Virginia Sample Letter for Medical Authorization for Client Medical History

State:
Multi-State
Control #:
US-0951LTR
Format:
Word; 
Rich Text
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This form is a sample letter in Word format covering the subject matter of the title of the form.
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  • Preview Sample Letter for Medical Authorization for Client Medical History

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FAQ

Authentication of medical record entries may include written signatures, initials, computer key, or other code. For authentication, in written or electronic form, a method must be established to identify the author.

The subpoena may be issued (i) upon filing a request therefor with the clerk of the circuit court wherein any eventual suit would be required to be filed, and upon payment of the fees required by subdivision A 18 of § 17.1-275, and fees for service or (ii) by the patient's attorney in a pending civil case in ance ...

Dear: [Contact Name/Medical Director], I am writing on behalf of my patient, [Patient First and Last Name] to document the medical necessity for treatment with [DRUG NAME]. This letter provides information about the patient's medical history, diagnosis and a summary of the treatment plan.

Virginia Code § 32.1-127. requires that when the health records of a pro se party or non-party witness are subpoenaed from the health care entity, a notice must be provided to the individual.

An attorney-issued subpoena shall be on a form approved by the Supreme Court, signed by the attorney and shall include the attorney's address. The summons and any transmittal sheet shall be deemed to be a pleading to which the provisions of VA Code §8.01-271.1 shall apply.

Answer: Virginia's Health Records Privacy statute [§ 32.1-127. (J)] states ?If an individual requests a copy of his health record from a health care entity, the health care entity may impose a reasonable cost- based fee, which shall include only the cost of supplies for and labor of copying the requested ...

A request for copies of medical records must be in writing, dated and signed by the person making the request, and include a reasonable description of the records sought. If someone is making a request on your behalf, he or she must provide evidence of the authority to receive the records (such as a power of attorney).

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Virginia Sample Letter for Medical Authorization for Client Medical History