441—9.6(17A,22) Procedure by which additions, dissents, or objections may be entered into certain records.
	9.6(1) All programs. Except as otherwise provided by law, a subject may file a request with the custodian to review, and to have a written statement of additions, dissents, or objections entered into, a record containing personally identifiable information pertaining to that subject. However, the subject is not authorized to alter the original copy of the record or to expand the official record of any department proceeding.
	a. 	The subject shall send the request to review such a record or the written statement of additions, dissents, or objections to the custodian or to the office of policy analysis.
	b. 	The request to review such a record or the written statement of additions, dissents, or objections must be dated and signed by the subject, and shall include the current address and telephone number of the subject or the subject’s representative.
	9.6(2) Additional procedures for protected health information.
	a. 	Right to amend. A subject may request that the department amend protected health information or a record about the subject in a designated record set for as long as the protected health information is maintained in the designated record set. A subject shall submit a request to the department using Form 470-3950, Request to Amend Health Information. The subject shall provide a reason to support the requested amendment.
	b. 	Timely action.
	(1)	The department shall act on a subject’s request for an amendment no later than 60 days after receipt of the request.
	(2)	If the department is unable to act on the amendment within 60 days, the department may extend the due date one time, for a period not to exceed 30 days. In order to extend the due date, the department shall provide the subject with a written statement of the reasons for the delay and the date by which the department will complete its action on the request. The department shall provide this written statement within the 60-day period after receipt of the request.
	c. 	Action on amendment. If the department grants the requested amendment, in whole or in part, the department shall comply with the following requirements.
	(1)	The department shall timely inform the subject that the amendment is accepted. The subject shall identify relevant persons with whom the amendment needs to be shared and agree to have the department share the amendment with these persons.
	(2)	The department shall make the appropriate amendment to the protected health information or record by, at a minimum, identifying the records in the designated record set that are affected by the amendment and appending or otherwise providing a link to the location of the amendment.
	(3)	The department shall make reasonable efforts to inform and provide the amendment to:
	1.	Persons identified by the subject as having received protected health information about the subject and as needing the amendment; and
	2.	Persons, including business associates, that the department knows have the subject’s protected health information and that may have relied, or could foreseeably rely, on the information to the detriment of the subject.
	d. 	Denial of amendment. The department may deny a subject’s request for amendment, if the department determines that the protected health information or record that is the subject of the request:
	(1)	Was not created by the department, unless the subject provides a reasonable basis for the department to find that the originator of the protected health information is no longer available to act on the requested amendment;
	(2)	Is not part of the designated record set;
	(3)	Would not be available for inspection under rule 441—9.9(17A,22); or
	(4)	Is accurate and complete.
	e. 	Action on denial of amendment. If the department denies the requested amendment, in whole or in part, the department shall provide the subject with a timely, written denial.
	(1)	The subject may submit to the department a written statement of disagreement with the denial of all or part of a requested amendment and the basis of the disagreement, in accordance with 45 CFR 164.526 as amended to August 14, 2002. The subject shall submit the statement of disagreement by filing an appeal request under subrule 9.14(7). The appeal request constitutes the statement of disagreement.
	(2)	The department shall prepare a written rebuttal to the subject’s statement of disagreement, in accordance with 45 CFR 164.526 as amended to August 14, 2002. The appeal decision constitutes the rebuttal statement. The department shall provide a copy of the appeal decision to the subject who submitted the appeal request.
	f. 	Record keeping of disputed amendments. The department shall, as appropriate, identify the record or protected health information in the designated record set that is the subject of the disputed amendment. The department shall append or otherwise link the subject’s request for an amendment, the department’s denial of the request, and the subject’s appeal and the final decision, if any, to the designated record set.
	g. 	Future disclosures regarding disputed amendments.
	(1)	If an appeal has been submitted by the subject, the department shall include the material appended in accordance with paragraph 9.6(2)“f” or, at the election of the department, an accurate summary of the information, with any subsequent disclosure of the protected health information to which the disagreement relates.
	(2)	If the subject has not submitted an appeal, the department shall include the subject’s request for amendment and its denial, or an accurate summary of the information, with any subsequent disclosure of the protected health information only if the subject has requested this action.
	(3)	When a subsequent disclosure is made using a standard transaction that does not permit the additional material to be included with the disclosure, the department may separately transmit the material required by subparagraph 9.6(2)“g”(1) or (2), as applicable, to the recipient of the standard transaction.
	h. 	Actions on notices of amendment. When the department is informed by another covered entity of an amendment to a subject’s protected health information, the department shall amend the protected health information in designated record sets as provided by subparagraph 9.6(2)“c”(2).