# 24. Seeking medical care: How to save money and avoid unnecessary hassle This section focuses on the practical steps involved in getting medical treatment — which hospitals to visit first, how to transfer between levels of care, and where you can cut down on expenses. It also explains how to wait in emergency queues, what evaluations and documents are required after serious injuries, and what benefits you may be eligible for (see Section 7). Long‑term management of chronic diseases is covered in Section 16, while immediate actions at the scene of an emergency are described in Section 13. The content is largely based on the “Several Measures on Accelerating the Development of a Hierarchical Medical System” issued by the General Office of the State Council in April 2026. This system directs patients to hospitals according to the severity of their condition. The document explicitly links using primary‑level facilities with lower medical costs. However, implementation varies by region, so the national rules outlined here should be cross‑checked with local policies issued by your social insurance and health authorities. Your “coordinated region” is simply the area where you’re enrolled in medical insurance — usually a city. ### 1. For common illnesses, patients should first visit community clinics; referrals then proceed stepwise to larger hospitals, after which the hospital deductible is calculated only once - Cost: No expense is required. You must first make a trip to a community clinic. The hard part is resisting the urge to book an appointment with a specialist right away. - In plain terms: Start by going to a community clinic, which will then refer you to a larger hospital for inpatient care. The amount you pay out-of-pocket at the start is counted only once. If you go directly to a tertiary hospital for admission and later return to a community clinic for recovery, you might have to pay that amount twice. However, if a larger hospital refers you back to a community clinic for continued treatment, the deductible is not recalculated for the same condition during that period. - Benefit: Insured patients who follow this stepwise referral process can have their hospital deductible accumulated across multiple facilities. The deductible represents the portion of each hospitalization you must pay personally before insurance coverage kicks in. Accumulation means that the total paid at both the community clinic and the larger hospital counts as a single deductible amount, so you do not have to pay it again. For patients transferred from a larger hospital back to a community clinic, no additional deductible is applied for the same illness during that timeframe. - Evidence grade: A - Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「统筹地区内经基层医疗卫生机构逐级转诊的参保患者，在上级医院的住院起付线可连续计算；由上级医院下转至基层医疗卫生机构的住院患者，同一疾病周期内不再另设住院起付线。」 - Notes: The deductible is the amount you pay out-of-pocket per hospitalization before insurance begins to reimburse costs. If you go directly to a tertiary hospital for admission and later return to a community clinic for recovery, you may end up paying this amount twice. Following the proper referral pathway ensures it is calculated only once. Specific referral rules are determined individually by each province, city, and medical consortium. Be sure to ask your community clinic about these rules before seeking care. ### 2. Within the same medical insurance region, the lower the hospital level, the higher the reimbursement rate — the difference is roughly 10 percentage points - Cost: No direct cost involved. The real challenge is resisting the urge to go to a larger hospital. - In plain terms: For the same hospitalization bill, the lower the hospital level, the more you get reimbursed. Regions are required to set reimbursement rates that differ by about 10 percentage points between each successive level. Choosing a larger hospital when a community clinic can handle the case means you’ll have to pay roughly 10% more out of pocket. Newly allocated medical insurance funds also favor primary‑care facilities. - Benefit: Policies mandate that reimbursement rates for inpatient care differ by roughly 10 percentage points across hospital levels. Consequently, for the same expenses, each step up to a higher‑level hospital results in about a 10% increase in personal costs. New annual medical‑insurance allocations likewise prioritize grassroots healthcare providers. - Evidence grade: A - Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「因地制宜适当拉开参保人员在不同等级医疗卫生机构的住院报销水平，原则上统筹地区内医疗卫生机构住院报销比例逐级拉开10个百分点左右的差距。」「具备条件的地方，可按分级诊疗导向酌情拉开参保人员在不同等级医疗卫生机构的门诊报销水平。」 - Notes: For the same hospitalization bill, the out‑of‑pocket difference between a community clinic and a tertiary hospital can reach several thousand yuan. This guideline does not suggest that every condition should be treated at a community level; rather, it advises seeking care at lower‑level facilities whenever possible. 