Physiotherapists often receive third-party requests for non-clinical services. These services can include: clinical record transfers or copies, providing a report or expert opinion and/or other patient related services that require a physiotherapist’s time and expertise. Third-parties are most commonly payors or lawyers but they can also be patients.

The Third-Party Requests practice guideline provides ethical considerations and some general information and recommendations related to third-party requests. While specific fee information is not included, some general information on fees is. In some situations, records management service fees are regulated by legislation (e.g., the Health Information Act – HIA or WCB) and reflect the maximum that can be charged.

View the Third-Party Requests practice guideline as a PDF.

  • Consider patient’s best interest in all decision making.
  • Do not exploit a patient for personal gain.
  • When acting on behalf of a third-party other than the patient, take reasonable steps to ensure the patient understands the nature and extent of your responsibility to the other party.
  • Upon request and with consent, provide a patient or a third-party with a copy of the patient record unless there is the potential for harm to the patient or others.
  • In determining fees to be charged for the service, consider nature of service requested, ability of the patient to pay and be prepared to discuss service/fee with patient or third-party.
  • Patients have a right to their health information upon request. The patient’s rights are the same if request is made by an agent of the patient (e.g., a lawyer).
  • Privacy legislation (HIA and Personal Information and Protection Act) governs the collection, use, disclosure of, and access to personal health information. This legislation applies to physiotherapists depending on employment setting. Therefore physiotherapists are responsible for familiarising themselves with the legislation that applies to their respective situation.
  • Reasonable fees may be charged when providing clinical records (in the case of the HIA, fees are prescribed in the legislation). Fees should be discussed with patients before producing the record and should reflect actual costs including:
    • time and cost required to retrieve record;
    • cost of copying the record;
    • cost to deliver the record if applicable. 

The transfer of clinical records is sometimes required (e.g., continuity of care) and at other times may not be required (e.g., when a physiotherapist relocates to another facility and the patient chooses to follow, the physiotherapist does not need to rely on information in the previous record). While each situation depends on the particular circumstances, the following guidelines are recommended:

  • As a professional courtesy, physiotherapists who recommend alternate service for patients (e.g., specialized services), should provide clinical records with patient consent and at no charge.
  • If patient requests their record transferred, the physiotherapist may charge a reasonable fee considering the factors previously mentioned.
  • When it is a new treating physiotherapist requesting a record transfer (and once patient consent is obtained), it is acceptable to charge a fee considering the factors previously mentioned. 

Certain fees have been negotiated with or set by payors or other groups such as the Workers’ Compensation Board or the Superintendent of Insurance and are not negotiable.

Services where a fee is to be determined should reflect:

Professional costs

  • nature of the service requested;
  • time;
  • knowledge/skill or expertise related to service.

Administrative costs

  • direct and indirect costs;
  • administrative support time and resources
  • supplies;
  • practice impact such as legal fees.

Patient’s ability to pay

Considerations in Billing for Third-party Requests

  • Be consistent in billing practices.
  • Review and update fees annually.
  • Maintain records of non-clinical services provided.
  • Display fees for common non-clinical services.
  • Ensure administrative staff is familiar with services provided and associated fees.
  • Ensure patient agrees to fee before providing the service.
  • Obtain patient consent for service.
  • Provide service(s) in a timely manner.
  • Develop standard form letters outlining your policies and procedures.
  • The third-party cannot be used as collection agency for outstanding payments.

Considerations in billing for third-party requests:

  • Be consistent in billing practices.
  • Review and update fees annually.
  • Maintain records of non-clinical services provided.
  • Display fees for common non-clinical services.
  • Ensure administrative staff is familiar with services provided and associated fees.
  • Ensure patient agrees to fee before providing the service.
  • Obtain patient consent for service.
  • Provide service(s) in a timely manner.
  • Develop standard form letters outlining your policies and procedures.
  • The third-party cannot be used as collection agency for outstanding payments.