This letter serves to notify client's medical provider of attorney's representation of client. Letter further requests disclosure to attorney of client's medical records and related other information.
West Virginia Letter to Doctor Requesting Client's Medical Information
State:
Multi-State
Control #:
US-PI-0017
Format:
Word;
Rich Text
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How to fill out Letter To Doctor Requesting Client's Medical Information?
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§16-29-2. (a) A provider may charge a patient or the patient's personal representative no more than a fee consistent with HIPAA, as amended, and any rules promulgated pursuant to HIPAA, plus any applicable taxes.
To obtain records, a patient, his or her personal representative as defined by HIPAA, or his or her authorized agent or authorized representative must submit a written request with the health care provider. The provider must furnish a copy of the records within 30 days of receiving the request.
Unless the person requesting the record specifically requests a paper copy, the records can be delivered in electronic or digital form and the per page fee cannot exceed 20 cents per page, not to exceed $150 inclusive of all fees, except for applicable taxes.
To obtain medical records, you may now request your records by using the records request tool, through MyWVUChart, email, mail, or calling 304-598-4110 (or toll free 844-484-0304) Monday through Friday from 8 am ? 4 pm.
HEALTH CARE RECORDS. §16-29-3. Retention and destruction of health care records. (a) The health care records of all persons who are not minors or under a disability, or both, shall be retained by the custodian of such records for ten years following the last date of treatment or contact.
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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 filled out; physician and nurses' notes; test results; consultations with specialists; referrals).]
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 filled out; physician and nurses' notes; test results; consultations with specialists; referrals).]