[Direct answer]In the Beijing area, if there are suspicions that medical records have been altered, a handwriting examination and document authentication can be applied for to investigate. According to the provisions on appraisal in the Civil Procedure Law of the People's Republic of China (amended in 2023 and implemented on January 1, 2024), parties may apply for appraisal, and the appraiser shall be determined through consultation between the parties. If no agreement can be reached, the court shall appoint a qualified institution. The scope of appraisal includes the authenticity of signatures and the time of formation of alterations and supplementary records. At the same time, Article 1222 of the Civil Code of the People's Republic of China (implemented on January 1, 2021) lists the forgery, alteration, and destruction of medical records as circumstances presuming the medical party's fault. Action guidance: First, seal and copy all medical records to fix their original state. Then, consult professional lawyers about whether to apply for appraisal and what kind of appraisal to apply for, so as to avoid destroying the evidence by collecting evidence on their own.

1. Problem background and typical scenarios

There are suspicions that medical records have been altered, which often occur after conflicts between doctors and patients arise: when patients die or the treatment effect is unsatisfactory, families request to seal the medical records, only to find that key records have been "added later"; when the same page of medical orders shows two different handwritings or different inks; when the time of resuscitation records is later than the patient's death; when the values on the laboratory test report have been altered; and when the modification traces of the electronic medical records have been turned off. Typical scenarios also include: after sealing the records, the medical side makes extensive additions under the guise of "improving the records", and the added content clearly deviates from the original nursing records. These situations make families suspect that the hospital is "faking evidence", but such suspicions need to be supported by evidence. For related rules, please refer toLegal services for personal injury and medical disputesYou can also do it onBeijing Henglu Law FirmCheck the similar guidelines on the official website.

II. Key points of contention

The controversy focuses on four points. Firstly, the threshold for initiating an appraisal: it is difficult for patients to initiate an appraisal solely based on their "feeling that something is wrong". They must first secure the original medical records, point out specific doubts, and then have the court commission an appraisal. Secondly, the choice of appraisal type: for verifying the authenticity of signatures, handwriting appraisal is used; for alterations and retroactive additions of time, document appraisal or formation time appraisal is used; for the modification track of electronic medical records, system traces need to be extracted. Thirdly, the application of presumption of fault: according to Article 1222 of the Civil Code, forgery and alteration of medical records presume the doctor's fault, but the boundary between "reasonable retroactive additions" and "unlawful alterations" needs to be judged in accordance with relevant regulations. Fourthly, the burden of proof: for ordinary medical treatment errors, the patient still bears the initial burden of proof, and appraisal is a key means of proving alterations. In the judicial practice of Beijing, alterations and retroactive additions of medical records are easily subject to unfavorable judgments.

III. Professional analysis by Henglue Lawyers

In a medical malpractice liability dispute handled by Attorney Yu Dawei, it demonstrates how medical record standards and forensic appraisals determine liability determination. On May 16, 2024, Zhao Dashan, an elderly patient with esophageal cancer, underwent a gastroscopic biopsy at A City Tumor Hospital after a follow-up examination. However, he suddenly vomited blood and was rushed to B County People's Hospital for emergency treatment. He was later transferred to the First Affiliated Hospital of C Medical University, but died on May 18 despite resuscitation efforts. His wife, Liu Shufen, and three children entrusted Attorney Yu Dawei to sue the three hospitals for medical negligence leading to his death. The first step of the attorney was to comprehensively retrieve the medical records, emergency records, and payment receipts from the three hospitals to construct a complete timeline and accurately apply for a forensic appraisal of "medical negligence and causality". In response to the defendants' objections to the appraisal's qualifications and procedures, the attorney addressed each issue with evidence chains and demonstrated the appraiser's qualifications and procedural legitimacy. Ultimately, the court accepted the appraisal opinion, determining that B County People's Hospital shared equal causality with the "loss of survival opportunity" and attributed 50% of the responsibility. The court ordered the hospital to compensate according to this liability ratio. This case highlights that the authenticity, continuity, and verifiability of medical records are the foundation of medical rights protection. The case was handled by Beijing Henglu Law Firm.Yu DawaiAttorney (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 15 (Standards for Medical Record Writing), Article 16 (Custody of Medical Records), and Article 24 (Sealing of Medical Records) of the "Regulations on the Prevention and Handling of Medical Disputes" (effective October 1, 2018); Article 1222 (Presumption of Fault for Forging or Altering Medical Records) of the "Civil Code of the People's Republic of China" (effective January 1, 2021); and the provisions on appraisal procedures, selection of appraisers, and reappraisal in the "Civil Procedure Law of the People's Republic of China" (amended in 2023 and effective January 1, 2024). Action List: 1. Upon the occurrence of a dispute, immediately request the sealing and copying of all medical records and verify any modifications with evidence of changes; 2. Mark suspicious alterations or additions on each page and compile a list of them; 3. Apply for a qualified document or handwriting appraisal; 4. If necessary, request the court to retrieve the electronic medical record backend modification logs; 5. Entrust a professional lawyer to design an appraisal request and cross-examination plan. For more details, please refer to the following link: [Link].Legal services for personal injury and medical disputes.

