Franklin Ohio Ejemplo de carta de solicitud de registros médicos - Sample Letter for Request for Medical Records

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

Description

Carta de solicitud de registros médicos. Subject: Request for Medical Records — Franklin, Ohio Dear [Healthcare Provider's Name], I hope this letter finds you in good health and high spirits. I am writing to formally request copies of my medical records from [name of clinic/hospital], located in Franklin, Ohio. As a diligent patient, I believe it is crucial to have access to my complete medical history for personal reference and future healthcare purposes. To expedite this process, I have outlined below the necessary details: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Current Address: [Your Current Address] — Phone Number: [Your Contact Number— - Email Address: [Your Email Address] 2. Record Details: — Dates of Treatment: [Specify the respective time range or specific appointments] — Treating Physicians: [List all doctors/providers involved in your care] — Type of Records Requested: [Specify if you require the entire medical history or specific records like laboratory tests, diagnostic reports, surgical notes, etc.] 3. Authorization and Legal Compliance: — Please find attached a signed authorization form, granting permission for the release of my medical records, as required by HIPAA regulations. — If additional documents, such as a copy of my government-issued identification or insurance information, are necessary, kindly inform me so that I can promptly provide them to support the request. 4. Preferred Method of Delivery: — I would appreciate it if the records could be securely delivered to me in a digital format via encrypted email or through an online patient portal, if available. However, if physical copies are the only option, kindly inform me about the associated cost and provide me with instructions to proceed with the payment. 5. Deadline: — As per HIPAA guidelines, I understand that medical facilities are generally obligated to fulfill records requests within 30 days. If, for any reason, you anticipate a delay or require additional time, please notify me promptly. In conclusion, I would like to express my gratitude for your cooperation in fulfilling this crucial request for my medical records. Should you have any questions or require further information, please feel free to contact me at the provided phone number or email address. Thank you for your attention to this matter and for your commitment to patient care. Sincerely, [Your Full Name] [Your Contact Number] [Your Email Address]

Subject: Request for Medical Records — Franklin, Ohio Dear [Healthcare Provider's Name], I hope this letter finds you in good health and high spirits. I am writing to formally request copies of my medical records from [name of clinic/hospital], located in Franklin, Ohio. As a diligent patient, I believe it is crucial to have access to my complete medical history for personal reference and future healthcare purposes. To expedite this process, I have outlined below the necessary details: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Current Address: [Your Current Address] — Phone Number: [Your Contact Number— - Email Address: [Your Email Address] 2. Record Details: — Dates of Treatment: [Specify the respective time range or specific appointments] — Treating Physicians: [List all doctors/providers involved in your care] — Type of Records Requested: [Specify if you require the entire medical history or specific records like laboratory tests, diagnostic reports, surgical notes, etc.] 3. Authorization and Legal Compliance: — Please find attached a signed authorization form, granting permission for the release of my medical records, as required by HIPAA regulations. — If additional documents, such as a copy of my government-issued identification or insurance information, are necessary, kindly inform me so that I can promptly provide them to support the request. 4. Preferred Method of Delivery: — I would appreciate it if the records could be securely delivered to me in a digital format via encrypted email or through an online patient portal, if available. However, if physical copies are the only option, kindly inform me about the associated cost and provide me with instructions to proceed with the payment. 5. Deadline: — As per HIPAA guidelines, I understand that medical facilities are generally obligated to fulfill records requests within 30 days. If, for any reason, you anticipate a delay or require additional time, please notify me promptly. In conclusion, I would like to express my gratitude for your cooperation in fulfilling this crucial request for my medical records. Should you have any questions or require further information, please feel free to contact me at the provided phone number or email address. Thank you for your attention to this matter and for your commitment to patient care. Sincerely, [Your Full Name] [Your Contact 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.