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.
Wyoming Letter to Doctor Requesting Client's Medical Information
State:
Multi-State
Control #:
US-PI-0017
Format:
Word;
Rich Text
Instant download
Description
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How to fill out Letter To Doctor Requesting Client's Medical Information?
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FAQ
Medical information requests (MIRs) are a crucial part of the healthcare and life sciences industry, allowing healthcare providers to obtain the information they need to provide the best possible care for their patients.
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).]
Under the Americans with Disabilities Act (ADA), employers cannot ask employees about their health or possible disabilities. However, your employer can ask about your health in two cases: If they suspect you may have a condition that could risk your safety in the workplace or ability to perform your job.
A description of the information that will be used/disclosed. The purpose for which the information will be disclosed. The name of the person or entity to whom the information will be disclosed. An expiration date or expiration event when consent to use/disclose the information is withdrawn.
The HIPAA Privacy Rule at 45 CFR 164.510(b) specifically permits covered entities to share information that is directly relevant to the involvement of a spouse, family members, friends, or other persons identified by a patient, in the patient's care or payment for health care.
Access. Only you or your personal representative has the right to access your records. A health care provider or health plan may send copies of your records to another provider or health plan only as needed for treatment or payment or with your permission.
With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans.
Your health information cannot be used or shared without your written permission unless this law allows it. For example, without your authorization, your provider generally cannot: Give your information to your employer.