Medical Records Request Letter Sample

Are you in need of a Medical Records Request Letter Sample? Look no further! Below, you will find examples of Medical Records Request Letter Samples that you can use and modify as needed to suit your specific situation.

Explaining the Need for a Medical Records Request Letter Sample

When you require access to your medical records for various reasons such as changing healthcare providers, filing insurance claims, or seeking a second opinion, you may need to submit a formal request to obtain copies of your medical records. A Medical Records Request Letter serves as a formal written request to the healthcare provider or facility that holds your medical records, asking them to provide you with a copy of your medical information. Here are some common reasons why you might need to request your medical records:

Transferring to a new healthcare provider
Filing an insurance claim
Seeking a second opinion
Participating in a research study
Legal purposes

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Example of a Medical Records Request Letter Sample

Dear [Recipient’s Name],

I am writing to request a copy of my medical records from [Healthcare Provider/Facility Name]. My full name is [Your Name] and my date of birth is [Your DOB]. I was a patient at your facility from [Date of Admission] to [Date of Discharge].

I am in need of my medical records for [Specify Reason – e.g. transferring to a new healthcare provider, filing an insurance claim, seeking a second opinion]. Please provide me with a complete copy of my medical records including all test results, treatment notes, and any other relevant information.

If there are any fees associated with obtaining a copy of my medical records, please let me know. I am willing to cover any costs incurred in the process of fulfilling this request.

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Thank you for your prompt attention to this matter. I would appreciate it if you could send me the requested medical records at your earliest convenience.

Sincerely,

[Your Name]