Bronx New York Ejemplo de carta de solicitud de registros médicos - Sample Letter for Request for Medical Records

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

Description

Carta de solicitud de registros médicos. Subject: Request for Medical Records — Bronx, New York Dear [Medical Records Department / Healthcare Facility], I am writing to request a copy of my medical records from [specific time period or date] to the present, as I recently relocated to Bronx, New York. I greatly appreciate your assistance with this matter and kindly request that you provide me with the following information: 1. Personal Details: Please ensure that my complete personal information is included in the medical records, such as: — Full name (including any maiden or previous names) Catbirdsrt— - Social security number — Home addres— - Contact number - Email address 2. Type of Records: Please include all relevant medical records, including but not limited to: — Doctor's notes ansummariesie— - Lab results — Radiology reports (X-rays, MRIs, CT scans, etc.) — Pathology report— - Surgical reports - Progress notes — Immunization record— - Medication history — Allergies and adverse reaction information 3. Primary Care Physician: If possible, kindly include the complete medical records of my primary care physician or any other relevant healthcare providers associated with my medical history. 4. Method of Delivery: Please inform me of the available options for receiving the medical records. I prefer to receive them through secure electronic means, such as email attachments or a secure online portal. Feel free to provide alternative methods if needed, but please ensure the chosen method guarantees confidentiality and data security. 5. Authorization and Fees: Should there be any fees associated with processing this request, please notify me in advance. Additionally, if required, I am willing to complete and sign any necessary authorization forms to comply with HIPAA regulations. 6. Timeframe: I kindly request that you process my request within the legally prescribed timeframe, which is 30 days under HIPAA guidelines. If this timeframe cannot be met, please notify me promptly with an estimated completion date. Lastly, I would like to express my gratitude in advance for your prompt attention to this matter. Your cooperation in providing my medical records will greatly benefit my ongoing healthcare management in Bronx, New York. If you require any further information or have any questions, please do not hesitate to contact me. Thank you for your support and assistance. Sincerely, [Your Full Name] [Date of Birth] [Address] [City, State, ZIP] [Contact Number] [Email Address]

Subject: Request for Medical Records — Bronx, New York Dear [Medical Records Department / Healthcare Facility], I am writing to request a copy of my medical records from [specific time period or date] to the present, as I recently relocated to Bronx, New York. I greatly appreciate your assistance with this matter and kindly request that you provide me with the following information: 1. Personal Details: Please ensure that my complete personal information is included in the medical records, such as: — Full name (including any maiden or previous names) Catbirdsrt— - Social security number — Home addres— - Contact number - Email address 2. Type of Records: Please include all relevant medical records, including but not limited to: — Doctor's notes ansummariesie— - Lab results — Radiology reports (X-rays, MRIs, CT scans, etc.) — Pathology report— - Surgical reports - Progress notes — Immunization record— - Medication history — Allergies and adverse reaction information 3. Primary Care Physician: If possible, kindly include the complete medical records of my primary care physician or any other relevant healthcare providers associated with my medical history. 4. Method of Delivery: Please inform me of the available options for receiving the medical records. I prefer to receive them through secure electronic means, such as email attachments or a secure online portal. Feel free to provide alternative methods if needed, but please ensure the chosen method guarantees confidentiality and data security. 5. Authorization and Fees: Should there be any fees associated with processing this request, please notify me in advance. Additionally, if required, I am willing to complete and sign any necessary authorization forms to comply with HIPAA regulations. 6. Timeframe: I kindly request that you process my request within the legally prescribed timeframe, which is 30 days under HIPAA guidelines. If this timeframe cannot be met, please notify me promptly with an estimated completion date. Lastly, I would like to express my gratitude in advance for your prompt attention to this matter. Your cooperation in providing my medical records will greatly benefit my ongoing healthcare management in Bronx, New York. If you require any further information or have any questions, please do not hesitate to contact me. Thank you for your support and assistance. Sincerely, [Your Full Name] [Date of Birth] [Address] [City, State, ZIP] [Contact Number] [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.