Question or Task | Responsible Party | Completion Date | Comment |
What is the date of the acquisition or closure? | | | |
Who will review federal guidelines? | | | |
Who will review state guidelines? | | | |
Who will review medical staff rules and regulations? | | | |
Does an accrediting body require notification? | | | |
Locations of records | | | |
Location A (office) | | | |
Location B (off-site storage) | | | |
Location C (other) | | | |
What are the retention guidelines for adult records? | | | |
What are the retention guidelines for pediatric records? | | | |
Will records be transferred to another provider or organization? | | | |
If yes, on what date? | | | |
If yes, provide name, address, phone number. | | | |
If yes, who is the sender contact? | | | |
If yes, who is the receiver contact? | | | |
Who will inventory records to be sent? | | | |
When is the inventory due? | | | |
What will the inventory include? | | | |
Will records need to be retrieved from multiple locations? | | | |
Are all records complete? | | | |
If no, when are records to be completed? | | | |
Who is responsible for ensuring records are completed? | | | |
Will records be transferred to a storage facility? | | | |
If yes, on what date? | | | |
If yes, provide name, address, phone number. | | | |
Has business associate agreement (BAA) been signed? | | | |
If yes, who is the sender contact? | | | |
If yes, who is the receiver contact? | | | |
Is the receiving facility capable of handling protected health information? | | | |
Are staff at the receiving facility trained for maintaining and releasing protected health information? | | | |
If no, who will provide the training? | | | |
Will the sending organization continue to have access to records? | | | |
If yes, for what time period? | | | |
Are boxes required? | | | |
If yes, order by what date? | | | |
Who is responsible for boxing and inventorying records? | | | |
Do records need to be destroyed before acquisition or closure? | | | |
If yes, will destruction be completed by a third party? | | | |
If yes, is a BAA needed? | | | |
BAA required by what date? | | | |
What date will the records be destroyed? | | | |
By what means will the records be destroyed? | | | |
Has the destruction method been verified to be HIPAA compliant? | | | |
Who will purge the records for destruction? | | | |
By what date? | | | |
Who will certify destruction method? | | | |
Who will approve destruction requests? | | | |
What types of media are records currently in? | | | |
Paper | | | |
CD or disk | | | |
Magnetic tape | | | |
Electronic | | | |
Other | | | |
Which media will be transferred? | | | |
Paper | | | |
CD or disk | | | |
Magnetic tape | | | |
Electronic | | | |
Other | | | |
Which media will be destroyed? | | | |
Paper | | | |
CD or disk | | | |
Magnetic tape | | | |
Electronic | | | |
Other | | | |
Who will post media notices? | | | |
By what date? | | | |
Location | | | |
Location | | | |
Location | | | |
Who will handle requests for copies of health records? | | | |
In what format will records be released (paper, electronic, CD)? | | | |
When will patient notice be posted? | | | |
How long will patients have to request records? | | | |
How will legal requests during this transition be handled? | | | |
Has a records inventory been completed within the last year? | | | |
Will a records inventory be required before acquisition or closure? | | | |
Who is responsible for records inventory? | | | |
Are any records currently involved in litigation? | | | |
Who will notify legal counsel? | | | |
How will opposing counsel be notified? | | | |
Who will be responsible for these records until the acquisition or closure? | | | |
Who will be responsible for these records after the acquisition or closure? | | | |
Electronic health records (EHRs) | | | |
What is the sending organization systems? | | | |
System A: | | | |
System B: | | | |
System C: | | | |
System D: | | | |
Other: | | | |
What is the receiving organization system? | | | |
System A: | | | |
System B: | | | |
System C: | | | |
System D: | | | |
Are EHR systems compatible? | | | |
If yes, will records be transferred electronically? | | | |
If no, how will records be transferred? | | | |
Are legacy systems required for record retention? | | | |
If yes, which systems? | | | |
Will system access be required for the receiving organization? | | | |
If yes, who will authorize? | | | |
Will any information be e-mailed? | | | |
If yes, are proper security protocols in place? | | | |
Are there system archives or back-ups to inventory? | | | |
If yes, what are the locations? | | | |
If yes, in what format? | | | |
If yes, will these be transferred or destroyed? | | | |
Who is responsible for maintaining? | | | |
Has all billing been completed? | | | |
If no, when is expected due date? | | | |
Budgetary Needs | | | |
Labor (including outside consultant, if appropriate) | | | |
Copy equipment | | | |
Copy supplies | | | |
Postage | | | |
Telephone | | | |
Utilities | | | |
Transportation costs (to receiving organization or storage facility) | | | |
Storage costs (paper and electronic) | | | |
Retrieval costs (from storage facility) | | | |
Destruction costs | | | |
Notification costs | | | |
Legal counsel | | | |
Consultation fees | | | |
Software fees (e.g., conversion or archive costs) | | | |
Other: | | | |
Other: | | | |