Fulton Georgia Ejemplo de carta de solicitud de registros médicos del paciente - Sample Letter for Request for Patient Medical Records

• Category: Cartas - No legales - Médicas
• State: Multi-State
• County: Fulton
• Control #: US-0328LR
• Format: Word

Description

Carta solicitando registros médicos del paciente. Subject: Request for Patient Medical Records from Fulton Georgia Healthcare Center Dear [Healthcare Provider's Name], I hope this letter finds you well. I am writing on behalf of [Patient's Name], who has authorized me to request copies of their medical records from Fulton Georgia Healthcare Center. [Patient's Name] received medical care at your esteemed facility between [Date Range]. In order to ensure continuity of care and for the purpose of managing their health effectively, we kindly request that you provide us with the following medical records: 1. Comprehensive Medical History: — Consultation note— - Progress notes - Discharge summaries — Hospital admission records, if applicable — Emergency department records, if applicable 2. Diagnostic Reports: — Laboratory test result— - Radiology reports (X-rays, MRI, CT scans) — Pathology report— - EKG/ECG results - Immunization records 3. Treatment Plans and Procedures: — Surgical report— - Prescription details — Notes on administered medication— - Rehabilitation and physical therapy records 4. Specialized Consultations: — Referrals to specialty clinic— - Specialist correspondence and reports — Mental health assessment records, if applicable The above-mentioned records are crucial for [Patient's Name]'s ongoing medical care and to facilitate consultations with other healthcare providers. We kindly request that you provide the records in an organized and easily readable format. If possible, digital copies sent via email would be highly appreciated. In case there are any charges associated with retrieving the medical records, please inform us in advance. For the purpose of verification, please find the necessary details regarding the patient and sender information below: Patient Information: — Full Name: [Patient's Full Name— - Date of Birth: [Patient's Date of Birth] — Address: [Patient's Current Address— - Contact Number: [Patient's Contact Number] Sender Information: — Full Name: [Your Full Name— - Relationship to Patient: [Your Relationship] — Address: [Your Address— - Contact Number: [Your Contact Number] Please provide the requested medical records within 30 days from the date of receipt of this letter. If it is not possible to fulfil this request within the specified timeframe, please notify us as to when we can expect them. Thank you in advance for your prompt attention to this matter. If you have any questions or require further information, please do not hesitate to contact me at [Your Contact Number] or via email at [Your Email Address]. We greatly appreciate your cooperation and assistance in providing us with the requested medical records. Your dedication to patient care and ensuring the continuity of their treatment is highly valued. Sincerely, [Your Name] [Your Title/Position, if applicable]

Subject: Request for Patient Medical Records from Fulton Georgia Healthcare Center Dear [Healthcare Provider's Name], I hope this letter finds you well. I am writing on behalf of [Patient's Name], who has authorized me to request copies of their medical records from Fulton Georgia Healthcare Center. [Patient's Name] received medical care at your esteemed facility between [Date Range]. In order to ensure continuity of care and for the purpose of managing their health effectively, we kindly request that you provide us with the following medical records: 1. Comprehensive Medical History: — Consultation note— - Progress notes - Discharge summaries — Hospital admission records, if applicable — Emergency department records, if applicable 2. Diagnostic Reports: — Laboratory test result— - Radiology reports (X-rays, MRI, CT scans) — Pathology report— - EKG/ECG results - Immunization records 3. Treatment Plans and Procedures: — Surgical report— - Prescription details — Notes on administered medication— - Rehabilitation and physical therapy records 4. Specialized Consultations: — Referrals to specialty clinic— - Specialist correspondence and reports — Mental health assessment records, if applicable The above-mentioned records are crucial for [Patient's Name]'s ongoing medical care and to facilitate consultations with other healthcare providers. We kindly request that you provide the records in an organized and easily readable format. If possible, digital copies sent via email would be highly appreciated. In case there are any charges associated with retrieving the medical records, please inform us in advance. For the purpose of verification, please find the necessary details regarding the patient and sender information below: Patient Information: — Full Name: [Patient's Full Name— - Date of Birth: [Patient's Date of Birth] — Address: [Patient's Current Address— - Contact Number: [Patient's Contact Number] Sender Information: — Full Name: [Your Full Name— - Relationship to Patient: [Your Relationship] — Address: [Your Address— - Contact Number: [Your Contact Number] Please provide the requested medical records within 30 days from the date of receipt of this letter. If it is not possible to fulfil this request within the specified timeframe, please notify us as to when we can expect them. Thank you in advance for your prompt attention to this matter. If you have any questions or require further information, please do not hesitate to contact me at [Your Contact Number] or via email at [Your Email Address]. We greatly appreciate your cooperation and assistance in providing us with the requested medical records. Your dedication to patient care and ensuring the continuity of their treatment is highly valued. Sincerely, [Your Name] [Your Title/Position, if applicable]

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.