corresponding claim in a paperless environment, the must claimant send the form directly to the medical care provider, or obtain the records and submit them to VA. g. Claimant As noted in M21-1, Part I, 1.C.5.a, VA must notify the claimant of its Notification inability to obtain relevant private treatment records identified by the When PMRs claimant. Are Unavailable Follow the steps in the table below, when attempts to obtain the private treatment records are unsuccessful. The RO must follow these steps to notify the claimant regardless Important: of whether the records were requested by the PMR Program contractor or the RO. Step Action 1 The decision maker must free text the following into the Evidence section of the rating decision. [name of Private Medical Records (PMR) requested from provider], but not received. 2 If using the Automated Decision Letter (ADL) process, the VSR must ensure the unavailable records are listed in the section of the decision notice. Evidence Considered If generating the decision notice through Personal Computer Generated Letters (PCGL), the VSR must ensure the rating decision with the free texted evidence from Step 2 is attached to the decision notice. For more information on References: the section of the rating decision, see M21-1, Part III, Subpart iv, Evidence 6.C.4, and decision notices, see M21-1, Part III, Subpart v, 2.B. The HIPAA Privacy Rule protects all h. General "individually identifiable health Information held or transmitted by a covered entity or its business associate, information" About HIPAA in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information protected health information (PHI). PHI includes the and present physical or mental health condition(s), and individual’s past the health care provided to the individual.
corresponding claim in a paperless environment, the claimant must send the form directly to the medical care provider, or obtain the records and submit them to VA. g. Claimant Notification When PMRs Are Unavailable As noted in M21-1, Part I, 1.C.5.a, VA must notify the claimant of its inability to obtain relevant private treatment records identified by the claimant. Follow the steps in the table below, when attempts to obtain the private treatment records are unsuccessful. Important: The RO must follow these steps to notify the claimant regardless of whether the records were requested by the PMR Program contractor or the RO. Step Action 1 The decision maker must free text the following into the Evidence section of the rating decision. Private Medical Records (PMR) requested from [name of provider], but not received. 2 If using the Automated Decision Letter (ADL) process, the VSR must ensure the unavailable records are listed in the Evidence Considered section of the decision notice. If generating the decision notice through Personal Computer Generated Letters (PCGL), the VSR must ensure the rating decision with the free texted evidence from Step 2 is attached to the decision notice. References: For more information on the Evidence section of the rating decision, see M21-1, Part III, Subpart iv, 6.C.4, and decision notices, see M21-1, Part III, Subpart v, 2.B. h. General Information About HIPAA The HIPAA Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information protected health information (PHI). PHI includes the individual’s past and present physical or mental health condition(s), and the health care provided to the individual.
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