West Virginia Ejemplo de carta de solicitud de registros médicos - Sample Letter for Request for Medical Records

• Category: Cartas - No legales - Solicitudes
• State: Multi-State
• Control #: US-0546LR
• Format: Word

Description

Carta de solicitud de registros médicos. Subject: Request for Medical Records — Urgent: [Patient's Name], [Patient's Date of Birth], [Patient's Address] Dear [Healthcare Provider's Name], I hope this letter finds you well. I am writing to request the release of the medical records pertaining to [Patient's Name], who was under the care of your esteemed medical institution. As the authorized representative of the patient, I kindly request your prompt attention to this matter. Patient Details: — Patient's Full Name: [Patient's Name— - Patient's Date of Birth: [Patient's Date of Birth] — Patient's Full Address: [Patient's Address] I am seeking the complete medical records of [Patient's Name] for the period starting from [Start Date] to [End Date]. These records are necessary to facilitate continuity of care, ensure accurate medical documentation, and assist in further medical evaluation and treatment planning. To facilitate the process, I would greatly appreciate it if you could provide the following documents: 1. Detailed medical history, including office visit notes, progress reports, primary care records, specialist consultations, and referrals. 2. Admission and discharge summaries from hospitalizations. 3. Laboratory and diagnostic test results, such as radiology reports, biopsy results, blood work panels, and pathology reports. 4. Immunization records, if applicable. 5. Medication history, including prescribed medications, dosages, and duration. 6. Any reports or documentation relating to ongoing treatment plans, surgical procedures, therapies, and medical conditions. If there are any fees associated with retrieving and/or copying the requested medical records, please inform me in advance. I understand that HIPAA permits a reasonable fee to be charged to cover the costs of duplication, mailing, and handling. I kindly request that you provide the requested medical records within 30 days from the date of this letter. Should it be necessary to extend this timeline, please notify me promptly, along with an estimated date of completion. Please feel free to contact me at [Your Contact Number] or via email at [Your Email Address] should you require any additional information or if there are any concerns regarding this request. Thank you for your attention to this matter. I greatly appreciate your cooperation in ensuring the timely provision of the requested medical records. Your assistance will assist in preserving continuity of care and aid in advancing the patient's overall healthcare journey. Sincerely, [Your Full Name] [Your Relationship to the Patient] [Your Address] [Your Contact Number] [Your Email Address] Additional types of West Virginia Sample Letter for Request for Medical Records: 1. West Virginia Sample Letter for Urgent Request for Medical Records 2. West Virginia Sample Letter for Request for Medical Records for Legal Purposes 3. West Virginia Sample Letter for Request for Medical Records for Disability Claim 4. West Virginia Sample Letter for Request for Medical Records for Second Opinion 5. West Virginia Sample Letter for Request for Medical Records for Insurance Claim 6. West Virginia Sample Letter for Request for Medical Records for Personal Records Management.

Subject: Request for Medical Records — Urgent: [Patient's Name], [Patient's Date of Birth], [Patient's Address] Dear [Healthcare Provider's Name], I hope this letter finds you well. I am writing to request the release of the medical records pertaining to [Patient's Name], who was under the care of your esteemed medical institution. As the authorized representative of the patient, I kindly request your prompt attention to this matter. Patient Details: — Patient's Full Name: [Patient's Name— - Patient's Date of Birth: [Patient's Date of Birth] — Patient's Full Address: [Patient's Address] I am seeking the complete medical records of [Patient's Name] for the period starting from [Start Date] to [End Date]. These records are necessary to facilitate continuity of care, ensure accurate medical documentation, and assist in further medical evaluation and treatment planning. To facilitate the process, I would greatly appreciate it if you could provide the following documents: 1. Detailed medical history, including office visit notes, progress reports, primary care records, specialist consultations, and referrals. 2. Admission and discharge summaries from hospitalizations. 3. Laboratory and diagnostic test results, such as radiology reports, biopsy results, blood work panels, and pathology reports. 4. Immunization records, if applicable. 5. Medication history, including prescribed medications, dosages, and duration. 6. Any reports or documentation relating to ongoing treatment plans, surgical procedures, therapies, and medical conditions. If there are any fees associated with retrieving and/or copying the requested medical records, please inform me in advance. I understand that HIPAA permits a reasonable fee to be charged to cover the costs of duplication, mailing, and handling. I kindly request that you provide the requested medical records within 30 days from the date of this letter. Should it be necessary to extend this timeline, please notify me promptly, along with an estimated date of completion. Please feel free to contact me at [Your Contact Number] or via email at [Your Email Address] should you require any additional information or if there are any concerns regarding this request. Thank you for your attention to this matter. I greatly appreciate your cooperation in ensuring the timely provision of the requested medical records. Your assistance will assist in preserving continuity of care and aid in advancing the patient's overall healthcare journey. Sincerely, [Your Full Name] [Your Relationship to the Patient] [Your Address] [Your Contact Number] [Your Email Address] Additional types of West Virginia Sample Letter for Request for Medical Records: 1. West Virginia Sample Letter for Urgent Request for Medical Records 2. West Virginia Sample Letter for Request for Medical Records for Legal Purposes 3. West Virginia Sample Letter for Request for Medical Records for Disability Claim 4. West Virginia Sample Letter for Request for Medical Records for Second Opinion 5. West Virginia Sample Letter for Request for Medical Records for Insurance Claim 6. West Virginia Sample Letter for Request for Medical Records for Personal Records Management.

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.