Subject: Request for Medical Records: {Patient Name, Date of Birth, Social Security Number} Dear [Healthcare Provider's Name], I hope this letter finds you well. I am writing to formally request copies of the medical records for {patient's full name}, who was under your care from {start date} to {end date}. As a concerned individual, it is crucial for me to obtain these records to facilitate ongoing healthcare assistance and ensure a seamless transition to new healthcare providers, if needed. To expedite the process, I would appreciate your guidance on the necessary steps and any forms that must be completed to complete this request. Additionally, please inform me of any fees associated with this request and the preferred payment method. {Patient's full name} was receiving treatment at your facility for {type of medical condition or reason for treatment}. Therefore, I kindly request copies of the following medical records: 1. Consultation notes: Comprehensive records of all consultations and evaluations conducted during the period of care. 2. Progress notes: Detailed information on the patient's progress, updates on medications, treatment plans, and any changes made during the treatments. 3. Laboratory reports: Copies of all laboratory tests, including blood tests, urinalysis, and other pertinent diagnostic tests. 4. Radiology records: X-ray, MRI, CT scan reports, or any other relevant imaging investigations performed. 5. Surgical reports, if applicable: Detailed records of any surgeries or procedures performed, including preoperative notes, postoperative progress, and operative reports. 6. Medication records: An updated list of prescribed medications, dosages, frequency, and duration of usage. 7. Therapist and specialist communication notes: Reports from therapists, specialists, or other healthcare professionals involved in the patient's care. 8. Discharge summary: A comprehensive summary outlining the treatment received, post-care instructions, and any referrals or recommendations made. Please notify me of any additional records that may be pertinent to {patient's full name}'s medical history and condition. Due to the urgency of this matter, I kindly request you to process this request as soon as possible. To facilitate a prompt response, I have enclosed a completed and signed authorization form, granting permission for the release of {patient's full name}'s medical records. If there are any additional forms or documentation required, please let me know at your earliest convenience. I would prefer to receive the requested medical records in an electronic format via secure email or a password-protected portal. However, if there are limitations in providing digital copies, please inform me of the available alternative methods for receiving the records. Thank you for your prompt attention to and understanding of this request. If you have any questions or require further information, please do not hesitate to contact me at {your contact information}. I look forward to your positive response and cooperation. Yours sincerely, {Your Name}
Georgia Sample Letter for Request for Medical Records
Description
How to fill out Georgia Sample Letter For Request For Medical Records?
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FAQ
If the patient wrote a personal letter requesting records, make sure the following patient information was in the original request:Date of birth.Name.Social Security number.Contact information (address and phone number)Email address.Dates of service and specific records requested (tests, discharge notes, etc.)More items...
If you are getting paper copies, the medical provider may charge up to $0.97 per page for the first 20 pages, $0.83 per page for pages 21-100, and $0.66 per page for pages over 100; and.
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 provided; physician and nurses' notes; test results, consultations with specialists; referrals.
State laws generally govern how long medical records must be retained. In Georgia, a provider must normally retain records for 10 years from the date the record item was created.
What information should be included in a patient's medical records?The initial health history and physical examination from the doctor.Consultation reports from specialists, as well as any notes.Operative reports / Medical procedure reports.More items...?
If the patient wrote a personal letter requesting records, make sure the following patient information was in the original request:Date of birth.Name.Social Security number.Contact information (address and phone number)Email address.Dates of service and specific records requested (tests, discharge notes, etc.)More items...
By Mail: Complete and send an Authorization for Use or Disclosure of Health Information form, a copy of photo ID and money order made payable to your county's health department. By Fax: Print and complete an Authorization for Use or Disclosure of Health Information form and fax it to your county's health department.
The subject line of your request should be "FOIL Request". Please inform me of the cost of providing paper copies of the following records include as much detail about the records as possible, including relevant dates, names, descriptions, etc..
Most practices or facilities will ask you to fill out a form to request your medical records. This request form can usually be collected at the office or delivered by fax, postal service, or email. If the office doesn't have a form, you can write a letter to make your request.