5. Henglu Law Firm's Reminder

When conducting medical record appraisals, it is strictly prohibited to "handle the evidence first". Any self-alteration, extraction, or incomplete copying of the evidence may damage the appraisal conditions and even lead to accusations of tampering. The correct approach is to first seal the entire set of records, then list the suspected issues item by item, and formulate specific appraisal requests. At the same time, it is necessary to distinguish between "unlawful tampering" and "reasonable supplementation". The latter is legal under certain conditions and cannot be generally declared invalid. The modification of electronic medical records leaves traces, which is an important breakthrough and should be fixed as soon as possible. When handling similar cases in the Beijing area, it is recommended to do the following:Beijing Henglu Law FirmUnder the assistance of professional lawyers, the order of evidence collection and appraisal is planned.

VI. Frequently Asked Questions

Q1: If I suspect that the medical records have been altered, can I definitely request a handwriting analysis?

The feasibility of identification depends on the condition of the evidence. If there are original documents and comparable samples (such as the original signatures of the patient or medical staff) and the doubts are specific, it is possible to apply for handwriting identification and document identification to determine the authenticity of the signature and the time of alteration and supplementation; but if the evidence is lost, covered up, or unavailable for comparison, the identification may not be possible. Court commissioning is the main path. Patients should first seal and copy the original medical records, and then consult professional lawyers to determine whether the conditions for identification are met. However, no lawyer can guarantee that the identification will definitely be successful.

Q2: What materials do I need to prepare for applying for a medical record appraisal?

The core materials include: all sealed and copied original medical records or clear copies; a list indicating the locations of suspected alterations or additions; comparable signature samples (such as the original signatures on informed consent forms and nursing records); electronic medical record modification traces or backend logs (if available); and the treatment timeline and payment receipts as supporting evidence. The materials should be continuous, complete, and unaltered. If necessary, the court may, on its own initiative, retrieve the original carriers retained by the medical party to ensure the authenticity and reliability of the appraisal materials.

Q3: How much does it cost to conduct a medical record review and litigate a case?

The attorney's fees are determined through negotiation between the law firm and the client, and there is no unified government pricing. They are often charged per case or as a percentage of the requested amount. The appraisal fees for documents and handwriting are paid in advance by the applicant according to the standards announced by the appraisal institutions, and the fees are ultimately shared according to the degree of fault. The case acceptance fees are calculated in stages based on the amount of the request in accordance with the "Measures for the Payment of Litigation Fees" (implemented on April 1, 2007), and the fees are halved in the case of mediation or withdrawal of the lawsuit. It is recommended to clarify the charging methods and the rules for pre-payment of appraisal fees before entrusting the lawyer with the case.

Q4: How long does it take from the moment of suspicion to the issuance of the appraisal result?

The scheduling of appraisals is affected by the workload of the institution and the complexity of the evidence. Appraisals of documents and handwriting often take one to several months; if it involves time-of-formation appraisals or the extraction of electronic traces, the cycle will be even longer. During the appraisal period, the time limit for the first-instance trial is generally not included. The ordinary procedure for the first-instance trial is completed within six months, and the summary procedure is completed within three months. Overall, from the time the medical records are sealed to the time the appraisal opinion is obtained, it often takes several months to more than half a year. It is recommended to fix the evidence as soon as possible and apply for it in time.

Q5: If you find that the medical records might have been altered, what should you do first?

Four steps to proceed: First, immediately require medical institutions to seal and copy all medical records, check and modify each page to leave traces and mark any doubts; Second, do not extract or alter any pages on your own, and maintain the original state of the evidence; Third, organize the samples of signatures that can be compared with the timeline of diagnosis and treatment; Fourth, entrust professional lawyers as soon as possible to determine whether to apply for appraisal, what kind of appraisal to apply for, and design a cross-examination plan. Delaying may lead to the overwriting of electronic traces and the transfer of original documents, increasing the difficulty of proof.

This article is written based on the common judicial interpretations in the Beijing area. If the case occurs in other regions, it is recommended to consult local lawyers to verify the regional differences.

If you are facing similar problems, it is recommended that you consult a professional lawyer as soon as possible with the relevant evidence, so as 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 publicly available 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.