When a medical practice closes, sells, or transitions to new ownership, patient notification is one of the most legally and ethically significant obligations the departing provider must meet. Patients have a right to know where their health records are going, how to access them, and who to contact when they need them.
Transferring records to a medical records custodian without adequate notification leaves patients without that information and exposes the practice and its principals to regulatory complaints, HIPAA enforcement actions, and state medical board proceedings.
Notifying patients before a records transfer is not optional, and it is not simply a courtesy. It is a defined obligation that requires specific content, appropriate delivery, documented execution, and enough lead time for patients to respond. This article explains what the notification process requires, what it should contain, how it should be sent, and how the medical records custodian fits into the process.
Why Patient Notification Is Required
The obligation to notify patients when a practice is closing or transferring records to a custodian flows from multiple sources simultaneously.
Under HIPAA, patients have a fundamental right to access their protected health information and to know who maintains it. When a practice closes and records move to a third-party custodian, that custodian becomes the new holder of the PHI.
Patients who are not informed of that change cannot exercise their access rights, cannot authorize transfer of records to a new provider, and cannot update their healthcare relationships with accurate information about where their history is maintained.
The American Medical Association’s Code of Medical Ethics and the guidance issued by most state medical associations describe patient abandonment as an ethical violation, and closing a practice without adequate notice or making records unavailable without explanation can be interpreted as a form of abandonment.
State medical boards take these complaints seriously, and enforcement actions related to practice closures frequently cite inadequate patient notification as a primary concern.
Many state medical practice acts contain explicit requirements about notifying patients when a practice closes, including minimum notice periods, required content, and acceptable delivery methods. These requirements vary by state and should be confirmed with the relevant state medical board or a healthcare attorney before the notification process begins.
Who Should Receive Notification
The question of which patients require notification is one that practices sometimes underestimate. A conservative and defensible approach is to notify all patients who have been seen within the past two to three years, as well as any patient who has an ongoing or active treatment relationship regardless of when they were last seen.
Beyond active patients, practices should consider notification for:
- Patients with pending referrals, test results, or treatment plans who may not know their care is being disrupted
- Patients with chronic conditions who are likely to need ongoing access to their history and medication records
- Parents or guardians of minor patients whose records will remain in the system until the children reach adulthood and may need them for school, insurance, or future care
- Patients who have specifically requested records transfer in anticipation of the closure, who should receive confirmation of where their records will be held
State laws sometimes specify a defined look-back period for patient notification, such as requiring notice to all patients seen within the past three years. Where state law is more specific than a general best-practice recommendation, the state standard controls.
What the Patient Notification Must Include
The content of the notification matters as much as the fact of sending it. A notice that tells patients the practice is closing but does not tell them how to access their records afterward is insufficient. A complete patient notification for a medical records custodian transfer should include:
- The name and contact information of the practice, including the departing physician’s name and the practice name
- A clear statement that the practice is closing or transitioning, with the effective date
- What is happening to the patient’s records, specifically that records will be transferred to and maintained by a named medical records custodian
- The name, address, phone number, and any relevant website or portal information for the medical records custodian so patients can contact them directly for future access requests
- How to request a copy of records before the transfer date, if patients wish to have their records in hand before the practice closes
- How to authorize transfer of records to a new healthcare provider, including any authorization form that should be completed
- How long records will be retained by the custodian, so patients understand that their records will remain accessible beyond the closure date
- Any deadline by which the patient should act, if the practice is accepting record requests only through a specific date before closure
- Instructions for patients who have questions, including who to call and a contact for the state medical board if a patient believes their rights have not been met
The tone of the notification matters too. Patients receiving notice that their physician’s practice is closing may be anxious about their care. The notification should be clear, calm, and focused on what the patient needs to do next rather than on the administrative or legal context of the closure.
How to Send Patient Notifications
The method of delivery affects both the reach of the notification and its defensibility if a patient later claims they were never informed.
Written notice by first-class mail is the most common and most defensible approach. A letter sent to the patient’s address on file creates a dated record of when the notification was sent and what it contained. For patients where delivery confirmation matters, certified mail with return receipt provides additional documentation.
Email notification is appropriate when the patient has previously consented to receiving communications electronically and when the practice’s records show a verified email address. Email notifications should not replace mailed notices but can supplement them for patients with active patient portal accounts or documented email consent.
Posted notice in the office is a useful supplement during the period the office is still operating. A notice at reception, in exam rooms, and on the practice’s website ensures that patients who call or visit during the transition period receive the information directly.
Local newspaper notice is required by some states as an additional step in the patient notification process and is particularly important for reaching patients who may have moved without updating their address on file. Even where not legally required, a newspaper notice is a recognized standard of care for practice closures.
Practice voicemail or phone tree message is a practical supplement that catches patients who call the practice during the transition period. The recorded message should include the same core information: that the practice is closing, who to contact for records, and how to reach the custodian.
Sending the notification with enough lead time for patients to act on it is as important as sending it at all. Most guidance from state medical associations and medical boards recommends a minimum of 30 days notice before closure, with 60 to 90 days preferred where circumstances allow.
For planned closures, longer lead times reduce the volume of last-minute requests and give patients more opportunity to establish care with a new provider before they are in urgent need.
