How to get all of your medical records, not just the portal view

If you have ever logged into a patient portal, you have seen your medical record. Or so it feels. Results, visit summaries, a medication list, some notes. It looks complete because there is no indication of what is not there.

The portal is a view, chosen by your health system, of a record that is much larger. People usually find this out at a bad moment: a disability hearing, a second opinion, a dispute with an insurer, or a new specialist who asks what the last one found. The folder they thought they had turns out to be a brochure.

This post covers what the full record contains, what United States federal law says you can have, how to ask so that you get all of it, and how to tell when you have not.

What the portal leaves out

Portals are built for the routine: recent results, upcoming appointments, messages, and since 2021 most visit notes. What they tend not to show:

• Anything from before the current software. Health systems change electronic record systems, and older records are often kept in an archive that the portal does not reach. Anything on paper, including most records from before roughly 2010, is out of reach entirely.
• Scanned and faxed documents. Referral letters, consult reports from outside specialists, records you brought in, operative reports from another hospital. These sit in a document folder that portals rarely surface.
• The parts of a hospital stay you did not see. Nursing notes, triage notes, medication administration records, vital sign flowsheets, anesthesia records, and the full discharge summary. The portal shows the physician’s summary, if that.
• Images. The radiology report may be in the portal. The images themselves are held by the imaging department in a separate system.
• Pathology and the full laboratory report. A result in the portal is a value. The report behind it may carry comments, method notes, and specimen details that never appear on screen.
• Correspondence and billing. Letters between your providers, prior authorization paperwork, and the billing record with its diagnosis codes. Billing records are part of your record under the law, and they are where a surprising diagnosis often first appears.
• Records held by someone else. The urgent care you visited once, the employer screening, the direct-to-consumer lab, the imaging center, the pharmacy. Your doctor’s office holds its own records. It will not collect these for you.

Two of the reference articles behind this post, from the disability-focused site How to Get On, make the point bluntly: do not settle for anything called a summary, and do not assume anyone, including a lawyer, is collecting your records for you. (How to collect all your medical records)

What you are entitled to

The federal right of access, at 45 CFR 164.524, gives you the right to inspect and obtain a copy of your protected health information in a designated record set. That phrase is the key to the whole exercise, because it is what you should ask for by name.

The regulation defines it as the medical records and billing records a provider maintains about you, plus anything else the organization uses, in whole or in part, to make decisions about you (45 CFR 164.501). That covers the notes, the scanned documents, the nursing records, the images, and the billing file.

There are exclusions. You do not have a right to psychotherapy notes, which are a narrow category: a mental health professional’s private session notes kept separate from the rest of your chart. Your diagnoses, medications, and treatment plan from a mental health provider are not psychotherapy notes, and you can have them. You also cannot get information compiled for a lawsuit, or internal quality review and peer review material that is not used to make decisions about you.

The rules around the request:

• Deadline. The provider has 30 calendar days to act. They may take one extension of up to 30 more days if they tell you in writing why, within the first 30.
• Format. If you ask for an electronic copy of records they keep electronically, they must provide one if it is readily producible. You can ask for a specific format such as PDF, and they must provide it if they can.
• Fees. Only a reasonable, cost-based fee: the labor of copying, supplies, postage if you asked for mail, and preparing a summary if you asked for one. They may not charge for searching for or retrieving your records. Many states cap fees lower than federal rules would allow, and the lower cap applies. HHS has said a flat fee of $6.50 is always acceptable for an electronic copy of electronic records.
• Barriers. They may require a written request, and may ask you to use their form, if they tell you so. They may not require you to come in person, use the portal, or give a reason.
• Sending it elsewhere. You can direct the copy to another person or organization, in a signed writing that names the recipient.

The HHS guidance on the right of access sets all of this out in plain language and is worth reading before you write to a records department that is giving you trouble. HHS has also brought dozens of enforcement actions against providers who ignored requests, which is useful context when a department tells you the rules are otherwise.

How to ask so you get everything

Records departments answer the question you asked. “A copy of my records” is often read as the visit summaries and results. Ask for the whole set, in writing, and list the pieces.

