[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 request copies of my medical records for the purpose of [state the reason why you need them, e.g., personal medical records management, obtaining a second opinion, transfer of care, legal purposes, insurance claims, etc.]. To facilitate this request, I have provided essential information related to my medical history below: 1. Full Name: [Your Full Name] 2. Date of Birth: [Your Date of Birth] 3. Social Security Number (optional): [Your SSN] 4. Patient ID (if applicable): [Your Patient ID] 5. Dates of Service: [Specify the range of dates or a specific timeframe for the records you require] I kindly ask that you provide copies of the following documents: 1. Consultation notes 2. Laboratory test results 3. Radiology reports (X-rays, MRIs, CT scans, etc.) 4. Immunization records 5. Medication list and prescriptions 6. Surgical reports 7. Pathology reports 8. Progress notes 9. All correspondence related to my care 10. Any other relevant medical documentation As per the Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws, I understand that I may be charged reasonable fees for copying and releasing my medical records. Please inform me about the associated costs, if applicable, before proceeding with the request. If it is more convenient and secure for you, I am open to receiving the medical records electronically via email or a secure online portal. Please let me know if this is a possibility and provide any necessary instructions. I would appreciate it if you could process my request in a timely manner. If there is any additional documentation or verification required, please don't hesitate to contact me. I can be reached at the phone number or email address provided above. Thank you very much for your prompt attention to this matter. I value your commitment to patient care and believe that obtaining my complete medical records from your esteemed institution is essential for ensuring continuity in my healthcare. Sincerely, [Your Name]
Guam Sample Letter for Request for Medical Records
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How to fill out Guam Sample Letter For Request For Medical Records?
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FAQ
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.
In Guam, the HIPAA Privacy Rule sets most of the standards that Guam health care providers must follow when they handle medical records. The Privacy Rule applies to most physicians, the civil hospital and other health care providers. In Guam, you have the right to: See and get a copy of your medical record.
It applies to everybody in the United States, and with regard to the security and privacy of health information in our country, there is no more important resource than HIPAA.
HIPAA does not protect all health information. Nor does it apply to every person who may see or use health information. HIPAA only applies to covered entities and their business associates.
Covered entities doing business in Puerto Rico are subject to compliance. HIPAA Puerto Rico consists of compliance with both federal HIPAA, as well as local Puerto Rico laws regarding medical record privacy and security.
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...
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..
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...