What to Do When Patients Do Not Respond
A common concern among practices planning a closure is what happens to patients who receive the notification but take no action. The answer is straightforward: their records are transferred to the custodian as planned.
The notification process gives patients an opportunity to exercise their rights. It does not require them to do so. A patient who receives notice and does not request copies or authorize transfer before the closure date can still request their records from the custodian after the transfer, using whatever process the custodian has established for access requests.
What the practice cannot do is withhold records from the custodian because some patients have not responded, or destroy records of non-responding patients. The retention obligation continues regardless of patient response, and the custodian assumes responsibility for fulfilling access requests throughout the applicable retention period.
The Medical Records Custodian’s Role in the Notification Process
A professional medical records custodian contributes to the patient notification process in several important ways.
First, the custodian’s contact information must be included in the notification. Patients need a specific, reliable point of contact for future record requests. If the practice sends notifications before confirming custodian arrangements, patients may receive contact information for an entity that is not yet prepared to receive their requests.
Second, an experienced custodian can often assist with drafting notification language, reviewing notification lists, and advising on the process based on their experience with other practice closures. This is particularly valuable for solo practitioners who are managing the closure process alongside patient care obligations and may not have administrative staff available to handle the notification workload.
Third, the custodian must have a Business Associate Agreement with the practice in place before any protected health information is discussed or transferred. The BAA establishes the custodian’s legal obligations under HIPAA to protect the records they will hold and is a prerequisite for the transfer of records, not an afterthought.
Once notifications have been sent and records are transferred, the custodian becomes the primary contact for record access requests. The practice should ensure that the custodian is prepared to receive requests from the date of transfer, has a process for verifying patient authorizations, and can fulfill requests within the timeframes HIPAA requires.
Documenting Your Patient Notifications
Documentation of the notification process is the evidence that protects the practice if a patient later claims they were not informed about the closure or cannot access their records.
A practical documentation approach includes:
- A copy of the notification letter sent to patients, dated and signed
- A record of the mailing list used, showing which patients were notified, at what address, and on what date
- Delivery confirmation documentation for any certified mail notices
- A copy of any newspaper notices, with the publication name and date
- A record of any changes to the practice’s voicemail, website, and office postings, with the dates those changes were made
- A log of patient responses, including requests for record copies, authorizations for transfer, and any complaints or inquiries received
This documentation should be retained separately from the patient records being transferred to the custodian, so it remains accessible to the departing physician or their estate even after the records have moved.
Frequently Asked Questions
Is it legally required to notify patients before transferring records to a medical records custodian?
Yes, in substance if not always in explicit statutory language. HIPAA’s right of access provisions require that patients be able to access their protected health information, which requires knowing where it is held and who to contact. Most state medical practice laws and state medical board guidelines require patient notification before a practice closes. The AMA’s Code of Medical Ethics establishes an ethical obligation to provide adequate notice. The combination of federal, state, and ethical requirements makes patient notification effectively mandatory in all circumstances.
How far in advance should patients be notified before a practice closes?
Most state medical associations and medical boards recommend a minimum of 30 days notice, with 60 to 90 days preferred when the timeline allows. Longer lead times reduce the volume of last-minute requests, give patients more time to establish care with a new provider, and reduce the risk that time-sensitive care needs go unmet during the transition. For unexpected closures due to a physician’s death or serious illness, retroactive notification should be sent as promptly as possible after the situation is stabilized.
What if a patient’s address is no longer current when notifications are sent?
Send the notification to the most recent address on file and document that you did so. For patients where mail is returned as undeliverable, some practices make reasonable additional efforts such as trying a phone number on file or checking for an updated address. A notice in a local newspaper of general circulation is a recognized supplemental method for reaching patients whose current addresses are unknown, and some states require it specifically for that reason.
Does the patient notification have to be sent before the records are physically transferred to the custodian?
Yes. Patients should receive notification before records are transferred, giving them an opportunity to request copies or authorize transfer to a new provider while the practice still has direct control of the records. Sending notification after transfer means patients who want to act before the transfer date have already lost that opportunity.
Can the medical records custodian handle patient record requests that come in before the records are transferred?
No. Until the transfer is complete, the practice retains control of and responsibility for the records. Record requests received before the transfer date should be fulfilled by the practice through its normal process. Once the transfer is complete, the custodian assumes responsibility for all incoming requests, which is why the custodian’s contact information and process should be communicated to patients clearly in the notification.
What should the notification say if the practice is selling rather than closing?
A practice sale requires patient notification for similar reasons. Patients should be told that the practice is under new ownership, who the new provider is, whether their records will remain with the new practice or be transferred to a custodian, and how to access records or transfer to a new provider if they prefer not to continue with the new ownership. The specific content depends on the structure of the sale and the agreements between the departing and incoming physicians, but the patient’s right to know and to access their records applies regardless of the transaction type.
If you are planning a practice closure, sale, or transition and need guidance on the medical records custodian process, including patient notifications, records transfer, and long-term retention management, Emerald Document Imaging can help. Our medical records custodian services support physicians and practice administrators through every stage of the transition.
Learn more about our Medical Records Custodian Services and contact us to discuss your situation.
