General Office Practices/Protocols - Frequently Asked Questions
- Are physicians required to have a chaperone present in the room when examining patients?
- Can a physician refuse me as a patient if I choose not to sign the doctor's Arbitration Agreement?
- Does a physician have to accept new patients?
- Does a physician have to write reports and sign documents for disability or Workers' Compensation purposes? Does this have to be done within a specific time frame? Can they charge for this service?
- Is a physician required to carry malpractice insurance?
- Can a physician refuse to treat a current patient?
- Does my physician have to provide a "back up" physician when he/she is unavailable; i.e., during vacations or after-hours care?
- How long must a physician's office maintain a patient's medical records?
- How do I obtain a death certificate to find out the name of the physician who signed the form?
- Can I file an anonymous complaint on behalf of a family member/friend against a physician if I believe he/she is overprescribing?
- I received a medical evaluation with faulty information which resulted in the cancellation of disability, Workers' Compensation, or other benefits. Can I file a complaint?
- Can the Medical Board help in finding a physician for Medi-Cal, Medicare, a specialist or a IME/QME?
- Can a physician treat and prescribe to family, friends or employees?
- Can a physician have a personal relationship with a patient?
- What if a personal relationship developed between the physician and the patient and it was consensual?
- My teenage child was seen by the physician and the physician refuses to disclose the reason for the visit. Can I withhold payment of the bill unless the physician answers my questions or provides me with the medical record from the visit?
- What is required by the Medical Board to open a medical clinic?
- How do I obtain copies of my lab results?
Are physicians required to have a chaperone present in the room when examining patients?
No. California law does not require physicians to have a male or female chaperone; however, if having a chaperone or assistant in the exam room makes the patient feel more comfortable and at ease, then the physician should accommodate the patient's request if possible or allow a friend or relative to accompany the patient.
Can a physician refuse me as a patient if I choose not to sign the doctor's Arbitration Agreement?
Yes, the physician can choose to not accept a new patient who does not want to sign the Arbitration Agreement.
Does a physician have to accept new patients?
No. A physician has a right to determine whom to accept as a patient, just as a patient has the right to choose his or her physician. A physician also may terminate a patient without cause as long as the termination is handled appropriately (see Question "Can a physician refuse to treat a current patient?").
Does a physician have to write reports and sign documents for disability or Workers' Compensation purposes? Does this have to be done within a specific time frame? Can they charge for this service?
There are no specific laws governing a physician's responsibility in regard to filling out forms for disability insurance or providing reports, etc. Patients should contact their attorney if one is involved, or the disability or Workers' Compensation program, requesting the information as they may have specific rules and/or laws regarding the timely filing of forms/reports. They also may have alternatives that the patient can use if the physician won't cooperate. The Medical Practice Act does not preclude the physician from charging for this service.
Is a physician required to carry malpractice insurance?
No. A physician only is required to carry liability insurance in an outpatient surgery setting pursuant to Business and Professions Code section 2216.2. However, a physician must follow the reporting requirements cited in Business and Professions Code section 802 in regard to lawsuit settlements and arbitration awards. You can find a complete description of the requirements in the Business and Professions Code at the official California Legislative Information Web site, www.leginfo.ca.gov.
Can a physician refuse to treat a current patient?
Yes, but the physician needs to follow appropriate guidelines. See California Medical Association (CMA) guidelines in regard to terminating the doctor/patient relationship. The CMA guidelines indicate a physician must notify the patient in writing informing the patient:
- the last day the physician will provide care, assuring the patient at least 15 days of emergency treatment and prescriptions before discontinuing service;
- alternative sources of medical care; i.e., referral to another physician, the patient's insurer/HMO, or the local county's medical society; and
- information necessary to obtain the patient's medical records compiled during this physician's care.
Does my physician have to provide a "back up" physician when he/she is unavailable; i.e., during vacations or after-hours care?
No. While there is no law mandating a physician provide "back up or cross covering" care when he/she is unavailable, most physicians do have emergency coverage available when they are unavailable, whether it be with another physician or directing the patient to Urgent Care or to a hospital's emergency department.
How long must a physician's office maintain a patient's medical records?
There is no general law requiring a physician to maintain medical records for a specific period of time. However, there are situations or government health plans that require a provider/physician to maintain their records for a certain period of time. Several laws specify a three-year retention period: Welfare and Institutions Code section 14124.1 (which relates to Medi-Cal patients), Health and Safety Code section 1797.98(e) (for services reimbursed by Emergency Medical Services Fund), and Health and Safety Code section 11191 (when a physician prescribes, dispenses or administers a Schedule II controlled substance). The Knox-Keene Act requires that HMO medical records be maintained a minimum of two years to ensure that compliance with the act can be validated by the Department of Corporations. In Workers' Compensation Cases, qualified medical evaluators must maintain medical-legal reports for five years. Health and Safety Code section 123145 indicates that providers who are licensed under section 1205 as a medical clinic shall preserve the records for seven years. However, there is no general statute which relates to all other types of medical records.
How do I obtain a death certificate to find out the name of the physician who signed the form?
