Dear [Healthcare Provider's Name], I hope this letter finds you well. I am writing to request copies of my medical records from your facility as I am moving to Houston, Texas and need to establish care with a new healthcare provider in the area. I am attaching a signed medical release form along with this letter. As per my understanding, Houston, Texas is known for its diverse and bustling healthcare system, offering a range of medical services and specialties. To ensure a smooth transition to my new healthcare provider, it is crucial that I have access to my complete medical history. Therefore, I kindly request you to provide me with copies of the following medical records: 1. Comprehensive medical history: This should include a detailed record of all my previous medical conditions, diagnoses, treatments, and surgeries, if any. Please include information about any chronic illnesses or ongoing medication regimens. 2. Laboratory and test results: Please provide copies of all my laboratory tests, radiology reports, and imaging studies such as X-rays, MRIs, CT scans, and ultrasounds. Including these reports will give my new healthcare provider a comprehensive understanding of my previous medical procedures and diagnostic findings. 3. Specialist consultation reports: If I have seen any specialists at your facility, I kindly request copies of their consultation reports. This would include reports from specialists such as cardiologists, orthopedists, neurologists, etc. 4. Medication history: Please provide a list of all medications prescribed to me during my time under your care. This should include the name of each medication, dosage instructions, and the duration of treatment. 5. Immunization records: To ensure proper vaccination coverage, I would greatly appreciate copies of my immunization records, including dates and types of vaccines received. I understand that there may be a fee associated with obtaining these records, and I am prepared to provide payment for any related charges. Please inform me of the total cost in advance, and I will gladly arrange for payment. I kindly request that you deliver the requested medical records to my address in Houston, Texas at your earliest convenience. If it is more convenient for you, I am also open to picking up the records in person. Thank you for your attention to this matter. I appreciate your cooperation and prompt response. If you have any questions or require additional information, please do not hesitate to contact me at [your contact information]. Sincerely, [Your Name] [Address] [City, State, ZIP Code] [Phone 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.