Subject: Request for Medical Records — Your Timely Assistance Appreciated Dear [Medical Records Department], I hope this letter finds you well. I am writing to request copies of my medical records in accordance with Section 90-411 of North Carolina General Statutes. It is crucial for me to have access to this information for personal reference and continuity of care purposes. My identifying information is as follows: Patient's Full Name: [Your Full Name] Date of Birth: [Your Date of Birth] Address: [Your Full Address] Phone Number: [Your Phone Number] Email Address: [Your Email Address] I kindly request copies of all available medical records for the period between [Start Date] and [End Date]. These records should include, but are not limited to, the following: 1. Physician notes from all healthcare providers involved in my care. 2. Laboratory test results, including blood tests, radiology reports, and any other diagnostic imaging results. 3. Treatment and medication records, including prescriptions and dosages. 4. Surgical reports and operative notes, if applicable. 5. Specialist consultation notes. 6. Emergency room records, if available. 7. Discharge summaries and any hospitalization records. 8. Immunization records. 9. Any other relevant medical records that pertain to my health and treatment during the specified time frame. I understand that there may be charges associated with the retrieval and duplication of these records. Therefore, to expedite the process, please find enclosed a check in the amount of [Specify Amount] as payment for any applicable fees. Should the expenses exceed this amount, please inform me in advance to make necessary arrangements. If it facilitates the retrieval process, I would be available to pick up the records in person. Kindly inform me of a suitable date and time for collection. Furthermore, I would like to express my gratitude for your prompt attention to this matter. As a beneficiary of North Carolina's medical services, I trust that you will handle my request with care and efficiently provide the necessary information. Understanding that medical record requests can be time-consuming, I genuinely appreciate your dedication in ensuring the smooth retrieval of my records. If you require any additional information or forms to complete this request, please do not hesitate to contact me at [Your Phone Number] or via email at [Your Email Address]. Thank you for your cooperation and understanding. I look forward to receiving the requested medical records within a reasonable timeframe, as stipulated by the North Carolina General Statutes. Sincerely, [Your Full Name] [Your Date of Birth] [Your Address] [Your Phone Number] [Your Email Address] Types of North Carolina Sample Letters for Request for Medical Records: 1. North Carolina Sample Letter for Request for Medical Records — Personal Medical History 2. North Carolina Sample Letter for Request for Medical Records — Continuity of Care 3. North Carolina Sample Letter for Request for Medical Records — Legal Proceedings 4. North Carolina Sample Letter for Request for Minor's Medical Records 5. North Carolina Sample Letter for Request for Deceased Individual's Medical Records.
North Carolina Sample Letter for Request for Medical Records
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How to fill out North Carolina Sample Letter For Request For Medical Records?
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FAQ
To obtain a copy of the medical records you must request the records from the medical care provider. To provide these medical records to you, your health care provider must follow government privacy laws called HIPAA. HIPAA is the Health Insurance Portability and Accountability Act of 1996.
North Carolina General Statutes §90-411$0.75 for first 25 pages. $0.50 for pages 26-100. $0.25 for pages over 100. Minimum fee of $10.00 permitted.
Can I view my medical records? Yes. You have a legal right to see your own records. You do not have to explain why you want to see them.
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.
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...
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..
3903 North Carolina Department of Health and Human Services is charged with creating policy regarding "health care facilities", and is written primarily for hospitals. According to the DHHS medical records of a facility must be maintained for at least 11 years after an adult patient's discharge.
NOTE: Records must be retained 11 years after last encounter at hospital. NOTE: Records must be retained 11 years after last encounter. NOTE: Records must be retained until the patient reaches 19 years of age in addition to this minimum time requirement.
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...?
