Dallas Texas Ejemplo de carta de solicitud de registros médicos - Sample Letter for Request for Medical Records

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

Description

Carta de solicitud de registros médicos. Subject: Request for Medical Records — Dallas, Texas Edition Dear [Medical Provider's Name], I hope this letter finds you well. I am writing to kindly request a copy of my medical records for my personal reference and ongoing healthcare management. I have been a patient at your esteemed medical facility, located in Dallas, Texas, and I appreciate the exceptional care and attention I have received from your dedicated team. Understanding the importance of comprehensive medical history, I believe having access to my medical records would greatly benefit my current and future healthcare needs. Therefore, I kindly request you to provide me with the following information: 1. Personal Information: Funnymanam— - Date of birth - Address - Contact number — Email address 2. Specifics of the Medical Records: — Dates of visits and treatment— - Consultation notes — Diagnosis detail— - Laboratory test results (including blood work, imaging studies, etc.) — Any surgical procedures undertake— - Prescribed medications and dosage information — Immunization record— - Any other relevant medical information Moreover, I understand that a nominal fee may be associated with the procurement and copying of these records. Please inform me about the exact cost involved and the preferred mode of payment. To facilitate the process, I have enclosed a signed and completed authorization form, granting you permission to release my medical records to the designated individual or entity. Kindly review and acknowledge this request, as per the regulations outlined by the Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws governing patient privacy. If it is more convenient for you, I would be available to visit the facility personally to complete any necessary paperwork or provide any further information required. Please inform me of a suitable date and time for such arrangements if necessary. I appreciate your attention to this matter and eagerly anticipate receiving my medical records in a timely manner. Should you have any queries or require additional information, please do not hesitate to contact me at your earliest convenience. Thank you for your continued commitment to patient care. I am grateful for your cooperation and assistance in fulfilling my request. Your prompt attention to this matter is highly appreciated. Sincerely, [Your Full Name] [Your Contact Information]

Subject: Request for Medical Records — Dallas, Texas Edition Dear [Medical Provider's Name], I hope this letter finds you well. I am writing to kindly request a copy of my medical records for my personal reference and ongoing healthcare management. I have been a patient at your esteemed medical facility, located in Dallas, Texas, and I appreciate the exceptional care and attention I have received from your dedicated team. Understanding the importance of comprehensive medical history, I believe having access to my medical records would greatly benefit my current and future healthcare needs. Therefore, I kindly request you to provide me with the following information: 1. Personal Information: Funnymanam— - Date of birth - Address - Contact number — Email address 2. Specifics of the Medical Records: — Dates of visits and treatment— - Consultation notes — Diagnosis detail— - Laboratory test results (including blood work, imaging studies, etc.) — Any surgical procedures undertake— - Prescribed medications and dosage information — Immunization record— - Any other relevant medical information Moreover, I understand that a nominal fee may be associated with the procurement and copying of these records. Please inform me about the exact cost involved and the preferred mode of payment. To facilitate the process, I have enclosed a signed and completed authorization form, granting you permission to release my medical records to the designated individual or entity. Kindly review and acknowledge this request, as per the regulations outlined by the Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws governing patient privacy. If it is more convenient for you, I would be available to visit the facility personally to complete any necessary paperwork or provide any further information required. Please inform me of a suitable date and time for such arrangements if necessary. I appreciate your attention to this matter and eagerly anticipate receiving my medical records in a timely manner. Should you have any queries or require additional information, please do not hesitate to contact me at your earliest convenience. Thank you for your continued commitment to patient care. I am grateful for your cooperation and assistance in fulfilling my request. Your prompt attention to this matter is highly appreciated. Sincerely, [Your Full Name] [Your 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.