〔10000〕 〔10000〕 〔3000〕 〔3000〕 〔80〕 〔80〕 〔70〕 〔70〕 〔1000〕 ### 3. Go to a major hospital via a referral from a local clinic or the hospital’s referral center — don’t turn to scalpers - Cost: No direct cost, but an extra referral step is required. - In plain terms: Major hospitals must set aside a portion of appointments and beds specifically for patients referred from local clinics. They must also establish a referral center or designate a dedicated department to handle referrals — this requirement will be fully implemented by 2027. Not being able to book a slot online does not mean there is no way in. Scalpers charge exorbitant fees and may even route you to the wrong department. - Benefit: Lead hospitals in tightly integrated medical networks must reserve a specific share of appointments and beds for patients referred from local clinics, and promptly admit them. Such networks consist of multiple hospitals and community health centers working together. In other words, there is a separate pool of appointments and beds reserved for referred patients, separate from the general booking pool. All hospitals must set up referral centers or assign a dedicated department by 2027. - Evidence grade: A - Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「牵头医院要为基层医疗卫生机构预留一定比例的号源和床位，并及时接诊经基层转诊患者。」「医疗机构要强化转诊服务统一管理，设立转诊中心或指定固定部门承担患者转诊服务工作，到2027年实现全覆盖。」 - Notes: The reserved appointments and beds are specifically meant for referred patients. Failing to book online does not mean there is no way in. Using scalpers is not only costly but may also lead to being assigned to the wrong department. If you cannot locate the referral center, call the hospital’s service line for help. ### 4. Before seeking medical care outside your home province, ask locally first — the need for such care should ideally be assessed by an associate chief physician or higher - Cost: No cost involved. It simply requires asking a few extra questions beforehand. - In plain terms: Whether a patient needs to travel elsewhere for treatment should, in principle, be evaluated by doctors holding the rank of associate chief physician or above at secondary or tertiary hospitals. Reimbursement rates for temporary out-of-area treatment differ from those offered at local hospitals of comparable level; exact terms depend on local regulations. Asking locally beforehand is far better than discovering later that no reimbursement is possible. - Benefit: The necessity of receiving medical care across different healthcare regions or provinces must, ideally, be assessed by qualified physicians at secondary or tertiary hospitals holding the rank of associate chief physician or higher. “Cross-regional care” refers to treatment sought outside one’s designated medical insurance area. This assessment must be performed by doctors meeting the required qualifications. Reimbursement levels for temporary out-of-province patients also differ reasonably from those at local hospitals of the same level; consequently, patients receive less coverage for identical treatments received elsewhere. - Evidence grade: A - Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「原则上由二、三级医院副主任医师及以上职称人员评估患者跨统筹地区、跨省异地就医的必要性。」「进一步强化异地就医直接结算管理服务，跨省临时外出就医人员报销水平与参保地同级别医疗机构报销水平保持合理差异。」 - Notes: “Temporary out-of-area treatment” and “long-term residence elsewhere” constitute two distinct registration categories, each with different reimbursement levels. Details regarding registration procedures and which conditions qualify for direct settlement are covered in Section 16. Do not travel to another province first and then worry about reimbursement later. ### 5. Stop treating tertiary hospitals as mere prescription hubs — stable chronic disease patients should turn to primary care - Cost: No monetary cost involved. The real challenge is breaking the habit of relying exclusively on large hospitals. - In plain terms: Moving forward, tertiary hospitals will primarily handle emergency cases, critically ill patients, and complex medical conditions. Routine follow-ups for common illnesses and regular outpatient visits for patients with stable chronic diseases will gradually be phased out. The same expert physicians who previously saw patients in tertiary hospitals will now provide care at community clinics. Continuing to use large hospitals solely for medication refills will become increasingly difficult as appointment slots dwindle. - Benefit: Tertiary hospitals can better focus on emergency care, critically ill patients, and complex medical issues by gradually reducing routine outpatient services for common illnesses and stable chronic disease cases. This means fewer appointment slots will be available for such visits. Meanwhile, expert medical teams from top-tier hospitals will extend their outpatient services to community-level facilities, making their expertise accessible locally. - Evidence grade: A - Sources:国务院 (2018). 