APPENDIX A

Description of Protected Health Information Requested

Patient: {{PATIENT_NAME}} | DOB: {{DOB}} | Date: {{DATE}}

What I Am Requesting

I am requesting a complete Electronic Health Information (EHI) Export of my patient record, produced using the EHI Export feature built into your Epic electronic health record system. This is a specific, named feature in Epic — distinct from a CCDA, MyChart download, or standard records release — that produces a bulk export of all structured data in my record as tab-separated value (TSV) files, plus any associated documents and images. The full specification is published by Epic at open.epic.com/EHITables.

Legal Basis

HIPAA Right of Access (45 CFR § 164.524): I have the right to receive my PHI in the electronic form and format I request, if readily producible. The EHI Export is a built-in feature, so it is readily producible.

21st Century Cures Act (45 CFR Part 171): Declining to use an available, certified EHI Export feature when a patient requests it could constitute information blocking.

ONC Certification § 170.315(b)(10): Since December 31, 2023, all certified EHR systems must support single-patient EHI export in a computable format. Epic's EHI Export satisfies this requirement.

How to Produce This Export

Search the Epic UserWeb (userweb.epic.com) for “EHI Export” — it contains configuration guides and step-by-step instructions.
Contact your Epic Technical Services (TS) rep if the feature hasn't been configured yet. It's a standard certified feature, not a custom build.
The export produces a zip file of TSV files (one per database table), plus rich-text documents and images.

Resource	URL
Epic EHI Tables spec	https://open.epic.com/EHITables
ONC certification test method	healthit.gov/test-method/electronic-health-information-export
21st Century Cures Act Final Rule	federalregister.gov/d/2020-07419

Delivery & Notes

Please provide the export electronically (encrypted USB drive, secure download link, or encrypted email). I'm happy to coordinate logistics.

Please do not substitute a CCDA, MyChart summary, or printed records. I am specifically requesting the full EHI Export.
Do not encrypt patient identifiers in my copy — since this is my own data, please provide unencrypted IDs so the export is usable.
Under HIPAA, you must act on this request within 30 days (with one 30-day extension if you notify me in writing).

Contact: {{PATIENT_NAME}} | {{PHONE}} | {{EMAIL}} | {{ADDRESS}}