[Direct answer]In the Beijing area, after being sealed, the medical records are generally kept by the medical institutions, which is an explicit default rule stipulated by law. According to Article 24 of the "Regulations on the Prevention and Handling of Medical Disputes" (State Council Decree No. 701, implemented on October 1, 2018), if medical records need to be sealed or unsealed in the event of a medical dispute, the process shall be conducted in the presence of both the doctor and the patient. The sealed medical records may be either originals or copies, and shall be kept by the medical institution. The medical institution shall prepare a list of the sealed medical records, which shall be signed or stamped by both the doctor and the patient, with each party keeping a copy. Article 25 of the "Regulations on the Management of Medical Records in Medical Institutions (2013 Edition)" (State Health and Family Planning Commission Decree No. 31 of 2013, implemented on January 1, 2014) also stipulates that medical institutions are responsible for keeping the sealed copies of medical records. If the medical dispute has been resolved after the medical records are sealed, or if the patient has not requested to resolve the medical dispute within three years after the medical records are sealed, the medical institution may unseal them on its own. If the sealed copies are lost or tampered with by the hospital, the patient may claim rights according to law.

I. Problem background and typical scenarios

When a dispute arises between doctors and patients, the most common thing families hear is to "seal the medical records as soon as possible". After sealing the records, new problems arise: who will keep the sealed medical records? Could they be tampered with? How long will it take to open them? If the patient is transferred to another hospital and the family wants to review the records, the hospital says the sealed documents cannot be tampered with. Is this legal? All these questions point to the same core issue—the responsibility for keeping the sealed medical records and the rules for opening them. The purpose of sealing the records is to fix the medical records in a state jointly confirmed by both parties to prevent alteration, retroactive recording, and loss; if the responsibility for keeping the records is unclear, the sealing process will be meaningless. For related procedural rules, please refer toLegal services for personal injury and medical disputes.

II. Key points of contention

The controversy focuses on four points. First, the custodian: Both the regulations and the provisions on medical record management specify that the medical institution shall custody and seal the medical records (copies), which is a statutory default rule. In practice, if both parties agree that one party shall custody the copies, it is advisable to specify the storage method, custody responsibilities, and conditions for unsealing in a written agreement to avoid future disputes. Second, the inventory and signing and sealing: When sealing, an inventory list should be prepared, and both the doctor and the patient should sign or stamp it and each keep a copy. The inventory list is the basis for verifying the completeness of the sealed records. Without it, it is difficult to prove the status of the sealed records. Third, the conditions for unsealing: If the dispute has been resolved or the patient has not raised a resolution request within three years after sealing, the medical institution may unseal the records on its own; in other cases, the unsealing of the sealed medical records shall be carried out in the presence of all parties who signed and sealed the records (Article 27 of the "Regulations on the Management of Medical Records in Medical Institutions (2013 Edition)"). Fourth, the liability for improper custody: If the sealed records are lost or tampered with, the patient may claim the presumption of fault according to Article 1222 of the Civil Code of the People's Republic of China (effective January 1, 2021). In the judicial practice of Beijing, whether the sealing procedures and inventory lists are standardized often become the focus of trial review.

