This letter serves to notify client's medical provider of attorney's representation of client. Letter further requests disclosure to attorney of client's medical records and related other information.
Arizona Letter to Doctor Requesting Client's Medical Information
State:
Multi-State
Control #:
US-PI-0017
Format:
Word;
Rich Text
Instant download
Description
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How to fill out Letter To Doctor Requesting Client's Medical Information?
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FAQ
Under Arizona law, your health care provider owns the original medical record. However, you have the right to see and get a copy of it.
I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment. [Identify records requested (e.g., medical-history form you filled out; physician and nurses' notes; test results; consultations with specialists; referrals).]
The key areas of focus are: Being clear on why you are writing the letter. Writing letters directly to the patient whenever possible. Using headings throughout the letter. Keeping the letter brief, clear, readable and relevant. Making sure that information is up to date, accurate and unambiguous.
6 Steps to Write a Medical Request Letter Step 1: Receiver Details. The first section in a request sample letter to start with is the details of the receiver to whom you are sending the letter. ... Step 2: Salutation. ... Step 3: Reason. ... Step 4: Hospital Details. ... Step 5: Gratitude. ... Step 6: Closing Signature.
Dear Dr. [Doctor's Last Name], I hope this letter finds you well. My name is [Your Name], and I am writing to seek your expert medical assistance regarding a [briefly describe the medical issue or concern].
A health care provider may only disclose that part or all of a patient's medical records and payment records as authorized by state or federal law or written authorization signed by the patient or the patient's health care decision maker.
I am writing on behalf of my patient, [Patient Name], to document the medical necessity to treat their [Diagnosis] with [Product Name]. This letter serves to document my patient's medical history and diagnosis and to summarize my treatment rationale. Please refer to the [List any Enclosures] enclosed with this letter.
Here is how to write a request letter in 7 steps: Collect information relating to your request. ... Create an outline. ... Introduce yourself. 4. Make your request. ... Explain the reason for the request. ... Offer to provide additional information. ... Show your gratitude and conclude the letter. ... Use a professional format.