for Civil Rights enforces that right. The rule is 45 CFR 164.524, and it is more specific than most people expect.

What you can ask for. Your medical record and your billing records, laboratory test reports, imaging reports, visit notes, consent forms, and the information the practice used to make decisions about your care. Psychotherapy notes kept separate from the chart, and material prepared for a legal proceeding, fall outside the right.

How long they have. A practice must act on your request no later than 30 calendar days after it receives the request. They may take a single extension of up to 30 more days, and only if they write to you inside that first 30-day window explaining why and giving the date they will be done. So 60 days is the outer edge, and it takes a written explanation to get there.

What they can charge you. A reasonable, cost-based fee, and the list of what it may cover is short: labor for making the copy, supplies such as paper or a disc, postage if you asked them to mail it, and labor to prepare a summary if you asked for a summary in advance and agreed to the cost.

What they cannot charge you for. Searching for and retrieving your records, verifying who you are, the clerical work of processing your request, or the cost of keeping their record system running. Those stay off your bill even where a state fee schedule appears to allow them.

Looking at your chart is free. You have the right to inspect your record rather than buy a copy, and a practice may not charge you for that, including when you photograph the pages with your own phone while you sit there.

An unpaid bill does not block you. A provider cannot deny you a copy of your records because you have not paid for care you received, and cannot hold the records back by applying your copy fee to an outstanding balance instead.

They cannot make you come in to ask. A practice may require the request in writing. It may not require you to appear in person to hand that request over when you could mail it, email it, or fax it.

Pennsylvania adds a layer on top. State law at 42 Pa.C.S. § 6155 gives a patient, or the person that patient designates, the right to their charts and records and to photocopies of them without any subpoena, and § 6152 caps what a provider may charge. The Pennsylvania Department of Health publishes the current fee schedule and adjusts it each January. When you are the one asking for your own records, the federal limits still govern the fee, so a state-listed search-and-retrieval charge does not become chargeable to you simply because it appears on a state schedule.

How do you write a records request that gets answered?

A records request gets answered faster when it is written, specific, and easy for a clerk to act on. Put it in an email or a letter rather than a voicemail. A written request starts the 30-day clock, and it leaves you holding proof of the date.

Name what you want item by item, rather than asking for "my records":

Visit notes for a date range you name
Laboratory results, including the values themselves rather than a summary letter
Imaging reports, and separately the images themselves
Pathology reports, if you have had a biopsy
Your immunization record
Your current medication list, with doses
Any referral or test order already placed that has not happened yet

Say where it goes. If you want the copy sent straight to a new physician, that request has to be in writing, signed by you, and clear about who the recipient is and where to send it. If you want the copy in your own hands, say the format you want: when a practice keeps your chart electronically, you have a right to an electronic copy in the form you asked for when they can produce it that way, and to a readable electronic alternative you both agree on when they cannot.

Then keep a dated copy of everything: what you sent, the day you sent it, who it went to, and the send confirmation. If you end up making the request by phone, follow it the same day with an email that repeats what you asked for and when. Documentation is what turns a stalled request into something a regulator can look at later.

One Philadelphia shortcut is worth running alongside the formal request. Penn, Jefferson, and Temple all run their patient portals on Epic MyChart, and a portal download is frequently available the same day, which gets a usable copy into your hands while the office copy is still in the queue. Our walkthrough of the MyChart export, with screenshots of each tap, covers both phone and desktop.

Why do you have to ask the imaging center separately for your scans?

The imaging center holds your pictures. The practice that ordered the scan usually has the radiologist's written report in its chart, and that report is a description of the images rather than the images themselves. The image files live in the archive at the facility where you had the exam.

That facility is a health care provider in its own right, so the same federal right of access reaches it directly and you can ask it directly. In practice this is often the fastest item on the whole list. Many centers will burn a disc while you wait at the front desk with a photo ID, and a growing number can share the study through an online portal or a secure image link. The American Medical Association's own guidance to physicians is to remind patients to ask for the disc before they leave the imaging appointment, which tells you how routine the ask is.

Ask for 2 things every time: the images, and the written report. A new physician can read a report in a minute, and a second look at a nodule, a mass, or anything that needs a side-by-side comparison against an older study takes the images. If you have had scans at more than 1 facility, each of them holds its own, so each of them gets its own request.

Can a new doctor order the next test without repeating everything?

Yes, in most situations. A physician orders the next test based on the evaluation in front of them: your story, your exam, and what today's clinical question calls for. Prior records make that work sharper and safer, and they are a help rather than a prerequisite.