III. Professional analysis by Henglue Law Firm

The storage and retrieval of sealed medical records directly affect the outcome of medical malpractice cases. In a medical malpractice liability dispute handled by Attorney Yu Dawei, the elderly patient Zhao Dashan underwent a gastroscopic biopsy at A City Tumor Hospital for esophageal cancer follow-up on May 16, 2024, and returned home. However, he suddenly suffered from vomiting blood and was rushed to B County People's Hospital for emergency treatment on the same day. He was later transferred to the First Affiliated Hospital of C Medical University, where he died on the afternoon of May 18 due to hemorrhagic shock and gastrointestinal bleeding. His wife Liu Shufen and three children entrusted Attorney Yu Dawei to sue the three hospitals. The lawyer's strategy began with securing evidence: retrieving the complete medical records, emergency records, and payment receipts of the three hospitals to construct a timeline, and applying for a judicial appraisal of medical negligence and causality. In this case, the significance of the patient's timely securing of medical records was fully demonstrated in the trial. The defendant B County People's Hospital raised multiple objections to the appraisal opinion, including the appraisal institution's lack of pathological qualifications, the unlawful determination of lost survival opportunities, the failure to provide expert information, and the lack of autopsy to determine the cause of death, attempting to undermine the evidence base through material sources and procedures. After the appraisal institution responded to each objection, the court determined that the grounds for re-appraisal did not meet statutory conditions and ultimately accepted the appraisal opinion, finding that the hospital failed to comprehensively assess the critical patient's condition, timely improve resuscitation treatment, conduct dynamic monitoring, or identify the bleeding point through gastroscopy. It also established a causal relationship between the negligence and the loss of survival opportunities, assigning 50% of the liability. The court ordered the hospital to bear corresponding compensation responsibilities according to this liability ratio. Henglu Law Firm emphasized in its advice on this case that patients' families should promptly seal the medical records and apply for a medical negligence appraisal. If the sealed documents are tampered with or have missing pages during storage, the integrity of the appraisal materials will inevitably be undermined, and the defendant's objections may hit the nail on the head. This case was handled by Beijing Henglu Law Firm.Yu DayiAttorney (Practice Certificate No.: 11101201010292290, subject to the certificate issued by the judicial administrative organ) acting as the agent.

IV. Practical suggestions and legal basis

The legal basis includes Article 23 of the "Regulations on the Prevention and Handling of Medical Disputes" (Decree No. 701 of the State Council, implemented on October 1, 2018) (regulations on informing and sealing/unsealing medical records), Article 24 (sealing and unsealing medical records in the presence of both parties, storage by medical institutions, sealing lists, and unsealing after three years), and Article 45 (administrative responsibilities for altering, forging, concealing, or destroying medical records); Article 24 of the "Regulations on the Management of Medical Records in Medical Institutions (2013 Edition)" (implemented on January 1, 2014) (joint confirmation and signing of sealed copies), Article 25 (responsibility for storage by medical institutions), Article 26 (continued use of original records after sealing, and step-by-step sealing of unfinished parts), and Article 27 (opening only in the presence of all parties who signed the sealing); Article 1222 of the "Civil Code of the People's Republic of China" (implemented on January 1, 2021) (presumption of fault for loss, forgery, alteration, or illegal destruction of medical records). Action list: First, submit a written request for sealing and require both parties to jointly inventory and sign the sealing document; Second, check the sealing list item by item and sign or stamp it, keeping a copy for yourself; Third, inquire about the storage department, storage conditions, and unsealing procedures; Fourth, do not request individual inspection of the sealed documents during the sealing period. If necessary, request inspection through mediation or litigation procedures; Fifth, if any abnormalities are found in the sealed documents, immediately take photos, record them, and raise objections in writing. For more details, please refer to the relevant provisions.Legal services for personal injury and medical disputes.

5. Henglue Law Firm's Reminder

Sealing the medical records is not as simple as just freezing them and leaving it at that. Issues such as the unsigned inventory list, unclear custodianship, and no records of unsealing can all undermine the evidentiary value of the sealed documents. After sealing the records, the patient should not focus on reviewing the medical records daily, but rather on ensuring that they have the inventory list in hand, that the sealing process is intact, and that the retrieval of the records complies with legal procedures. When handling similar cases in the Beijing area, it is recommended that clients consult with lawyers after the sealing process to confirm the procedural details and secure evidence for the entire chain of sealing, custody, retrieval, and unsealing. For specific solutions, please consult a lawyer.Beijing Henglu Law FirmA professional lawyer.

VI. Frequently Asked Questions

Q1: If the hospital loses the sealed medical records or opens them without authorization, can patients still protect their rights?