医疗纠纷预防和处理条例（国务院令第 701 号）第十六条：「患者有权查阅、复制其门诊病历、住院志、体温单、医嘱单、化验单（检验报告）、医学影像检查资料、特殊检查同意书、手术同意书、手术及麻醉记录、病理资料、护理记录、医疗费用以及国务院卫生主管部门规定的其他属于病历的全部资料。」「患者要求复制病历资料的，医疗机构应当提供复制服务，并在复制的病历资料上加盖证明印记……可以收取工本费，收费标准应当公开。」「患者死亡的，其近亲属可以依照本条例的规定，查阅、复制病历资料。」第十五条「任何单位和个人不得篡改、伪造、隐匿、毁灭或者抢夺病历资料。」；国家卫生计生委、国家中医药管理局 (2013). 医疗机构病历管理规定（2013 年版）：医疗机构「应当指定部门或者专（兼）职人员负责受理复制病历资料的申请」，复制在申请人在场的情况下进行并加盖证明印记. - Notes: This reflects official policy direction rather than a recommendation. Access to routine outpatient services at large hospitals will become increasingly limited in the future. For patients with stable chronic diseases, primary care clinics can issue medication prescriptions valid for up to 12 weeks — see Section 16 for details. ### 6. If you have doubts about treatment, request to seal the medical records on the spot; both parties must be present, a list must be drawn up, and each side gets a copy - Cost: No cost at all. Simply ask the hospital to seal the records; both you and the medical staff must be present to complete the paperwork. The real challenge is mustering the courage to say this out loud in front of the doctors. - In plain terms: If you’re unsure about any aspect of your treatment, you have the right to request that your medical records be sealed. Both you and the medical staff must be present for this process, which involves creating a detailed list, signing and stamping it, and each side receiving a copy. If the records aren’t fully completed yet, only the finished portions should be sealed first; the rest can be sealed later. Should you suspect that an intravenous infusion, blood transfusion, injection, or medication caused a problem, the actual fluid bag, medicine vial, and infusion set must also be sealed together with the records. - Benefit: Regulations clearly state that “whenever a medical dispute arises and it is necessary to seal or unseal medical records, this must be done while both the patient and medical staff are present.” The sealed documents may be either originals or copies, which the hospital then stores. If the records are still being written, only the completed sections should be sealed first; the remainder can be sealed later. The hospital must produce a sealing list, signed or stamped by both parties, with each side keeping a copy. In cases where an adverse effect is suspected to stem from an IV, blood transfusion, injection, or medication, both parties must jointly seal and later unseal any related physical items. If testing is required, both parties must jointly appoint a qualified laboratory; should they fail to agree, the local health authority at the county level where the hospital is located will make the appointment. Should a transfusion-related problem be suspected and blood samples need sealing, the hospital must notify the blood bank to send representatives to the scene. Additionally, there is a strict rule: “No organization or individual may alter, forge, conceal, destroy, or seize medical records.” Once a dispute is resolved or three years pass without any further claims, the hospital may unseal the documents on its own initiative (nationwide, effective 1 October 2018). - Evidence grade: A - Sources:国务院 (2018). 医疗纠纷预防和处理条例（国务院令第 701 号，第十五、二十四、二十五条）. - Notes: Sealing records and making copies are two distinct actions. Copying records is something you should do proactively, as explained in item 6 (always keep your own copies of medical records and imaging). Sealing, on the other hand, serves to preserve evidence at the moment a dispute arises, preventing any later alterations or additions. If you suspect that an IV, blood transfusion, injection, or medication caused a problem, you must seal not only the records but also the fluid bag, medicine vial, and infusion set; otherwise they might be removed or discarded. Hospitals are required to prominently display information about dispute resolution procedures, contact details, and to maintain a dedicated complaints department. In case of any issue, approach that department rather than confronting the attending physician directly. ### 7. After every medical visit, keep a personal copy of your medical records, test reports, and imaging scans - Cost: No cost involved. Hospitals may charge a nominal fee for photocopying, but the rate must be publicly disclosed. The real challenge is remembering to make a copy after each visit. - In plain terms: You have a legal right to access and copy your own medical records. This includes outpatient records, inpatient charts, lab results, imaging scans, surgical and anesthesia notes, pathology reports, and itemized billing statements. Hospitals provide dedicated counters for this purpose, where only basic copying fees apply. These documents prove invaluable when switching doctors, seeking a second opinion, filing commercial insurance claims, or in case of any legal disputes. - Benefit: Laws explicitly recognize access to and duplication of medical records as a fundamental patient right. This entitlement covers all relevant documents such as outpatient and inpatient records, lab results, imaging scans, surgical and anesthesia notes, pathology reports, and billing statements. They serve as essential evidence when changing healthcare providers, obtaining a second medical opinion, filing insurance claims, or in any legal proceedings. - Evidence grade: A - Sources:国家卫生健康委办公厅 (2024). 