The Research Directorate was unable to find a complete list of the documents that one would find in a Bulgarian medical record among the sources consulted. The National Health Insurance Fund, which oversees health care professionals for insurance purposes, requires medical staff to complete and file copies of ambulatory cards, referral cards, request/result forms for cytological examination of vaginal pap smears and prescription forms for medications (Bulgaria June 2000, Arts. 98.1, 100). These "primary documents" must be created during an examination and "remain in the outpatient health establishment for storage and use" (ibid, Art. 98.2). The Research Directorate was also unable to find information detailing the specific personal information an individual's medical file might contain, or an indication of how long a file is maintained by an institution, among the sources consulted.

Record Keeping

Several reports indicate that the Bulgarian authorities have only recently introduced a number of medical record-related reforms to the health care system (World Bank 18 Sept. 2000; CEEBIC 21 Feb. 2001; Feschieva and Mircheva 2001, 1019; Eurasia Health n.d.). Previously, according to the Bulgarian Institute for Legal Development (BILD), Bulgarian medical records, as well as other records containing personal information, were "very much paper-based" (1 Aug. 1998). In a project begun 22 June 2000, Bulgarian initiated reform of its health sector (Eurasia Health n.d.), including the procurement of new patient record systems for 3,500 family practices and hospital management systems for some 150 hospitals (World Bank 18 Sept. 2000; CEEBIC 21 Feb. 2001). According to a project description on the Eurasia Health Knowledge Network Website, the completion of the new data management information systems program is set for 2005 (n.d.).

Several reports comment on Bulgarian medical record keeping practices in various state institutions (AI Oct. 2002, 12, 23, 40, 66; COE 28 Jan. 2002, 18, 58 59; BHC 2001). Amnesty International (AI) described records in psychiatric facilities as "poor" (Oct. 2002, 66), and the Council of Europe (COE) reported that detention facilities had records of a quality and level of confidentiality that raised serious concerns among observers (28 Jan. 2002, 58). Amnesty International further noted that patients' medical records evidenced haphazard standards in the reporting of medical procedures performed, medical history and disease etiology, current patient vital statistics, and incidents suffered while under care (Oct. 2002 12, 23, 40, 66). The Council of Europe noted that medical records for individuals alleging ill treatment in detention facilities had brief entries "limited to general descriptions such as 'multiple injuries'" (ibid. 18). Furthermore, the Bulgarian Helsinki Committee (BHC) found that in state-run correctional and social education boarding schools, children's medical records were missing "all sorts of documents, ... including medical cards" (2001, Sec. 3).

Duplication of Personal Medical Records

The Research Directorate was unable to find specific information detailing whether an exact duplication of an individual's complete medical record is available for either personal or legal use. The 1998 BILD report stated that citizens could reproduce their personal documents-specifying social security and medical records as examples-for submission to "administrative bodies." Several reports refer to individuals obtaining their medical certificates to document specific injuries (ERRC 2002a; 2002b; HRP 6 Sept. 2002). The Bulgarian Helsinki Committee noted that in the case of psychiatric patients, some prosecutor's offices required such certificates from psychiatrists as evidence of mental disease (BHC Dec. 2001). However, according to a 2002 International Helsinki Federation for Human Rights (IHF) statement to the Organization of Security and Cooperation in Europe (OSCE), Roma have reportedly faced difficulties obtaining medical certificates in cases of police abuse (28-29 Oct. 2002, 12). In addition, the IHF statement claims that police instructed forensic doctors and general practitioners were to not issue certificates to such victims (ibid.).

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim to refugee status or asylum. Please find below the list of additional sources consulted in researching this Information Request.

Amnesty International (AI). October 2002. "Bulgaria: Far from the Eyes of Society. Systematic Discrimination Against People with Mental Disabilities." (AI Index: EUR 15/005/2002) http://web.amnesty.org/aidoc/aidoc_pdf.nsf/Index/EUR150052002ENGLISH/$File/EUR1500502.pdf [Accessed 13 May 2003]

Bulgaria. June 2000. National Health Insurance Fund. "National Framework Contract Between the National Health Insurance Fund and the Bulgarian Medical Doctor's Union and The Union of Dentists in Bulgaria." http://www.nhif.bg/eng/nrd2000.phtml [Accessed 13 May 2003]

