Hawaii 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 Dear [Healthcare Provider/Patient Records Department], I hope this letter finds you well. I am writing to formally request a copy of my medical records from [Hospital/Clinic Name] in Hawaii for personal and reference purposes. I require these records to ensure accurate continuity of care, gather relevant historical information regarding my health, and for potential future medical consultations or treatments. In order to facilitate the process, I kindly request that you provide the following medical records related to my time as a patient at your facility: 1. Office visit notes and consultation summaries: Please include records of all visits, including dates, times, and details of discussions or findings during appointments with any healthcare professionals. 2. Laboratory and diagnostic test results: I would appreciate obtaining any reports related to blood tests, urine tests, imaging studies (such as X-rays, CT scans, MRIs), pathology reports, and any other relevant diagnostic procedures performed during my visits. 3. Medical/surgical procedures and reports: If I have undergone any surgeries, medical procedures, or treatments during my time as a patient at your establishment, I kindly request the associated documentation like pre-op and post-op notes, operation reports, and discharge summaries. 4. Medication and prescription history: Please provide a detailed list of medications prescribed to me, including dosage instructions, duration, and any adjustments made during subsequent visits. 5. Immunization records: If available, I would appreciate receiving my immunization history, including dates of administration and types of vaccines received. 6. Mental health records (if applicable): If I have received mental health services at your facility, I kindly request access to my mental health evaluations, treatment plans, therapy notes, or any other relevant records. I understand that there may be fees associated with retrieving and copying my medical records. Kindly advise me of the applicable charges and the preferred method of payment for these services. Please forward the requested records to the address below within the legally mandated timeframe, which is usually within 30 days. If you have any questions or require additional information, please do not hesitate to contact me at the phone number or email address provided. [Your Name] [Your Address] [City, State, ZIP] [Phone number] [Email address] Thank you for your attention to this matter. I greatly appreciate your cooperation in providing the requested information promptly. Your contributions will assist me in managing my healthcare effectively and ensuring my well-being. Sincerely, [Your Name]

Dear [Healthcare Provider/Patient Records Department], I hope this letter finds you well. I am writing to formally request a copy of my medical records from [Hospital/Clinic Name] in Hawaii for personal and reference purposes. I require these records to ensure accurate continuity of care, gather relevant historical information regarding my health, and for potential future medical consultations or treatments. In order to facilitate the process, I kindly request that you provide the following medical records related to my time as a patient at your facility: 1. Office visit notes and consultation summaries: Please include records of all visits, including dates, times, and details of discussions or findings during appointments with any healthcare professionals. 2. Laboratory and diagnostic test results: I would appreciate obtaining any reports related to blood tests, urine tests, imaging studies (such as X-rays, CT scans, MRIs), pathology reports, and any other relevant diagnostic procedures performed during my visits. 3. Medical/surgical procedures and reports: If I have undergone any surgeries, medical procedures, or treatments during my time as a patient at your establishment, I kindly request the associated documentation like pre-op and post-op notes, operation reports, and discharge summaries. 4. Medication and prescription history: Please provide a detailed list of medications prescribed to me, including dosage instructions, duration, and any adjustments made during subsequent visits. 5. Immunization records: If available, I would appreciate receiving my immunization history, including dates of administration and types of vaccines received. 6. Mental health records (if applicable): If I have received mental health services at your facility, I kindly request access to my mental health evaluations, treatment plans, therapy notes, or any other relevant records. I understand that there may be fees associated with retrieving and copying my medical records. Kindly advise me of the applicable charges and the preferred method of payment for these services. Please forward the requested records to the address below within the legally mandated timeframe, which is usually within 30 days. If you have any questions or require additional information, please do not hesitate to contact me at the phone number or email address provided. [Your Name] [Your Address] [City, State, ZIP] [Phone number] [Email address] Thank you for your attention to this matter. I greatly appreciate your cooperation in providing the requested information promptly. Your contributions will assist me in managing my healthcare effectively and ensuring my well-being. Sincerely, [Your Name]