Dear [Healthcare Provider], I hope this letter finds you well. I am writing to request the medical records of [patient's name] for the purpose of [state the reason for the request, e.g., continued medical care, second opinion, legal documentation, etc.]. As a valued healthcare provider, I understand the significance of patient confidentiality and the importance of maintaining the security of personal health information. Therefore, I assure you that the requested medical records will be handled with utmost care and used solely for the stated purpose. Kindly provide the following medical records for [patient's name]: 1. Medical history and physical examination reports 2. Diagnostic test results (such as lab reports, X-rays, MRI scans, etc.) 3. Daily progress notes and nursing records 4. Medication and prescription history 5. Surgical and operative reports, if applicable 6. Specialist consultation reports 7. Discharge summary/summary of care, if applicable 8. Mental health records, if relevant To ensure accuracy and completeness, please include the records for the following time period: [specific dates or time frame]. In addition, if there are any updated or recent healthcare documents available, please include them as well. The requested medical records are necessary for the continuity of care and to assist in making informed decisions regarding [patient's name]'s health condition. Your prompt attention to this matter would be greatly appreciated. If there are any associated costs for retrieving or copying the records, kindly notify me in advance. Please feel free to contact me at [your contact information] should you require any additional information or if there are any concerns regarding this request. Thank you for your attention and cooperation. I look forward to receiving the requested medical records at your earliest convenience. Sincerely, [Your Name] [Your Contact Information] Keywords: Nassau New York, request, patient, medical records, healthcare provider, confidentiality, personal health information, continued medical care, second opinion, legal documentation, medical history, physical examination, diagnostic test results, progress notes, nursing records, medication history, surgical reports, specialist consultation reports, discharge summary, mental health records, accuracy, completeness, continuity of care, informed decisions, prompt attention, associated costs, contact information.
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.