An insurer wants a complete record for a coverage decision. The patient's been with the practice for fifteen years across two EHR systems and a folder of paper letters. Combining everything into one coherent PDF is half a day's work — done well.
A disorganised pack invites questions. An organised one closes them.
Start with a chronological frame
Sort every document by date before combining. Within the same date, order by document type (consultation notes first, then investigations, then correspondence). Convert image scans to PDF so everything is in the same format. The chronological frame is what makes the pack navigable.
Merge in order
Use merge PDF to combine. If documents are in folders by year, merge year-by-year for predictability. For a long history, consider a structure: childhood records, then primary care, then specialist consultations, then current care. Whatever the structure, document it on the cover page.
Cover page and index
Cover page with patient identifiers, the period covered, and the purpose of the pack (insurance review, referral, subject access request). Index page listing sections with starting page numbers. Build the index after the pack is paginated. The reader can find what they need in seconds rather than hunting through hundreds of pages.
Final checks
Spot-check by jumping to section boundaries. Confirm dates are in order. Compress PDF if the pack exceeds 25MB — common for long histories with imaging. Password-protect before sending, especially for external distribution like insurers.
FAQ
Should I include everything in the record or curate?
Depends on purpose. For a subject access request, the patient is entitled to everything (with statutory exceptions). For insurance reviews, curate to what's clinically relevant to the decision.
How do I handle records from different EHR systems?
Export each system's records to PDF, then merge. Don't try to reconcile into a single format — preserve each system's native presentation.
What if some records are paper-only?
Scan to PDF, OCR if you can, and merge in chronological order. Paper-only records should be flagged in the index.
Should I include third-party communications?
Yes if they're clinically relevant. Redact any third-party patient identifiers before including.
An organised record pack closes the insurance question. Build the pack in Flint and the half-day becomes the morning.