In my practice, a first visit with no records at all still ends with a plan. We take the history in detail, examine what needs examining, and order the labs or the imaging that the current question calls for. When your old chart arrives 3 weeks later it adds trajectory, which is often where the answer has been hiding all along: a value that read "normal" at each visit on its own, while climbing steadily for 6 years, tells a different story than the same number seen once.

Old records mostly prevent repetition. A CT from 4 months ago rarely needs redoing, a colonoscopy from 2023 sets the interval for the next one, a specialist's note says what has already been ruled out, and a medication list keeps you from retrying something that did not agree with you. All of that is a good reason to chase the records, and a poor reason to postpone the appointment.

What can you do when the office does not respond at all?

When the request goes unanswered, escalation is a ladder, and each rung is written rather than spoken.

Start with the practice manager or the privacy officer. Every practice that keeps health records has to name a privacy official and a contact person for complaints, and the contact is usually printed on the Notice of Privacy Practices you signed at your first visit. Email that person, restate the date of your original request, attach it, and ask for a written answer by a date you name. A surprising number of stalled requests move at this step, because it is the first time the request reaches someone whose job includes it.

File a right of access complaint with the Office for Civil Rights. This is the federal route for records that never arrive. You can file through the OCR complaint portal or by mailing or emailing a signed complaint, and the customer response center is at 800-368-1019 (TDD 800-537-7697). File within 180 days of when you knew about the problem; OCR can extend that window for good cause. OCR investigates these complaints and publishes its resolutions.

If the holdup is electronic, there is a second federal route. When a practice or its software vendor is blocking access to electronic health information, that can be reported as information blocking, and HealthIT.gov explains how to submit that complaint.

For a concern about the care itself, the route in Pennsylvania is the Department of State. A finding nobody followed up on, an order nobody placed, a result nobody explained: those are care concerns rather than records concerns, and they go to the Bureau of Professional and Occupational Affairs, which routes them to the State Board of Medicine. You file a Statement of Complaint form through the Department of State complaint page. The complaint hotline is 1-800-822-2113 from inside Pennsylvania or 717-783-4849 from outside it, and RA-ST-Complaints@pa.gov will help you with the form.

Each of these routes exists so that a stuck request has somewhere to go. Using one is a way of getting your own information out of a system that has slowed down around it.

When should you stop waiting and get seen?

This is the part of the page I would ask you to hold onto. Some things should not wait on a records department, and the right move is to get seen now and let the paperwork catch up. Book the visit when any of this is true:

A lump, mass, or swelling you can feel, whether or not it hurts
A symptom that keeps getting worse week over week rather than holding steady
Bleeding with no clear explanation, from anywhere
An overdue follow-up on something already being watched: a nodule with a repeat scan due, an abnormal result that needed a recheck, a screening interval that has come and gone
A result you were told about but never had explained, and never got a plan for
Weight loss you did not set out to have, a fever that keeps returning, or night sweats that soak the sheets

Chest pain, trouble breathing, weakness on one side, a sudden severe headache, or new confusion needs an emergency department today, and 911 is the right call for any of those.

The records chase runs alongside all of that, and it never gates the visit. A new physician can examine you, order imaging, and start a workup on day 1 with nothing more than your own account of what has been happening, and the old chart adds context whenever it shows up. Waiting 6 weeks for a fax so that the first visit can be "complete" is how a small problem gets the time it needs to become a bigger one.

How does Fishtown Medicine handle a transfer that has stalled?

At Fishtown Medicine the records request is our work rather than yours. Once you sign the consent to coordinate care, you tell us where to pull from, whether that is a practice name, a hospital, or a whole system, and our team sends the requests and follows them. When a request has already been sitting somewhere for weeks, we restate it in writing with the original dates attached and push from our side, which is a different conversation than a patient calling alone.

While that is in motion, the medicine keeps going. Dr. Ash can order labs and imaging that your health insurance covers, so a scan that has been waiting on a callback can be ordered at your first visit instead of after the file arrives. Orders go straight to the laboratory or the imaging center, and results come back to us for review with you. When a test is not covered, or a high deductible makes cash the cheaper path, we compare local Philadelphia prices with you before anything is booked, and we pass the rate through without a markup. Prior authorizations are ours to handle too.

Fishtown Medicine is out of network for every insurance plan, and membership is a flat fee paid directly to the practice. We do not serve patients on Medicare or Medicaid, and if that describes you or someone in your family, our Medicare and Medicaid guides point toward good primary care and free counseling here in Philadelphia.