Find the right office first. In a hospital it is usually called Health Information Management or Release of Information. A physician group may have its own, separate from the hospital it is attached to, even when both use the same portal. Ask for their form and use it, then attach a letter that says what you actually want:

I am requesting a complete copy of all records in my designated record set under 45 CFR 164.524, for dates of service from [date] through [date]. This includes but is not limited to: all progress and clinic notes, consultation reports, hospital records including nursing notes, medication administration records and discharge summaries, operative and anesthesia records, laboratory and pathology reports, radiology reports, scanned and outside documents, correspondence, and billing records with diagnosis codes. Please provide the records electronically as PDF. Please also tell me how to obtain copies of any radiology images.

If any portion of this request is denied, please identify what was withheld and the basis for the denial, as the regulation requires.

Some practical points:

• One request per organization. The hospital, the physician group, the lab, the imaging center, and the pharmacy are separate custodians. If you saw a specialist once, they hold that record, not your primary care office.
• Date ranges help. A request for “everything since 1998” can trigger the extension. Splitting a long history into a few ranges often gets each one faster.
• Images are separate. Ask the imaging department for a disc or download of the studies themselves, not just the reports. Most now offer an online download.
• Ask what archives exist. If the organization changed systems, ask whether records from the previous system are included. Often they must be requested separately from a legacy archive, and staff will not mention it unless asked.
• Keep the paper trail. Note the date you sent the request. The 30 days run from then.

How to tell if something is missing

There is no table of contents for your record, so you cannot check the delivery against a list. You can check it against your own memory and against itself.

• Count the visits. For each year, list the encounters you remember. Every one should have a note. An admission should have far more than a discharge summary.
• Look for the outside documents. If a specialist sent a report to your primary care doctor, it should be in the primary care record as a scanned document. If the chart refers to a letter, an image, or a prior report, that item should be there too.
• Read the notes for references you cannot follow. “Discussed results from outside labs” or “reviewed prior imaging” means another record exists.
• Check the billing file against the clinical file. A diagnosis code on the bill should correspond to something in a note. When it does not, either a note is missing or the code is wrong. The second case is the subject of the next post.
• Notice how easy it was. The second reference article observes that a records department that asks you to sign nothing and charges you nothing is often handing over a summary, not the record. (How to tell if there are medical records you have not seen)
• Ask for the accounting of disclosures. Under 45 CFR 164.528 you can ask who your records were sent to, outside of treatment, payment, and operations. It is a partial list, but it can reveal organizations holding copies you did not know about.

If the delivery is thin, write back, name what is missing, and quote the request. Departments frequently fill the gap once someone asks specifically.

When they stall or refuse

Escalate in order. The records supervisor first, then the organization’s privacy officer, whose contact details must appear in the notice of privacy practices you were handed at your first visit. Put the history in writing: the date of your request, what you received, what is missing, and the deadline that has passed.

If that fails, you have two federal complaint routes. The HHS Office for Civil Rights takes complaints about the right of access, and you generally have 180 days from the violation to file. Separately, a provider that unreasonably interferes with your access to electronic health information may be committing information blocking under the 21st Century Cures Act, which you can report to the Office of the National Coordinator. Since October 2022 that rule covers all of your electronic health information, not just a core subset, and it is the reason your notes now show up in the portal at all.

What to do with a complete record

A full record from three or four organizations is a large pile of PDFs. The valuable part for day-to-day health is a fraction of it: the lab and pathology results, the medication list, the problem list, and the notes that explain why things changed.

HealthViewer is built to hold that part. It reads PDF reports, CSV files, Epic CDA exports and MyChart ZIP bundles, recognizes the major lab report formats, and connects directly to health system portals over SMART on FHIR so future results arrive without another request. Everything is stored in an encrypted file on your own computer. HealthViewer is a lab results tracker first, and the reason to collect a complete record is the same reason to track results at all: a single value tells you where you are, and only the whole history tells you where you are going.

Once you have read your complete record, you may find things in it that are wrong. The follow-up post, how to fix an error in your medical records, covers what you can correct, what you can only annotate, and how to do each.

This post describes United States federal rules as of September 2026 and is general information, not legal advice. State law adds requirements in many places, including shorter deadlines and lower fee caps, and special handling for mental health, substance use, HIV, and genetic information.