Medical Record Release Letter Sample

Are you in need of a Medical Record Release Letter Sample? Look no further! Below, you will find examples of Medical Record Release Letter Samples that you can use and modify as needed.

Understanding the Need for a Medical Record Release Letter Sample

When you need to request your medical records from a healthcare provider, you may be required to submit a formal request in writing. This is where a Medical Record Release Letter comes in handy. By providing a written request, you can ensure that your request is clear, concise, and legally binding. Here are some common reasons why you may need to use a Medical Record Release Letter:

To transfer your medical records to a new healthcare provider
To provide your medical records to an insurance company for a claim
To access your own medical records for personal use

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Example of Medical Record Release Letter Sample

Dear [Recipient’s Name],

I am writing to request a copy of my medical records from [Healthcare Provider’s Name]. I was a patient at your facility from [Date] to [Date].

Enclosed with this letter is a signed authorization form granting permission for the release of my medical records. Please send the copies to the following address:

[Your Name]
[Your Address]
[City, State, Zip Code]

If there are any fees associated with this request, please let me know as soon as possible. I appreciate your prompt attention to this matter.

Sincerely,

[Your Name]