If you are in the middle of something worrying and the office has gone quiet, tell Dr. Ash what is going on. The intake asks what you have been dealing with, and a free 20-minute call with Dr. Ash follows from there.

Guidance from the Clinic

"What I want people to hear is that the record is a help and never a gate. I have started plenty of workups with nothing but the story someone told me across the table, and the chart caught up to us later. If something is growing or changing while a fax sits in a queue somewhere across town, come in and let me look at it, and we will chase the paper in the background. Nobody should have to run a records department and a symptom at the same time."

Actionable Steps in Philly

A records chase that runs in the background while your care keeps moving.

Send the written request today. Email it if you have an address for the office. Name the date range and the item list, say where it goes, and save the sent copy. The 30-day clock starts when they receive it.
Pull what you can yourself, in parallel. Penn, Jefferson, and Temple run their portals on Epic MyChart, and the export is frequently ready the same day. Our step-by-step walkthrough has the screenshots.
Call the imaging center directly about the scans. Ask for the images on a disc or through their portal, and ask for the written report as well. Many Philadelphia centers will hand you a disc at the desk with a photo ID.
Book the medical appointment on its own timeline. If a finding is being watched or a symptom is changing, that visit happens now, and the records catch up to it.
If 30 days pass with no answer, escalate in writing, then file. Practice manager or privacy officer first, then the OCR complaint portal for the records, and the Pennsylvania Department of State for a concern about the care.

Key Takeaways

The HIPAA right of access is a rule with a deadline. A practice must act on your request within 30 calendar days, with a single 30-day extension available only if it explains the delay to you in writing inside that first month.
An unpaid bill cannot buy your records back from you. A provider may not deny access because you owe money, and may not apply your copy fee to an outstanding balance as a way of holding the records.
The fee is narrow and specific. Copying labor, supplies, postage, and an optional summary are chargeable; searching, retrieving, verifying, and system maintenance are not, even where a state schedule lists them.
Imaging is its own request. The images live at the facility that performed the scan, so ask that facility directly and ask for the images and the report as separate items.
Care never waits on paperwork. A new physician can examine you and order the next test on day 1 with nothing but your account, so an active finding gets an appointment now while the records request keeps running in the background.

Building Your Health History: How to Share Previous Records - the MyChart export walkthrough and how to get old files to us
When You Feel Dismissed by Your Doctor - telling honest reassurance apart from dismissal, and how to be heard
Managing Labs and Imaging With Ease in Philadelphia - how orders, insurance, prior authorizations, and cash pricing work here
Specialist Synchronization - how referrals and specialist coordination are handled
Scope of Practice - what Fishtown Medicine treats, and where the edges are
Getting Started - what the first 90 days of a transfer look like

Scientific References

U.S. Department of Health & Human Services, Office for Civil Rights. "Individuals' Right under HIPAA to Access their Health Information, 45 CFR § 164.524." The governing federal guidance on scope, timelines, form and format, third-party directives, and permissible fees.
HHS Office for Civil Rights, FAQ 2050. "How timely must a covered entity be in responding to individuals' requests for access to their PHI?" The 30-calendar-day requirement and the single 30-day extension.
HHS Office for Civil Rights, FAQ 2024. "May a covered entity charge individuals a fee for providing the individuals with a copy of their PHI?" What a reasonable, cost-based fee may and may not include.
HHS Office for Civil Rights, FAQ 2031. "Are costs authorized by State fee schedules permitted to be charged to individuals when providing them with a copy of their PHI?" State-authorized search and retrieval costs remain non-chargeable.
HHS Office for Civil Rights, FAQ 2065 and FAQ 2034. "Is a health care provider permitted to deny an individual's request for access because the individual has not paid for health care services?" and "May a health care provider withhold a copy of an individual's PHI... to instead pay an outstanding bill?"
HHS Office for Civil Rights, FAQ 2035 and FAQ 2054. "Can an individual be charged a fee if the individual requests only to inspect her PHI?" and "Do individuals have the right to an electronic copy of their PHI?"
HHS Office for Civil Rights, FAQ 2036. "Can an individual, through the HIPAA right of access, have his or her health care provider send the individual's PHI to a third party?" Written, signed, and specific about the recipient.
HHS Office for Civil Rights. "How to File a Health Information Privacy or Security Complaint." The 180-day filing window and the OCR complaint portal.
Pennsylvania Department of State. "File a Complaint Against a PA-Licensed Professional." Statement of Complaint process through the Bureau of Professional and Occupational Affairs.
Pennsylvania Department of Health. "Medical Record Fees." The state fee schedule under 42 Pa.C.S. §§ 6152, 6152.1 and 6155, adjusted annually by the Consumer Price Index.
42 Pa.C.S. § 6155. "Rights of patients." Patient and designee access to charts and records without a subpoena.
American Medical Association. "Patient Access FAQs on Requesting Images on CD." Patient right to images in the requested form and format, and the practice of providing the disc at the imaging visit.
Radiological Society of North America and American College of Radiology. "How to Obtain and Share Your Medical Images." Image files are stored at the facility that performed the exam.
Assistant Secretary for Technology Policy / Office of the National Coordinator for Health IT. "If I experience information blocking, how do I submit a complaint to HHS?" Reporting route for withheld electronic health information.