关于印发急诊医学等 6 个专业医疗质量控制指标（2024 年版）的通知（国卫办医政函〔2024〕150 号）附件 1，指标四「急诊分级分诊执行率」. ；北京市卫生健康委员会 (2019). 北京市加强急诊预检分诊分级工作方案及附件《北京市医院急诊预检分诊分级标准（试行）》：「坚持急危重症优先就诊原则。按照患者病情的严重程度，遵循从重到轻、从病情迅速变化到相对稳定的原则，合理安排患者就诊顺序。」「在急诊科入口的显著位置，设置急诊预检分诊区域」. - Notes: Hospitals maintain dedicated counters for record copying — no need to ask doctors for help. To ensure completeness, simply read aloud the list stipulated in Article 16 of the Regulations on Prevention and Handling of Medical Disputes. It includes outpatient records, inpatient charts, temperature logs, physician orders, lab results, imaging scans, surgical and anesthesia notes, pathology reports, nursing records, and billing statements. Once obtained, organize them chronologically in a dedicated folder. The most critical documents are discharge summaries, surgical reports, pathology findings, and key imaging scans. For chronic disease management, record all relevant metrics in one notebook as described in Section 16. 〔80〕 〔80〕 〔70〕 〔70〕 〔2024〕 〔30〕 〔180〕 〔40〕 〔40〕 ### 8. Even without money or ID, and unable to identify yourself, emergency care must be provided first - Cost: No cost at all. - In plain terms: The state maintains an emergency medical assistance fund designed to cover emergency treatment costs for two groups of patients: those whose identities cannot be verified, and those whose identities are known but who cannot afford the bills. Healthcare facilities are prohibited from refusing, delaying, or shirking emergency care for any reason. Likewise, emergency dispatch centers cannot decline or delay responses due to payment concerns. Therefore, never hesitate to call for help just because you lack funds — this fund covers only the initial emergency phase; subsequent inpatient treatment still relies on yibao (basic medical insurance) and other medical assistance programs. - Benefit: This emergency assistance program is intended for “patients experiencing acute, severe, or life-threatening injuries or illnesses within China who require urgent care but lack verifiable identity or means to pay.” The fund pays two types of expenses: “emergency treatment costs incurred by patients whose identities cannot be determined,” and “outstanding emergency bills for patients whose identities are known but who cannot pay.” Official documents further stipulate that “all healthcare institutions and staff must promptly and effectively treat such patients without any excuses for refusal, delay, or evasion.” Nationwide, the emergency medical hotline is 120; dispatch centers are forbidden from rejecting or delaying service due to scheduling or payment issues. Transport follows the principle of “proximity, urgency, professional suitability, and patient preference” (implemented nationwide since 2013). - Evidence grade: A - Sources:国务院办公厅 (2013). 关于建立疾病应急救助制度的指导意见（国办发〔2013〕15 号）. ；国家卫生和计划生育委员会 (2014). 院前医疗急救管理办法（委令第 3 号，第十三、二十二、二十三、二十五条）. - Notes: This fund applies strictly to emergency treatment costs. Care is delivered first, after which hospitals submit claims to the fund — patients do not receive direct payments. Those covered by yibao continue using that system as usual. Application procedures and limits vary by province. Per the transport guidelines, “proximity” and “urgency” take precedence over “patient preference”; thus ambulances may not take you to a hospital of your choice if a closer facility can handle your condition. Should post-emergency expenses remain unaffordable, additional assistance is available under medical aid programs — see Section 7, Item 10. ### 9. Disability assessments must be conducted only after treatment is complete; doing it too early results in a lower rating - Cost: The cost of such assessments ranges from a few hundred to two thousand yuan, typically paid upfront by the party requesting the evaluation. Assessments are only permitted after treatment has ended or when clinical outcomes have stabilized — usually three to six months post-injury, though sometimes longer. The difficulty lies in resisting the urge to get an early assessment when recovery is still underway. - In plain terms: The amount of compensation one receives depends largely on the disability rating assigned, which in turn reflects how much functional ability remains after full recovery. Official guidelines stipulate that assessments must be performed only after treatment concludes or when clinical results are stable. If an assessment is done while bones are still healing or metal implants remain in place, it reflects the individual’s condition at that moment, effectively lowering their rating. For ordinary fractures that