request-my-ehi

A Claude Code skill that helps patients request their complete Electronic Health Information (EHI) Export from healthcare providers.

Every certified EHR system in the US has been required to support single-patient EHI Export since December 31, 2023 (ONC § 170.315(b)(10)). This feature produces a bulk export of all structured data in a patient's record -- far more complete than a CCDA, patient portal download, or standard records release. Most patients don't know it exists, and many providers haven't used it before.

This skill walks the patient through the entire process: identifying their provider's EHR system, gathering their details, finding (or generating) the right request form, filling it out, attaching a cover letter and detailed appendix explaining the request, and producing a ready-to-submit PDF package.

What It Produces

A 3-page PDF package:

Cover letter (page 1) -- addresses the records department, explains this is a Right of Access request, and suggests routing to HIM/IT
Access request form (page 2) -- either the provider's own ROI form (filled via pdf-lib's form field API) or a generic HIPAA-compliant access request form
Appendix A (page 3) -- explains what EHI Export is, the legal basis, how the provider's IT team can produce it, and delivery preferences

The appendix is customized per EHR vendor, citing the specific product name, export formats, documentation URL, and entity/field counts from a database of 70+ certified vendors.

Supported Vendors

Supports Epic plus 70+ other certified EHR vendors via the EHI Export Analysis vendor database. The skill identifies the provider's EHR system from their patient portal URL, web search, or the patient's knowledge, then generates vendor-specific documentation.

Prerequisites

Claude Code CLI
Node.js >= 18
pdf-lib (npm install --prefix /tmp pdf-lib -- the skill handles this automatically)
ImageMagick (optional, for signature transparency)

Installation

# Clone into your Claude Code skills directory
git clone https://github.com/jmandel/request-my-ehi.git ~/.claude/skills/request-my-ehi

Or for a project-level install:

mkdir -p .claude/skills
git clone https://github.com/jmandel/request-my-ehi.git .claude/skills/request-my-ehi

Usage

Once installed, just tell Claude Code what you need:

I need to request my complete medical records from Associated Physicians of Madison.

Help me get my EHI export from my doctor. They use athenahealth.

I want to request all my health data from my provider. Their patient portal is at mychart.myhealthsystem.org.

Claude will recognize the intent and activate the skill. It will guide you through:

Understanding your situation and explaining EHI Export
Identifying your provider's EHR system
Collecting your details (or extracting from an uploaded file like a FHIR Patient resource)
Finding the provider's request form (or using the generic one)
Finding the provider's fax/mailing address for submission
Filling out the form programmatically
Capturing an e-signature (via E2EE relay, image upload, or print-and-sign)
Generating a cover letter and vendor-specific appendix
Merging into a final 3-page PDF
Helping you actually submit the request (including fax via relay server)

Files

request-my-ehi/
├── SKILL.md                              # Skill definition and instructions
├── scripts/
│   ├── config.json                       # Relay server URL (set relayUrl here)
│   ├── _resolve-server.ts              # Shared helper: resolves server URL from config or CLI
│   ├── lookup-vendor.ts                 # Search the 71-vendor EHI database
│   ├── generate-appendix.ts             # Generate vendor-specific appendix PDF
│   ├── generate-cover-letter.ts         # Generate static cover letter PDF
│   ├── list-form-fields.ts              # Enumerate fields in any PDF form
│   ├── fill-and-merge.ts                # Reference: fill form + merge with cover letter & appendix
│   ├── create-signature-session.ts      # Create an E2EE signature capture session
│   ├── poll-signature.ts                # Poll for and decrypt a completed signature
│   ├── send-fax.ts                       # Send a PDF via fax API
│   └── check-fax-status.ts              # Check fax delivery status
├── server/                               # Relay server (deployed separately)
│   ├── src/                              # Bun + Hono server source
│   ├── public/                           # sign.html (signature capture UI)
│   ├── data/                             # SQLite database (created automatically)
│   │   └── events.db                     # Event log for dashboard stats
│   ├── ehi-relay.service.sample          # systemd service file template
│   ├── Dockerfile
│   └── package.json
└── templates/
    ├── appendix.pdf                      # Pre-built Epic appendix (static)
    ├── authorization-form.pdf            # Generic fillable HIPAA access request form
    ├── authorization-form.tex            # LaTeX source for the access request form
    └── cover-letter.pdf                  # Pre-built static cover letter

Relay Server

The server/ directory contains an optional relay server (Bun + Hono) that provides:

E2EE Signature Capture -- patient draws their signature on a mobile-friendly web page; encrypted in-browser with ECDH P-256 + AES-256-GCM before reaching the server
Fax API -- send faxes via configured provider (Sinch) and check delivery status
Public Dashboard -- anonymous usage statistics at /dashboard

The relay scripts (create-signature-session, poll-signature, send-fax, check-fax-status) read the server URL from scripts/config.json. Set relayUrl there after deploying.

Development

cd server && bun install && bun run dev  # localhost:8000

Production Deployment

The server stores event data in SQLite at server/data/events.db. This file is created automatically on first run.

# 1. Create .env file with required secrets
cat > server/.env << 'EOF'
BASE_URL=https://your-domain.com
SINCH_PROJECT_ID=your-project-id
SINCH_KEY_ID=your-key-id
SINCH_KEY_SECRET=your-key-secret
SINCH_SERVICE_ID=your-service-id
EOF

# 2. Install systemd service
sudo cp server/ehi-relay.service /etc/systemd/system/
sudo systemctl daemon-reload
sudo systemctl enable ehi-relay
sudo systemctl start ehi-relay

# 3. Check status
sudo systemctl status ehi-relay
journalctl -u ehi-relay -f

The service runs as the current user from the server/ directory. Logs go to journald and include JSON-formatted events for monitoring.

Legal Context

HIPAA Right of Access (45 CFR § 164.524) -- patients can request their PHI in electronic form
21st Century Cures Act (45 CFR Part 171) -- declining to use a certified export feature may constitute information blocking
ONC Certification § 170.315(b)(10) -- EHI Export has been required since December 31, 2023
Vendor EHI database -- https://joshuamandel.com/ehi-export-analysis/

License

Apache-2.0. See LICENSE.

Request My Ehi

Install / Use

README