You may contact the Department of Vital Statistics at (916) 445-1719 to obtain a copy of a death certificate.
Can I file an anonymous complaint on behalf of a family member/friend against a physician if I believe he/she is overprescribing?
The Board receives and investigates a number of complaints about physician prescribing concerns which are sent by someone other than the patient. These complaints can be difficult to investigate when the patient does not consent to allow the Board to evaluate the care and treatment. It is very helpful in these situations if the Board is provided with as much information as possible about what specific medication is being prescribed and the quantity and frequency. Sometimes this information can be obtained from the pharmacy where the prescriptions are filled. The Board will try to validate the information and in the event that sufficient evidence is available to support a possible violation of the law, an investigational subpoena will be issued for the patient's medical records.
I received a medical evaluation with faulty information which resulted in the cancellation of disability, Workers' Compensation, or other benefits. Can I file a complaint?
The Board has very limited jurisdiction over independent evaluation reports. The role of the evaluator is to provide an "independent opinion" of the individual's condition after 1) examining the patient and/or 2) reviewing the records of the treatment obtained by the other treating physicians involved in the patient's care. The Board will normally recommend that disability patients pursue an appeal through the disability insurance company.
Worker's compensation independent (IME) and qualified medical examiner (QME) evaluations are governed by the Medical Unit of the Division of Workers' Compensation. This state agency is responsible for regulating the conduct of IMEs and QMEs in workers' compensation cases, and may be able to advise you on other workers' compensation-related issues. You may contact them at P.O. Box 8888, San Francisco, CA 94128-8888.
Can the Medical Board help in finding a physician for Medi-Cal, Medicare, a specialist or a IME/QME?
No, the Board does not provide referrals to physicians. You can contact your local medical association for referrals in various medical specialties or your individual insurance plan or HMO. To locate the medical association/society in your area you can log onto the California Medical Association's Web site at http:/www.cmanet.org/ PUBLICDOC.cfm?docid=63.
Can a physician treat and prescribe to family, friends or employees?
There is no law which specifically prohibits a physician from evaluating, diagnosing, treating, or prescribing controlled substances to a family member, employee or friend. However, the practice is discouraged. There are laws to consider when assessing any prescribing issues which include: 1) a physician cannot prescribe without a "good faith" exam and 2) a medical record must be created which documents the medical need for the prescription. Basically, a physician must follow the same practice/protocol for any patient in which medications are prescribed.
Can a physician have a personal relationship with a patient?
Business and Professions Code section 726 states that sexual abuse, misconduct or relations with a patient are considered unprofessional conduct and grounds for disciplinary action. The Board considers any type of personal relationship between the doctor and the patient to be a very serious breach of public trust and investigates these complaints. Please refer to "Questions and Answers about Investigations" which provides general information about complaint investigations.
What if a personal relationship developed between the physician and the patient and it was consensual?
The fact that the personal relationship between the physician and the patient at some point was consensual does not negate the fact that the physician breached professional ethics and boundaries, and possibly broke the law, by initiating a personal relationship with a patient. Filing a complaint with the Board would be strongly encouraged so the issue could be investigated in the event that other complaints with similar allegations had been reported.
My teenage child was seen by the physician and the physician refuses to disclose the reason for the visit. Can I withhold payment of the bill unless the physician answers my questions or provides me with the medical record from the visit?
No. Children from the age of 12-17 have the authority to "consent" to some types of treatment without the permission of their parent or guardian. The physician is obligated to maintain the doctor/patient confidentiality, particularly when the physician feels that the disclosure of the information will have a negative impact on the relationship with the patient. HIPAA also prevents the disclosure of doctor/patient information to the parent. i.e., treatment related to the prevention of sexually transmitted diseases.
What is required by the Medical Board to open a medical clinic?
The medical clinic must be wholly owned and controlled by a physician or physicians (a layperson cannot own a clinic). See Business and Professions Code sections 2400 - 2417 and Corporations Code sections 13400 - 13410 for the requirements on what business structures can be used (sole ownerships, professional partnerships, and professional corporations). If the physician/owner is practicing under a name other than his/her own name (i.e., a clinic name, like "Sun Valley Medical Clinic"), the physician must obtain a Fictitious Name Permit (FNP) from the Medical Board. This is separate from any fictitious business name filings required by city or county governments. Applications for the Medical Board's FNP can be obtained either on the Board's Web site or from the Consumer Information Unit at 1-800-633-2322. If a physician who owns a clinic is a Medicare provider, he or she can obtain certification for the clinic through the Department of Public Health without having to apply for an FNP.
How do I obtain copies of my lab results?
Health and Safety Code section 123148 requires the health care professional who requested the test be performed to provide a copy of the results to the patient, if requested either orally or in writing. When the patient requests his/her lab results, the health care provider should provide the results to the patient within a "reasonable" time period after the results are received by the provider. Depending on the results of the tests, some physicians may want the patient to schedule an appointment to review and discuss the results and any follow-up testing or treatment that might be required. The test results cannot be released by the lab performing the test and must be released by the provider requesting the test(s).