Los Angeles 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: Los Angeles
• Control #: US-0546LR
• Format: Word

Description

Carta de solicitud de registros médicos. Subject: Request for Medical Records — Los Angeles California Dear [Medical Facility/Healthcare Provider], I hope this letter finds you well. As a former patient of your esteemed institution, I am writing to request a copy of my medical records. I understand that as a resident of Los Angeles, California, I am entitled to access and obtain these records as stipulated by state and federal laws. My personal information for identification purposes is as follows: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Address: [Your Residential Address— - Contact Number: [Your Contact Number] — Email Address: [Your Email Address] To ensure a smooth process, I kindly request your guidance on the following points: 1. Purpose of the request: Please state the purpose for which I am requesting the medical records. This could be for personal reference, continuity of care, insurance claims, legal proceedings, or second opinions if required. 2. Timeframe: Kindly inform me of the expected timeframe for receiving the requested medical records. As per federal and state regulations, I understand that this should be accomplished within 30 days from the date of the request. 3. Delivery format: If possible, I would appreciate receiving my medical records in an electronic format (PDF) via secure email or on a CD. However, if physical copies are the only option, please let me know the pick-up process or if there are any associated costs. 4. Comprehensive record inclusion: I kindly request that my complete medical records are provided. This should include diagnostic test results, consultation notes, treatment summaries, discharge summaries, medication history, and any other relevant information related to my medical history. 5. Authorization signature: Enclosed with this letter, you will find a signed and completed authorization form granting permission for the release of my medical records. Please let me know if any additional documentation is required. I understand there might be fees associated with accessing my medical records. Kindly inform me of the applicable charges, if any, and the preferred payment method. Your prompt attention to this matter would be greatly appreciated. If there are any concerns or further requirements regarding this request, please do not hesitate to contact me at the provided contact information. Thank you for your cooperation and understanding. I look forward to receiving my medical records as soon as possible. Sincerely, [Your Full Name]

Subject: Request for Medical Records — Los Angeles California Dear [Medical Facility/Healthcare Provider], I hope this letter finds you well. As a former patient of your esteemed institution, I am writing to request a copy of my medical records. I understand that as a resident of Los Angeles, California, I am entitled to access and obtain these records as stipulated by state and federal laws. My personal information for identification purposes is as follows: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Address: [Your Residential Address— - Contact Number: [Your Contact Number] — Email Address: [Your Email Address] To ensure a smooth process, I kindly request your guidance on the following points: 1. Purpose of the request: Please state the purpose for which I am requesting the medical records. This could be for personal reference, continuity of care, insurance claims, legal proceedings, or second opinions if required. 2. Timeframe: Kindly inform me of the expected timeframe for receiving the requested medical records. As per federal and state regulations, I understand that this should be accomplished within 30 days from the date of the request. 3. Delivery format: If possible, I would appreciate receiving my medical records in an electronic format (PDF) via secure email or on a CD. However, if physical copies are the only option, please let me know the pick-up process or if there are any associated costs. 4. Comprehensive record inclusion: I kindly request that my complete medical records are provided. This should include diagnostic test results, consultation notes, treatment summaries, discharge summaries, medication history, and any other relevant information related to my medical history. 5. Authorization signature: Enclosed with this letter, you will find a signed and completed authorization form granting permission for the release of my medical records. Please let me know if any additional documentation is required. I understand there might be fees associated with accessing my medical records. Kindly inform me of the applicable charges, if any, and the preferred payment method. Your prompt attention to this matter would be greatly appreciated. If there are any concerns or further requirements regarding this request, please do not hesitate to contact me at the provided contact information. Thank you for your cooperation and understanding. I look forward to receiving my medical records as soon as possible. Sincerely, [Your Full Name]

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.