Mecklenburg North Carolina Ejemplo de carta de solicitud de registros médicos - Sample Letter for Request for Medical Records

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

Description

Carta de solicitud de registros médicos. [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Healthcare Provider's Name] [Healthcare Provider's Address] [City, State, ZIP Code] Subject: Request for Medical Records Dear [Healthcare Provider's Name], I hope this letter finds you in good health. I am writing to formally request a copy of my medical records as a patient of [Healthcare Provider's Name]. I recently moved to a new healthcare facility and would like to transfer my complete medical history for continuity of care. Patient Name: [Your Full Name] Date of Birth: [Your Date of Birth] Kindly provide the following medical records in an electronic format, preferably as PDF files, to the email address or physical address mentioned above: 1. Consultation Notes: Detailed notes from all consultations, including primary care physicians, specialists, and other healthcare professionals. 2. Laboratory and Pathology Reports: Results of blood tests, urine tests, biopsies, and any other diagnostic tests conducted. 3. Radiology and Imaging Reports: X-rays, MRIs, CT scans, ultrasounds, and mammograms, along with their corresponding reports. 4. Allergies and Medications: A comprehensive list of known allergies, prescribed medications, and dosages. 5. Surgical Reports: Copies of any surgical procedures performed, including operative notes and post-operative care instructions. 6. Hospital Discharge Summaries: Summaries of any hospitalizations, detailing the reason for admission, procedures undertaken, and prescribed treatments. 7. Immunization Records: A record of vaccinations received, including dates and types of vaccinations. 8. Mental Health Records: Progress notes, assessments, and treatment plans related to any mental health services received. Please note that according to federal law, specifically HIPAA (Health Insurance Portability and Accountability Act), I am entitled to access my medical records. As such, I would appreciate receiving these records within the next 30 days. If there are any fees associated with this request, please inform me in advance. If providing the records electronically presents a challenge, please let me know beforehand, so we can make suitable arrangements for alternative delivery. I appreciate your prompt attention to this matter and your cooperation in ensuring the safe transfer of my medical records. If you require any additional information to fulfill this request, please do not hesitate to contact me via the provided contact details. Thank you for your assistance. Sincerely, [Your Full Name]

[Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Healthcare Provider's Name] [Healthcare Provider's Address] [City, State, ZIP Code] Subject: Request for Medical Records Dear [Healthcare Provider's Name], I hope this letter finds you in good health. I am writing to formally request a copy of my medical records as a patient of [Healthcare Provider's Name]. I recently moved to a new healthcare facility and would like to transfer my complete medical history for continuity of care. Patient Name: [Your Full Name] Date of Birth: [Your Date of Birth] Kindly provide the following medical records in an electronic format, preferably as PDF files, to the email address or physical address mentioned above: 1. Consultation Notes: Detailed notes from all consultations, including primary care physicians, specialists, and other healthcare professionals. 2. Laboratory and Pathology Reports: Results of blood tests, urine tests, biopsies, and any other diagnostic tests conducted. 3. Radiology and Imaging Reports: X-rays, MRIs, CT scans, ultrasounds, and mammograms, along with their corresponding reports. 4. Allergies and Medications: A comprehensive list of known allergies, prescribed medications, and dosages. 5. Surgical Reports: Copies of any surgical procedures performed, including operative notes and post-operative care instructions. 6. Hospital Discharge Summaries: Summaries of any hospitalizations, detailing the reason for admission, procedures undertaken, and prescribed treatments. 7. Immunization Records: A record of vaccinations received, including dates and types of vaccinations. 8. Mental Health Records: Progress notes, assessments, and treatment plans related to any mental health services received. Please note that according to federal law, specifically HIPAA (Health Insurance Portability and Accountability Act), I am entitled to access my medical records. As such, I would appreciate receiving these records within the next 30 days. If there are any fees associated with this request, please inform me in advance. If providing the records electronically presents a challenge, please let me know beforehand, so we can make suitable arrangements for alternative delivery. I appreciate your prompt attention to this matter and your cooperation in ensuring the safe transfer of my medical records. If you require any additional information to fulfill this request, please do not hesitate to contact me via the provided contact details. Thank you for your assistance. 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.