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Frequently Asked Questions

Common Questions

A doctor's office must act on your request for a copy of your records no later than 30 calendar days after it receives the request, under the HIPAA right of access at 45 CFR 164.524. The office may take a single extension of up to 30 additional days, and only if it notifies you in writing inside the first 30 days with the reason for the delay and the date it will finish. That makes 60 calendar days the outer limit, and it requires a written explanation to reach it.

No. A health care provider cannot deny you a copy of your records because you have not paid for the services you received, and cannot withhold your records by applying the copy fee you paid toward an outstanding balance. The Office for Civil Rights has addressed both situations directly. An unpaid balance is a billing matter, and your right of access to your own health information is separate from it.

A practice may charge a reasonable, cost-based fee that covers only labor for making the copy, supplies such as paper or a disc, postage if you asked for it to be mailed, and labor to prepare a summary if you requested a summary in advance and agreed to that cost. It may not charge you for searching for and retrieving your records, verifying your identity, processing the paperwork, or maintaining its record system, even where a state fee schedule appears to permit those charges. Inspecting your chart in person, rather than buying a copy, carries no fee at all.

Ask the imaging facility that performed the scan, because that facility holds the image files while the ordering practice usually holds only the radiologist's written report. Most centers can provide the study on a disc, sometimes while you wait at the front desk with a photo ID, and many now offer an online portal or a secure image link. Request the images and the written report as 2 separate items, and repeat the request at each facility if your scans were done in more than 1 place.

For records that never arrive, file a right of access complaint with the U.S. Department of Health and Human Services Office for Civil Rights, through its online complaint portal or by mailing or emailing a signed complaint, generally within 180 days of when you knew about the problem. Escalate to the practice manager or privacy officer in writing first, since many stalled requests move at that step. For a concern about the care itself, such as a finding that nobody followed up on, Pennsylvania complaints go to the Department of State's Bureau of Professional and Occupational Affairs, which routes them to the State Board of Medicine.

Deep-Dive Questions

A HIPAA right of access complaint to the Office for Civil Rights is about the information: records that were not provided, were delayed past the deadline, or came with charges the rule does not allow. A state medical board complaint, filed in Pennsylvania through the Department of State's Bureau of Professional and Occupational Affairs, is about professional conduct and the standard of care: an abnormal result nobody acted on, a referral nobody placed, a pattern of unreturned calls about an active problem. The 2 routes answer different questions and can run at the same time, and neither one has to be finished before you establish care somewhere else.

Pennsylvania law at 42 Pa.C.S. § 6152 caps what a provider may charge for producing medical charts and records, and the Pennsylvania Department of Health publishes the schedule and adjusts it every January using the Consumer Price Index. When you are requesting your own records under the federal right of access, though, the HIPAA fee limits still control, and the Office for Civil Rights has said plainly that costs a state authorizes cannot be charged to you unless HIPAA also permits them. In practical terms that means a search-and-retrieval line item on a state schedule is not chargeable to a patient exercising the right of access.

When a practice closes or a physician retires, the records are usually transferred to a custodian, to another physician, or to a records storage company, and your right of access follows the records to whoever is holding them now. Start with any closing letter or notice you received, since it typically names the custodian and gives a phone number. If you have nothing, the state licensing board is often able to say where the records went, and hospital-affiliated practices generally keep the chart inside the health system's own record, which means the system's patient portal may still have it.

Old records change the interpretation more than they change the first plan. The first visit produces a plan either way, because the physician is working from your history, your exam, and today's clinical question. What the old chart adds is trajectory, which is where a lot of early disease shows itself: a fasting glucose that was called normal at each visit on its own while climbing steadily for 6 years, a TSH that has doubled over 3 years while staying inside the reference range, a nodule that was 4 mm and is now 7 mm. It also prevents repeat testing and tells the new physician what has already been ruled out, which is why the request is worth sending even when the appointment happens first.

Ready when you are