Bulgarian Helsinki Committee (BHC). December 2001. "Inpatient Psychiatric Care in Bulgaria and Human Rights." http://www.bghelsinki.org/en/special/2001mental.htm [Accessed 14 May 2003]

_____. 2001. Krassimir Kanev. Correctional Boarding Schools and Social Educational Boarding Schools in Bulgaria. Sofia, Bulgaria: Bulgarian Helsinki Committee. http://www.bghelsinki.org/en/special/spivui.html [Accessed 14 May 2003]

Bulgarian Institute for Legal Development (BILD). 1 August 1998. "Forum- Information Society: Theme Paper." http://www.bild.net/infosoc/forum.htm [Accessed 13 May 2003]

Central and Eastern Europe Business Information Center (CEEBIC) [Washington, DC]. 21 February 2001. "Medical Equipment and Healthcare Management Procurements." http://199.88.185.106/eebic/countryr/bulgaria/market/bgwbmedical.htm [Accessed 13 May 2003]

Council of Europe (COE). 28 January 2002. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. Report to the Bulgarian Government on the Visit to Bulgaria Carried Out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 25 April to 7 May 1999. (CPT/Inf [2002] 1) http://www.cpt.coe.int/documents/bgr/2002-01-inf-eng.pdf [Accessed 13 May 2003]

Eurasia Health Knowledge Network. n.d. "Bulgarian Health Sector Reform Project." http://www.eurasiahealth.org/english/projects/fullinfo.cfm?projectID=8 [Accessed 14 May 2003]

European Roma Rights Center. 2002a. Roma Rights. No. 1. "Police Brutality Against Romani Youths in Bulgaria." http://www.errc.org/rr_nr1_2002/snap34.shtml [Accessed 14 May 2003]

_____. 2002b. Roma Rights. No. 2. "Racist Assaults on Roma in Bulgaria." http://www.errc.org/rr_nr2_2002/snap1.shtml [Accessed 12 May 2003]

Feschieva, Nevyana and Iskra Mircheva. 2001. "Proofs of the Necessity of Medical Informatics for the Physicians in Bulgaria." In MEDINFO 2001. Edited by R. Rogers, R. Haux and V. Patel. Vol. 84, Studies in Health Technology and Informatics. Amsterdam: IOS Press. http://adams.mgh.harvard.edu/PDF_Repository/228_FESCHIEVA.PDF [Accessed 13 May 2003]

Human Rights Project (HRP). 6 September 2002. "Bulgaria: A Roma Man Severely Beaten Up by Policemen in Kjustendil." (MINELRES/30 Sept. 2002) http://lists.delfi.lv/pipermail/minelres/2002-September/002316.html [Accessed 14 May 2003]

International Helsinki Federation for Human Rights (IHF). 28-29 October 2002. "Bulgaria." In The Role of Community Policing in Building Confidence in Minority Communities: I. Albania, Bulgaria, Croatia, Macedonia, Romania and Serbia." Report of the International Helsinki Federation for Human Rights (IHF) to the OSCE Supplementary Human Dimension Meeting on the Role of Community Policing in Building Confidence in Minority Communities, Vienna. http://www.ihf-hr.org/viewbinary/viewdocument.php?doc_id=386 [Accessed 14 May 2003]

World Bank. 18 September 2000. "The Ministry of Health Launches the Health Sector Reform Project Workshop." (News Release 2000/17/ECCBG) http://www.worldbank.bg/press/2000-17-eccbg.phtml [Accessed 13 May 2003]

A former project advisor to the Bulgarian National Insurance Fund was unable to respond to inquiries.

Unsuccessful attempt to contact the Ministry of Health, Bulgaria.

Unsuccessful attempt to contact the Bulgarian Medical Association.

Internet sites, including:

Bulgaria. Law for the Medical Establishments (1999/2000)

Bulgaria. Ministry of Health

Bulgarian Association of Medical Doctors

Bulgarian Chamber of Commerce

Bulgarian Health Project

Bulgarian Red Cross

European Country of Origin Information Network

European Journal of General Health

European Union
Management Systems International.

Social Sector Assessment Bulgaria: July 2001

Mircheva, Iskra. "Aspects of Healthcare Computer Network Security in the Education of Students of Medicine and Healthcare Management." (March 2001).

National Social Security Institute, Bulgaria

United States. Social Security Administration

World Health Organization