This letter serves to notify client's medical provider of attorney's representation of client. Letter further requests disclosure to attorney of client's medical records and related other information.
Illinois Letter to Doctor Requesting Client's Medical Information
State:
Multi-State
Control #:
US-PI-0017
Format:
Word;
Rich Text
Instant download
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How to fill out Letter To Doctor Requesting Client's Medical Information?
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FAQ
6 Steps to Write a Medical Request Letter Step 1: Receiver Details. The first section in a request sample letter to start with is the details of the receiver to whom you are sending the letter. ... Step 2: Salutation. ... Step 3: Reason. ... Step 4: Hospital Details. ... Step 5: Gratitude. ... Step 6: Closing Signature.
Medical records are considered confidential documents, which means they may only be viewed by those who need to know (such as nurses, doctors, and health care administrators) or who have been given consent. Normally, doctors may not share your medical information without your permission.
What to include in your document request email or letter Introduce yourself. State who you are using full name, position and company name. ... Purpose for written request. Then, explain why you are writing. ... Call to action. ... Benefit to the client. ... Closing. ... Contact Information.
I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment. [Identify records requested (e.g., medical-history form you filled out; physician and nurses' notes; test results; consultations with specialists; referrals).]
I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment. [Identify records requested (e.g., medical-history form you filled out; physician and nurses' notes; test results; consultations with specialists; referrals).]
Request a Copy of Your Medical Record To submit your request by mail, fax, email or in person: You may download the medical record request form in English or Spanish. Complete, sign and fax the form to 847-984-5619 or email to Medical Records. Bring your request to Medical Records at the location listed above.
The maximum fees that can be charged for copying medical records in 2022 are as follows: Paper: $1.18 per page for the first 25 pages, $0.79 per page for pages 26 to 50, and $0.39 per page for each page in excess of 50.
You can submit your medical records request via email or mail to the hospital from which you're seeking the records. If you send via mail, please address the envelope to the attention of the Health Information Management Department at the hospital.
