Subject: Request for Patient Medical Records — North Dakota Sample Letter Dear [Healthcare Provider's Name], I hope this letter finds you well. I am writing to request the release of my medical records in accordance with the applicable laws and regulations in the state of North Dakota. I am a patient at your esteemed healthcare facility, and I would greatly appreciate your assistance in providing me with a copy of my complete medical records. As a responsible individual actively involved in managing my healthcare, it has become essential for me to gather and maintain a comprehensive record of my medical history, diagnoses, treatments, and any other pertinent information related to my health. This is crucial for me to make informed decisions about my ongoing healthcare needs. In adherence to the Health Insurance Portability and Accountability Act (HIPAA) and the North Dakota state laws, which protect patient privacy and provide guidelines for releasing medical records, I kindly request your prompt attention to my request for the following records: 1. Complete medical history, including medical reports, progress notes, and consultations. 2. Laboratory test results, including blood work, imaging exams, and pathology reports. 3. Prescription and medication records, including details of dosages and frequencies. 4. Records of immunizations and vaccinations received. 5. Surgical reports and related documentation. 6. Treatment plans, including physical therapy, occupational therapy, and any other specialized care. 7. Radiology and diagnostic imaging reports, such as X-rays, MRI scans, and ultrasounds. 8. Any psychological or psychiatric evaluations conducted, if applicable. 9. Correspondence with other healthcare providers relevant to my care. I understand that there may be a nominal fee associated with processing this request. Kindly inform me of any charges, and I will be happy to provide payment promptly. I also request that you inform me of the estimated time required to fulfill this request. Please forward the requested records to my attention at the following address: [Your Full Name] [Your Complete Address] [City, State, ZIP Code] [Phone Number] [Email Address] If it is more convenient, you may also provide the records in electronic format, provided they are secure and password-protected. Please let me know if this option is available and any instructions for accessing the electronic records. I understand that North Dakota state laws allow for a period of up to thirty (30) days for the fulfillment of a medical records request. However, if it is possible to expedite the process, I would be sincerely grateful. Thank you in advance for your prompt attention and cooperation regarding this matter. Should you require any additional information or documentation to proceed with this request, please do not hesitate to contact me at the phone number or email address provided. I value the healthcare services provided by your esteemed institution and appreciate your assistance in promptly providing the requested medical records. Your cooperation in this matter is highly appreciated. Sincerely, [Your Full Name]
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.North Dakota Ejemplo de carta de solicitud de registros médicos del paciente - Sample Letter for Request for Patient Medical Records
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