Meet the Medical Records Department
The Medical Records Department is located in the back of the Hospital and consists of seven employees. This Department is responsible for coding, storing and handing over (parts of) medical records to inter alia former patients, foreign hospitals and insurance companies for invoicing purposes. This Department also provides important data to the Management and Board of Directors of the HOH to support strategic decision-making by the Hospital and for the purpose of COVID-19 reporting.
Patient Medical Record
A medical record is kept of each patient treated in the Hospital, including hospitalized patients and one-day patients, by the care providers involved in the treatment. This also applies to treatments on an outpatient basis. However, these treatments are not coded by the Medical Records Department as yet. A medical record contains all data and information related to the treatment of a patient in the Hospital. Examples include data and information obtained from the medical history, type of surgery, duration of surgery, examination results, medication administered, etc. When a patient leaves the Hospital, his or her record is submitted to the Medical Records Department. This concerns the paper record.
Since a number of years, the Hospital has an EMR (Electronic Medical Record). The majority of treatments are currently documented in this program.
The statutory retention period for a medical record is 10 years. The retention period for a medical record of minors, persons under the age of 18, begins when that person becomes of age, i.e., 18 years. This record is retained until that person turns 28. After the expiration of this period, this record is also destroyed unless special circumstances arise that require a longer retention period.
Request of Medical Record
It may be that a patient wants to inspect or needs information from his or her medical record, for example, to continue medical treatment abroad, to request a second opinion or for the benefit of an insurance company. In such a case, a patient may submit an authorization for disclosure of personal health information form to the Medical Records Department.
The administration fee involved is AWG 25.- if the person picks up the record at the Medical Records Department. If the record has to be sent abroad, the administration fee involved is USD 70.-.
Authorization for disclosure of personal Health Information Forms
As a (former) patient, you may apply for a copy of your record. To do so, you must bring a valid identification document. You may also authorize someone to do it for you. The authorization must clearly state to whom it is granted, what information is requested and for what purpose the information is requested. The person authorized who is coming to pick up a copy of the record must have a signed authorization letter with him or her, including a valid copy of the (former) patient’s ID. This person must also show his or her own valid ID. It will first be verified whether the (former) patient has no outstanding debt with the Hospital. Outstanding invoices must first be paid.