do not impair function even after healing, no disability rating is assigned at all. - Benefit: According to the “Classification of Human Injury and Disability Levels,” assessments must be conducted “after primary injuries and any related complications have been fully treated or when clinical outcomes have stabilized.” The standard further divides disability levels into ten grades, ranging from Grade 1 (100% disability rate) to Grade 10 (10% disability rate), with each grade differing by 10% in terms of functional impairment. Evaluation criteria include structural damage to tissues and organs, resulting functional limitations, and the degree of dependence on medical care or nursing, while also accounting for social and psychological impacts caused by disability. Specific criteria relevant to fractures include: (1) compression fractures of one vertebra where compression reaches one-third or more, or comminuted fractures; (2) two or more fractures of the pelvis or comminuted pelvic fractures resulting in deformity; and (3) loss of 25% or more function in any major joint of the limbs, excluding the ankle joint. Multiple disabilities affecting the same area or of similar nature must not be counted repeatedly. In cases involving multiple disabilities, each respective grade must be explicitly stated (National Standard, effective January 1, 2017). - Evidence grade: A - Sources:最高人民法院、最高人民检察院、公安部、国家安全部、司法部 (2016). 关于发布《人体损伤致残程度分级》的公告（2016 年 4 月 18 日发布，2017 年 1 月 1 日施行），标准第 4.2、4.4、4.5、5.10.6、6.2 条. - Notes: Three distinct disability assessment systems exist and must not be confused. For injuries resulting from assaults, traffic accidents, or other personal injuries, the “Classification of Human Injury and Disability Levels” is used for judicial assessments, determining compensation amounts (see Section 9). Workplace injuries are evaluated via a separate ten-grade system for work capacity assessments, governing eligibility for occupational injury benefits (see Section 19). To qualify for disability-related policies and benefits, individuals must also obtain a Disability Certificate (see Article 11). Prior to any assessment, ensure all medical records, surgical reports, and follow-up imaging are fully prepared (see Article 6 regarding personal record-keeping); missing imaging is a common cause of lower disability ratings. When current injuries coexist with pre-existing conditions, the assessment must specify the proportion of disability attributable to the current injury alone — this directly influences compensation calculations. ### 10. After treatment, functional impairments may indeed remain; apply for a disability certificate at the county-level disability association in your hukou area - Cost: There is no fee for issuing the certificate itself. In principle, applicants must cover the assessment and photography costs, though those in financial hardship may request exemptions. You’ll need to bring your ID, hukou registration, and three two-inch photos with a white background to the county-level disability association. Once approved, the decision is posted in your village or community for five working days, after which the association has ten working days to finalize the process. The main difficulty lies in making multiple trips and waiting through this period. - In plain terms: A disability certificate serves as a prerequisite for receiving disability-related benefits; it is not a medical proof of injury. It categorizes disabilities into seven types — visual, hearing, speech, physical, intellectual, mental, and multiple — each with four severity levels. The application process involves submission, acceptance, assessment at a designated facility, public posting, review, and issuance; the certificate remains valid for ten years and can be renewed free of charge. If you do not meet the criteria, no amount of personal connections can secure one. - Benefit: The disability certificate is “the legal proof of a person’s disability status and classification, serving as a key basis for accessing national and local preferential policies.” Assessment follows the national standard GB/T 26341-2010. Applications are voluntary and administered locally. All seven disability types qualify for levels one through four. County-level associations handle applications and issuance based on evaluations conducted by provincially designated hospitals or specialized institutions. Approved cases are posted publicly for five days, then finalized within ten days. No fee is charged for the certificate; assessment and photography costs are normally the applicant’s responsibility, though some regions offer subsidies or exemptions for those in need. The certificate lasts ten years and can be renewed at no cost; re-evaluation is possible if conditions change. Disagreements with assessment results may be appealed to municipal or provincial expert committees within ten days (effective nationwide since 1 January 2018). - Evidence grade: A - Sources:中国残疾人联合会、国家卫生和计划生育委员会 (2017). 