[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Medical Provider's Name] [Medical Provider's Address] [City, State, ZIP] Subject: Request for Medical Records Dear [Medical Provider's Name], I hope this letter finds you in good health. I am writing to formally request copies of my medical records from your esteemed facility, [Medical Provider's Name]. I have been a patient at your establishment and would greatly appreciate having access to my complete medical history for personal reference and continuity of care. As I aim to obtain a comprehensive and accurate record, please provide me with the following medical records: 1. Consultation Reports: Any reports or summaries from consultations with healthcare professionals, including specialists, hospitals, and clinics. 2. Medical Test Results: Copies of all test results, such as blood work, imaging scans (X-rays, MRIs, CT scans), biopsy reports, electrocardiogram (ECG) results, etc. 3. Surgical Reports: Detailed information regarding any surgical procedures I may have undergone, including operative notes, anesthesia records, discharge summaries, and postoperative care instructions. 4. Treatment Plans: Documentation outlining the recommended treatment plans, including prescribed medications, therapies, or any special procedures. 5. Progress Notes: Complete medical notes and records generated during my visits, including descriptions of symptoms, diagnoses, treatment approaches, and any modifications made to my treatment over time. 6. Immunization History: A record of all immunizations administered to me, including dates, types, and batch numbers. 7. Allergies and Reactions: Documentation of any known allergies or adverse drug reactions that are pertinent to my medical history. As required by law, please provide these records within 30 days from the receipt of this letter. If copying fees apply, kindly inform me in advance. If by any chance, my medical records have been transferred to another facility, I kindly request guidance on how to appropriately retrieve them. To expedite the process, I have enclosed a completed Release of Medical Records form, authorizing the disclosure of my medical records to me. If any additional forms or verifications are necessary, kindly inform me, and I will promptly provide them to ensure a smooth retrieval process. I appreciate your prompt attention to this matter and look forward to receiving the requested records. In case of any questions or concerns, please do not hesitate to contact me via the provided phone number or email address. Thank you for your cooperation and for your commitment to maintaining accurate and confidential medical records. Your efforts are critical in ensuring my continuous care and overall well-being. Yours sincerely, [Your Name]
Kansas Sample Letter for Request for Medical Records
Description
How to fill out Sample Letter For Request For Medical Records?
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FAQ
If the patient wrote a personal letter requesting records, make sure the following patient information was in the original request:Date of birth.Name.Social Security number.Contact information (address and phone number)Email address.Dates of service and specific records requested (tests, discharge notes, etc.)More items...
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 provided; physician and nurses' notes; test results, consultations with specialists; referrals.
Open with a professional greetingWriting a professional greeting, followed by a comma, is a friendly way to start your request letter. The word 'Dear', followed by your recipient's title and surname suits most letters of request. If your recipient is someone you know well, you may address them by their first name.
Most practices or facilities will ask you to fill out a form to request your medical records. This request form can usually be collected at the office or delivered by fax, postal service, or email. If the office doesn't have a form, you can write a letter to make your request.
The subject line of your request should be "FOIL Request". Please inform me of the cost of providing paper copies of the following records include as much detail about the records as possible, including relevant dates, names, descriptions, etc..
If the patient wrote a personal letter requesting records, make sure the following patient information was in the original request:Date of birth.Name.Social Security number.Contact information (address and phone number)Email address.Dates of service and specific records requested (tests, discharge notes, etc.)More items...
Before you write a request letter, one should know to whom the letter is addressed....Here is the simple format of the request letter:Date.Recipient Name, designation and address.Subject.Salutation (Dear Sir/Mam, Mr./Mrs./Ms.)Body of the letter.Gratitude.Closing the letter (Your's Sincerely)Your Name and Signature.
What information should be included in a patient's medical records?The initial health history and physical examination from the doctor.Consultation reports from specialists, as well as any notes.Operative reports / Medical procedure reports.More items...?
To write a letter of request, start by greeting the recipient with Dear, followed by the person's last name and title, or To Whom It May Concern. Then, briefly explain who you are and why you're writing in the 1st paragraph. Next, provide additional context and details about your request in the 2nd paragraph.
