Illinois Sample Letter for Request for Medical Records [Your Name] [Your Address] [City, State, ZIP] [Date] [Healthcare Provider's Name] [Healthcare Provider's Address] [City, State, ZIP] Dear [Healthcare Provider's Name], RE: REQUEST FOR MEDICAL RECORDS I am writing to formally request copies of my medical records in accordance with the Illinois Medical Patient Rights Act (ILPGA) and the Health Insurance Portability and Accountability Act (HIPAA). I have been a patient at your facility, [Facility Name], from [Dates of Treatment]. I have recently changed healthcare providers and would like to obtain my complete medical records for continuity of care purposes. To expedite the process, I have enclosed a signed and completed Authorization for Release of Medical Records form, which meets HIPAA regulations (or include any specific form required by the healthcare provider). Please find the necessary information filled in accurately to assist you in locating my records promptly. In compliance with Illinois state law, I understand that I may be charged a reasonable fee for the duplication of medical records. However, I kindly request that you inform me about the associated charges before proceeding with the request. Please provide the following medical records: 1. Consultation notes 2. Hospital admission and discharge summaries 3. Laboratory reports and test results 4. Radiology and imaging reports (x-rays, MRI, CT scans, etc.) 5. Progress notes 6. Pathology reports, if applicable 7. Medication and prescription history 8. Allergies and adverse reaction records 9. Diagnostic reports 10. Immunization history, if available Is there are any additional records or details relevant to my medical history which are not listed above, please include them as well. I would greatly appreciate it if you could provide these records in an electronic format, preferably via secure email or a password-protected online portal. If electronic transmission is not feasible, please inform me of the available options. Please acknowledge receipt of this request within five business days and provide an estimate of when the records will be ready for collection. I understand that HIPAA allows a maximum of 30 days to fulfill this request, but I sincerely hope it can be done sooner to ensure uninterrupted healthcare management. Thank you for your attention to this matter. Should you have any questions or require further clarification, please do not hesitate to contact me at [Your Phone Number] or [Your Email Address]. I look forward to a prompt response. Yours sincerely, [Your Name]
Illinois Sample Letter for Request for Medical Records
Description
How to fill out Sample Letter For Request For Medical Records?
US Legal Forms - one of many greatest libraries of authorized varieties in America - delivers a wide array of authorized file web templates you may acquire or print. While using site, you may get 1000s of varieties for company and person reasons, categorized by types, states, or search phrases.You can get the most recent types of varieties like the Illinois Sample Letter for Request for Medical Records within minutes.
If you currently have a membership, log in and acquire Illinois Sample Letter for Request for Medical Records from your US Legal Forms library. The Obtain button can look on each kind you perspective. You get access to all formerly delivered electronically varieties in the My Forms tab of your respective account.
If you want to use US Legal Forms initially, listed below are straightforward recommendations to help you get began:
- Be sure to have picked the best kind for the city/state. Select the Review button to check the form`s content material. Browse the kind description to ensure that you have chosen the proper kind.
- In the event the kind does not fit your needs, make use of the Look for field towards the top of the display to get the one who does.
- When you are pleased with the form, validate your option by visiting the Get now button. Then, select the prices prepare you prefer and give your qualifications to register for an account.
- Process the purchase. Make use of your credit card or PayPal account to finish the purchase.
- Pick the file format and acquire the form in your device.
- Make changes. Load, change and print and signal the delivered electronically Illinois Sample Letter for Request for Medical Records.
Every format you included in your bank account lacks an expiry day and is your own property eternally. So, in order to acquire or print an additional version, just visit the My Forms portion and then click on the kind you require.
Gain access to the Illinois Sample Letter for Request for Medical Records with US Legal Forms, the most extensive library of authorized file web templates. Use 1000s of expert and state-specific web templates that fulfill your small business or person requires and needs.
Form popularity
FAQ
However, the actual dollar amount is adjusted annually by the Comptroller for the State of Illinois. The maximum fees that can be charged for copying medical records in 2020 are as follows: Paper: $1.09 per page for the first 25 pages, $0.73 per page for pages 26 to 50, and $0.36 per page for each page in excess of 50.
Yes, it is obligatory for doctors, hospitals to provide the copy of the case record or medical record to the patient or his legal representative.
Who can see my medical records? Anyone authorised to see your medical records has a legal, ethical and contractual duty to protect your privacy and confidentiality.
Request a Copy of Your Medical RecordYou may download the medical record request form in English or Spanish. Complete, sign and fax the form to 847-984-5619 or email to Medical Records.In Person. Bring your request to Medical Records at the location listed above.Patient Portal.
If the patient wrote a personal letter requesting records, make sure the following patient information was in the original request:Date of birth.Name.Social Security number.Contact information (address and phone number)Email address.Dates of service and specific records requested (tests, discharge notes, etc.)More items...
Before you write a request letter, one should know to whom the letter is addressed....Here is the simple format of the request letter:Date.Recipient Name, designation and address.Subject.Salutation (Dear Sir/Mam, Mr./Mrs./Ms.)Body of the letter.Gratitude.Closing the letter (Your's Sincerely)Your Name and Signature.
While the statute says nothing about original medical records, it clearly creates a duty to maintain medical records for at least 10 years, and longer if litigation is pending. Pursuant to the Hospital Licensing Act, the Illinois Department of Public Health (DPH) issued rules on medical record retention.
What information should be included in a patient's medical records?The initial health history and physical examination from the doctor.Consultation reports from specialists, as well as any notes.Operative reports / Medical procedure reports.More items...?
The subject line of your request should be "FOIL Request". Please inform me of the cost of providing paper copies of the following records include as much detail about the records as possible, including relevant dates, names, descriptions, etc..
