District of Columbia Sample Letter for Request for Medical Records

• Category: Letters - Nonlegal - Requests
• State: Multi-State
• Control #: US-0546LR
• Format: Word; Rich Text

Description

Sample Letter for Request for Medical Records [Your Name] [Your Address] [City, State, Zip] [Email Address] [Phone Number] [Date] [Name of Medical Facility] [Address] [City, State, Zip] Subject: Request for Medical Records Dear [Medical Facility's Name], I hope this letter finds you in good health. I am writing to formally request copies of my medical records as allowed by law under the District of Columbia's regulations. I am a resident of the District of Columbia and a patient of your esteemed medical facility. As I believe it is essential to maintain a complete personal medical history, I kindly request that you provide me with copies of my medical records for the following time period: [start date] to [end date]. To facilitate this process, I would appreciate it if you could include all the following relevant information in the medical records: 1. Consultations and examinations conducted by any medical practitioners within the facility 2. Laboratory test results 3. Radiology and diagnostic imaging reports 4. Surgical procedures performed, including associated operative reports 5. Prescriptions or medication history 6. Any documentation related to hospital admissions, discharges, or overnight stays 7. Immunization records 8. Psychological or psychiatric evaluations (if applicable) To ensure accurate identification and prompt processing of my request, I have attached a copy of my government-issued identification document (e.g., driver's license, passport) and any additional documentation required by your facility. Please inform me if there are any further forms or fees necessary to fulfill this request. I kindly request that you provide these records within the legally prescribed timeframe of up to 30 days. If for any reason my request cannot be honored within this period, please inform me promptly with an explanation and an estimate of when the records will be available. In accordance with District of Columbia regulations, I understand that reasonable fees may be applied for the duplication and preparation of these records. However, I kindly request that you provide me with an itemized list detailing the costs associated with this request in advance. Please note that I will be responsible for any applicable fees and charges associated with this request. If you have any inquiries or require additional information, please do not hesitate to contact me at the provided email address or phone number. Your cooperation and prompt attention to this matter are greatly appreciated. Thank you for your assistance. I look forward to receiving my medical records in a timely manner. Sincerely, [Your Name]

[Your Name] [Your Address] [City, State, Zip] [Email Address] [Phone Number] [Date] [Name of Medical Facility] [Address] [City, State, Zip] Subject: Request for Medical Records Dear [Medical Facility's Name], I hope this letter finds you in good health. I am writing to formally request copies of my medical records as allowed by law under the District of Columbia's regulations. I am a resident of the District of Columbia and a patient of your esteemed medical facility. As I believe it is essential to maintain a complete personal medical history, I kindly request that you provide me with copies of my medical records for the following time period: [start date] to [end date]. To facilitate this process, I would appreciate it if you could include all the following relevant information in the medical records: 1. Consultations and examinations conducted by any medical practitioners within the facility 2. Laboratory test results 3. Radiology and diagnostic imaging reports 4. Surgical procedures performed, including associated operative reports 5. Prescriptions or medication history 6. Any documentation related to hospital admissions, discharges, or overnight stays 7. Immunization records 8. Psychological or psychiatric evaluations (if applicable) To ensure accurate identification and prompt processing of my request, I have attached a copy of my government-issued identification document (e.g., driver's license, passport) and any additional documentation required by your facility. Please inform me if there are any further forms or fees necessary to fulfill this request. I kindly request that you provide these records within the legally prescribed timeframe of up to 30 days. If for any reason my request cannot be honored within this period, please inform me promptly with an explanation and an estimate of when the records will be available. In accordance with District of Columbia regulations, I understand that reasonable fees may be applied for the duplication and preparation of these records. However, I kindly request that you provide me with an itemized list detailing the costs associated with this request in advance. Please note that I will be responsible for any applicable fees and charges associated with this request. If you have any inquiries or require additional information, please do not hesitate to contact me at the provided email address or phone number. Your cooperation and prompt attention to this matter are greatly appreciated. Thank you for your assistance. I look forward to receiving my medical records in a timely manner. Sincerely, [Your Name]