[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Healthcare Provider's Name] [Healthcare Provider's Address] [City, State, ZIP] Subject: Request for Medical Records Dear [Healthcare Provider's Name], I hope this letter finds you well. I am writing to request copies of my medical records maintained at your facility, in accordance with my rights under Missouri state law and the Health Insurance Portability and Accountability Act (HIPAA). I am a resident of Missouri and have received medical services from your healthcare facility [name of facility] within the specified dates of [start date] to [end date]. To ensure accuracy and efficiency, I kindly request that you provide me with a complete set of my medical records, which should include but not be limited to: 1. Consultation and examination notes 2. Laboratory test results 3. Imaging reports (X-rays, MRI, CT scans, etc.) 4. Surgical reports 5. Pathology reports 6. Medication records, including prescriptions and dosages 7. Immunization records 8. Any relevant diagnostic reports 9. Treatment summaries and progress notes 10. Referral documents 11. Correspondence with other healthcare professionals If separate from the medical records, I would also appreciate receiving the billing information associated with the medical services rendered during the aforementioned period. To facilitate the process, please find enclosed a signed Authorization for Release of Medical Information form, as required by both state and federal laws. If you have your own facility-specific request form, kindly let me know, and I will be more than willing to complete it. Additionally, please advise me of any fees associated with processing this request, including costs for copying, postage, or administrative fees. If the costs are beyond what I can currently afford, I kindly request that you provide me with an estimate before proceeding with the release of records. Moreover, please inform me of the expected timeline for receiving the requested records. I would greatly appreciate your prompt attention to this matter. If you have any questions or require any further information, please do not hesitate to contact me at [phone number] or via email at [email address]. Thank you in advance for your cooperation. Sincerely, [Your Name]
Missouri Sample Letter for Request for Medical Records
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How to fill out Sample Letter For Request For Medical Records?
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FAQ
Filling out a medical necessity form requires you to enter patient details and specify the medical services or items needed. You should also include the diagnosis and the rationale for requesting those services. To enhance clarity and compliance, refer to a Missouri Sample Letter for Request for Medical Records for the appropriate structure and content.
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..
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...?
Missouri Revised Statute 334.097 (2) provides that Patient records remaining under the care, custody and control of the licensee shall be maintained by the licensee of the board, or the licensee's designee, for a minimum of seven years from the date of when the last professional service was provided.
For medical records, call (314) 657-1548 to discuss your request with a Department of Health employee. If records are available, you will be given a time to retrieve the records from the Department of Health office at 1520 Market Street, 4th Floor, St. Louis, MO 63103. Records are $10, cash only.
The new maximum fees for copying will be $27.46 plus $0.63 per page, or $120.32 total, whichever is less, for copies provided electronically. Section 191.227, RSMo sets the statutory base rate for calculating the maximum fees for copying medical records at $24.85 and $.
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...
Who can see my medical records? Anyone authorised to see your medical records has a legal, ethical and contractual duty to protect your privacy and confidentiality.
Normally, one would simply have to call the health care provider and request a copy of the record and pick them up, after signing a release for the records. Some records that patients may want to request are test results, reports for surgeries, doctor's notes, discharge summaries and specialists' reports.