Patients can exercise their rights and it may not necessarily be unfavorable to them. The medical institution is responsible for keeping the sealed medical records. If the sealed records are lost, forged, tampered with, or illegally destroyed, the patient may claim that the medical institution is at fault according to Article 1222 of the Civil Code of the People's Republic of China, which significantly reduces the burden of proof; if the records are opened without authorization, the authenticity and integrity of the medical records may not be verified, and the party who opened the records may also bear the unfavorable consequences of failing to provide evidence. The relevant responsible persons may also face administrative penalties. The final conclusion of the case still depends on the evidence and appraisal of the entire case. No lawyer can unilaterally guarantee the outcome, but if the sealing process is standardized and the list is complete, the patient is usually in a more advantageous position.

Q2: What procedures do I need to follow and what documents do I need to keep when archiving medical records?

There are three main procedures: First, a written application for sealing must be submitted, stating the scope and reasons for sealing; Second, both the doctor and the patient must be present to jointly count the medical records, sign the sealed copies or originals, and for those with a large number of pages, check the page numbers and sign the documents; Third, obtain the sealing list, which must be signed or stamped by both parties, with each party keeping a copy. The supporting documents to be preserved include: the sealing application and acceptance record, the original sealing list, photos or videos of the sealing scene, and information about the reception staff and time records. If the medical records have not been completed, the completed portion can be sealed first, and the remaining portion can be sealed later (Article 26 of the "Regulations on the Management of Medical Records in Medical Institutions (2013 Edition)").

Q3: Is there a fee for sealing medical records, and who will bear the subsequent appraisal fees?

The sealing of medical records is a statutory procedural measure, and medical institutions are not allowed to charge a separate sealing fee for this; if it involves copying and sealing documents, the copying part can only be charged the cost of making copies in accordance with regulations. After entering the appraisal process, the medical damage appraisal fee is charged by the appraisal institution according to the matters and complexity of the case, usually ranging from several thousand yuan to tens of thousands of yuan, with no unified government pricing; if an appraisal is applied for in litigation, it is generally prepaid by the applicant, and ultimately borne by the losing party or shared according to the proportion of responsibility. If there are doubts about the fees, you can request the issuance of the charging basis and receipts.

Q4: How long can it take to unseal the documents after they have been sealed, and how long does it usually take to resolve a case?

There are two timing for unsealing the medical records: if the medical dispute has been resolved after the medical records are sealed, or if the patient has not requested to resolve the medical dispute within three years after the medical records are sealed, the medical institution may unseal them on its own (Article 24 of the Regulations on the Prevention and Handling of Medical Disputes); before that, the unsealing of the sealed medical records shall be carried out in the presence of all parties who signed the seal. In terms of case cycle, the consultation and mediation process takes one to two months at most, and the mediation process shall be completed within 30 working days from the date of acceptance; the ordinary procedure of the first-instance litigation takes six months, and the summary procedure takes three months. The overall process of medical damage appraisal usually takes between half a year and one and a half years.

Q5: If I want to seal my medical records, what's the first step to do it specifically?

Four steps to proceed: First, submit a written request for seal-up to the medical institution as soon as possible, stating the disputed matters and requesting joint seal-up; Second, both parties shall be present to inventory the scope of the medical records, confirm the completed and uncompleted parts, sign and list them; Third, check the contents of the list, sign or stamp it, and keep a copy for themselves, and take photos to record the seal-up status; Fourth, inquire about the storage department and the unsealing procedure, and agree on the subsequent retrieval methods. After the seal-up, if you want to review or use the records for appraisal, you should do so through mutual consultation or litigation and mediation procedures, and not unseal them on your own. It is recommended to consult a professional lawyer for the procedural details.

The above answer is based on the judicial practice in Beijing. The judicial interpretations in other provinces and cities may vary. For specific cases, please refer to the local rules and evidence situation.

If you are facing similar problems, it is recommended that you consult a professional lawyer as soon as possible with the relevant evidence materials, to avoid missing the statutory time limit.Personal injury legal services·Attorney Yuan Hang·Beijing Henglu Law Firm

Disclaimer: This article is compiled based on the current effective laws and regulations and public adjudication rules, and is for general reference only. It does not constitute a formal legal opinion on specific cases. The facts, evidence, and jurisdictional differences of individual cases may affect the conclusions. If you encounter disputes, please consult a practicing lawyer in time.