Dear [Healthcare Provider], I am writing to request a copy of my complete medical records in accordance with the Utah state laws regarding access to personal health information. I believe it is essential to have a comprehensive record of my medical history for personal reference and to ensure the continuity of my healthcare. As a resident of Utah, I am aware of my rights under the Utah Medical Records Act, which guarantees individuals the right to access their medical records. According to the law, healthcare providers are required to provide the requested records within 30 days of receiving a formal request. I kindly request that you provide me with the following information from my medical records: 1. Diagnosis and treatment information: I would like a detailed account of all diagnoses I have received and the corresponding treatments or medications administered. 2. Laboratory and test results: Please include all results from laboratory tests, radiographs, x-rays, MRI scans, and any other diagnostic procedures that have been performed. 3. Progress notes: Please provide all progress notes and summaries documented by healthcare professionals during my visits, including any recommendations or modifications to my treatment plan. 4. Surgical reports: If I have undergone any surgical procedures, I request copies of the surgical reports and related documents. 5. Immunization records: Please include a complete record of all immunizations I have received, including dates and types of vaccinations. 6. Allergies and adverse reactions: Please provide information about any known allergies or adverse reactions I have experienced in the past, as this is crucial for avoiding potential complications or adverse effects during future treatments. 7. Discharge summaries: If I have been hospitalized, I request copies of the discharge summaries provided upon my release. I understand that there may be costs associated with copies of my medical records. If applicable, kindly inform me of any fees or charges beforehand. I am willing to settle these expenses to ensure the prompt processing of my request. If possible, I would prefer to receive my medical records in electronic format (such as a PDF file) via securely encrypted email. If electronic format is not possible, please inform me of the available options for receiving a hard copy. Thank you for your attention to this matter. I appreciate your prompt response to my request. If you have any questions or require any further documentation, please do not hesitate to contact me at [your contact information]. Sincerely, [Your Name] [Date]
Utah 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
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...
May not charge a fee for the electronic copy that exceeds $150 regardless of the number of pages and regardless of whether the original medical records are stored in electronic format.
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.
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..
How to Request Your Medical Records. 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.
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...?
The short answer is most likely five to ten years after a patient's last treatment, last discharge or death. That being said, laws vary by state, and the minimum amount of time records are kept isn't uniform across the board.
Hospitals must retain medical records for 7 years. Medical records of minor patients must be kept for 4 years past the minor's 18 birthday, but...
There is a medical record request form on the Salt Lake Regional Medical Center website under Medical Records. Fill out the request and fax along with a photo identification to 801-350-4390.