中华人民共和国残疾人证管理办法（2017 年 5 月 27 日发布，2018 年 1 月 1 日施行；第二、三、五、七、九、十七、十九、二十二、二十五条）. - Notes: Calculate the costs and benefits before deciding to apply. The certificate itself does not provide direct financial aid; rather, it unlocks two main subsidies: living allowances for disabled individuals in dibao households, and care subsidies for those at levels one and two requiring long-term assistance — details appear in Section 7, Article 8. It also qualifies holders for local rehabilitation services, assistive devices, tax reductions, employment support, and transport perks; exact criteria vary widely by province, so consult your local disability association website first. Importantly, this certificate differs from judicial disability evaluations or occupational injury assessments — see Section 10 regarding post-treatment evaluation timing. The certificate is strictly personal and non-transferable; misuse or failure to meet ongoing criteria results in revocation, with a one-year ban on reapplication. For multiple disabilities, the most severe category determines the classification level. ### 11. Thank the doctors who saved you — send thank-you letters, banners, or satisfaction ratings instead of cash gifts. The rules prohibit money, not gratitude - Cost: It costs nothing at all. Writing a thank-you letter or filling out a satisfaction survey takes just a few minutes. - In plain terms: Offering money beforehand to “jump the queue” won’t work — allocating appointment slots, beds, scarce medicines, tests, or surgeries is strictly forbidden. After treatment, it’s perfectly fine to show gratitude toward doctors who saved your life, but the method matters. Accepting cash or alcohol gifts puts them in violation of professional ethics. Three proper ways to thank them are: completing a satisfaction survey, writing a personalized thank-you letter, or presenting a commemorative banner, plus following medical advice for follow-up care. - Benefit: Article 7 of the “Nine Guidelines on Ethical Conduct for Medical Staff” (No. 41, 2021) states: “Maintain orderly medical practices and ensure fairness. Uphold equality to foster a just healthcare environment. It is strictly prohibited to accept personal benefits in exchange for allocating scarce medical resources such as appointment slots, beds, medicines, tests, or surgeries.” Article 8 adds: “Build harmonious relationships without accepting ‘red envelopes’ from patients. Adhere strictly to medical ethics and self-discipline.” It further specifies that accepting gifts, cash, gift cards, securities, or other valuables from patients or relatives is forbidden. Likewise, attending paid meals or entertainment arranged by patients is prohibited. Hospitals must enforce these rules, conduct inspections, and penalize violations. Satisfaction ratings now form part of performance evaluations for all tertiary public hospitals under national policy. According to official documents, hospital satisfaction comprises both patient and staff satisfaction, measured via surveys of outpatients, inpatients, and medical staff. A unified national platform collects these results, which are then factored into hospital performance reviews. Hospitals must also handle patient complaints per regulations, establishing dedicated offices to receive, investigate, and respond to concerns regarding medical services, safety, and quality. The relevant policy document was issued in 2019, 2020, and 2021 respectively, with all three years clearly stated in the official materials. - Evidence grade: A - Sources:国家卫生健康委、国家医保局、国家中医药局 (2021). 关于印发医疗机构工作人员廉洁从业九项准则的通知（国卫医发〔2021〕41 号）. 国务院公报 ；国务院办公厅 (2019). 关于加强三级公立医院绩效考核工作的意见（国办发〔2019〕4 号）. ；国家卫生健康委 (2019). 医疗机构投诉管理办法（委令第 3 号）. - Notes: Both you and your doctors benefit from this practice. It does not mean you should never express gratitude — after a night of emergency treatment, it’s natural to want to say thanks. The key is choosing appropriate methods. Cash gifts and alcohol place doctors at risk of disciplinary action; thank-you letters, banners, and satisfaction ratings are fully aligned with official policies. If a doctor declines a gift you’ve already offered, it’s not personal — it’s his duty to refuse. Note also that offering gifts to doctors falls under professional ethics and hospital rules, whereas giving bribes to law enforcement or investigators constitutes a criminal offense under the law; these situations are entirely different. While thank-you letters and banners are widely accepted, there is no official rule stating they become part of personal or departmental records — this is merely anecdotal experience. Only the inclusion of satisfaction ratings in hospital performance assessments has solid policy backing. Should you have doubts about treatment, you may request immediate medical record sealing and retain copies for yourself as described in relevant sections. 〔40〕 〔40〕