Alameda California Ejemplo de carta de solicitud de registros médicos - Sample Letter for Request for Medical Records

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

Description

Carta de solicitud de registros médicos. [Your Name] [Your Address] [City, State, ZIP Code] [Date] [Medical Provider's Name] [Medical Provider's Address] [City, State, ZIP Code] Subject: Request for Medical Records Dear [Medical Provider's Name], I hope this letter finds you in good health and high spirits. I am writing to request a copy of my medical records as it is imperative for my ongoing healthcare management. I, [Your Full Name], with a date of birth of [Your Date of Birth], have been a patient at your esteemed clinic/hospital/medical facility in Alameda, California. The purpose of this request is to acquire a complete copy of my medical records, encompassing all diagnoses, treatments, laboratory results, medications, reports, and any other relevant information documented during my visits to your facility from [Specific Date — Start of Treatment] to [SpecifiDATat— - End of Treatment]. Should there be any fees associated with this request, kindly inform me in advance. I am willing to pay reasonable charges for the compilation and provision of these records. As per the Health Insurance Portability and Accountability Act (HIPAA) guidelines, please provide me with an itemized bill explaining any costs involved. To expedite the process, I have attached a signed HIPAA release form authorizing you to disclose my medical records to me. This authorization complies with all relevant legal requirements and safeguards the confidentiality of my personal health information. I would appreciate it if you could deliver the copies in a timely manner. If the records are extensive, I kindly request that they be provided in an electronic format, such as a secure email attachment or a digital download link. In case electronic delivery is not possible, please confirm the address to which the medical records should be mailed. For security reasons, I kindly request that the records be sent by certified mail or any other secure method to ensure their safe and confidential delivery. If you have any questions regarding this request or require any additional information, please do not hesitate to contact me at [Your Phone Number] or [Your Email Address]. Your prompt attention to this matter would be highly appreciated, as I require these medical records for an upcoming medical consultation. I would like to thank you in advance for your assistance and cooperation. Yours sincerely, [Your Full Name] [Your Date of Birth] [Your Phone Number] [Your Email Address]

[Your Name] [Your Address] [City, State, ZIP Code] [Date] [Medical Provider's Name] [Medical Provider's Address] [City, State, ZIP Code] Subject: Request for Medical Records Dear [Medical Provider's Name], I hope this letter finds you in good health and high spirits. I am writing to request a copy of my medical records as it is imperative for my ongoing healthcare management. I, [Your Full Name], with a date of birth of [Your Date of Birth], have been a patient at your esteemed clinic/hospital/medical facility in Alameda, California. The purpose of this request is to acquire a complete copy of my medical records, encompassing all diagnoses, treatments, laboratory results, medications, reports, and any other relevant information documented during my visits to your facility from [Specific Date — Start of Treatment] to [SpecifiDATat— - End of Treatment]. Should there be any fees associated with this request, kindly inform me in advance. I am willing to pay reasonable charges for the compilation and provision of these records. As per the Health Insurance Portability and Accountability Act (HIPAA) guidelines, please provide me with an itemized bill explaining any costs involved. To expedite the process, I have attached a signed HIPAA release form authorizing you to disclose my medical records to me. This authorization complies with all relevant legal requirements and safeguards the confidentiality of my personal health information. I would appreciate it if you could deliver the copies in a timely manner. If the records are extensive, I kindly request that they be provided in an electronic format, such as a secure email attachment or a digital download link. In case electronic delivery is not possible, please confirm the address to which the medical records should be mailed. For security reasons, I kindly request that the records be sent by certified mail or any other secure method to ensure their safe and confidential delivery. If you have any questions regarding this request or require any additional information, please do not hesitate to contact me at [Your Phone Number] or [Your Email Address]. Your prompt attention to this matter would be highly appreciated, as I require these medical records for an upcoming medical consultation. I would like to thank you in advance for your assistance and cooperation. Yours sincerely, [Your Full Name] [Your Date of Birth] [Your Phone Number] [Your Email Address]

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.