Idaho Sample Letter for Request for Patient Medical Records

• Category: Letters - Nonlegal - Medical
• State: Multi-State
• Control #: US-0328LR
• Format: Word; Rich Text

Description

This form is a sample letter in Word format covering the subject matter of the title of the form. Dear [Healthcare provider], I am writing to formally request copies of my medical records as a patient at your facility in Idaho. I require these records for personal reference, future medical consultations, and to provide accurate medical information to other healthcare providers. I kindly ask for your assistance in promptly providing the following medical records: 1. Medical history: This should include a comprehensive overview of my past and present medical conditions, diagnoses, treatments, and surgeries. 2. Laboratory results: Please include any blood tests, urine tests, biopsies, or other laboratory reports conducted during my visits to your facility. 3. Imaging reports: I would greatly appreciate the inclusion of X-ray, CT scan, MRI, ultrasound, or any other imaging reports that have been conducted on me. 4. Medication records: Please provide a list of medications I have been prescribed, including dosage instructions, start and stop dates, and any medication allergies or adverse reactions documented. 5. Consultation and referral notes: If I have been referred to other healthcare providers, please include any correspondence or notes related to these consultations. 6. Surgical records: If I have undergone any surgeries or medical procedures at your facility, please include detailed operative notes, postoperative records, and discharge summaries. 7. Progress notes: Please provide all progress notes from my visits to your facility, including notes from physicians, nurses, therapists, or any other healthcare professionals involved in my care. 8. Immunization records: If you have records of the immunizations I have received, please include them in the medical records. To ensure compliance with the relevant laws and regulations surrounding the release of medical records, please find enclosed the necessary authorization forms. If there are any additional forms or fees required, kindly inform me at your earliest convenience. I understand that there may be charges associated with copying and mailing these records, and I am prepared to cover these expenses. Please send the requested medical records to the following address: [Your Full Name] [Your Address] [City, State, ZIP Code] I appreciate your prompt attention to this matter. If you require any further information or have any questions regarding this request, please do not hesitate to contact me at [Your contact information]. Thank you for your cooperation, and I look forward to receiving the requested medical records. Sincerely, [Your Full Name]

Dear [Healthcare provider], I am writing to formally request copies of my medical records as a patient at your facility in Idaho. I require these records for personal reference, future medical consultations, and to provide accurate medical information to other healthcare providers. I kindly ask for your assistance in promptly providing the following medical records: 1. Medical history: This should include a comprehensive overview of my past and present medical conditions, diagnoses, treatments, and surgeries. 2. Laboratory results: Please include any blood tests, urine tests, biopsies, or other laboratory reports conducted during my visits to your facility. 3. Imaging reports: I would greatly appreciate the inclusion of X-ray, CT scan, MRI, ultrasound, or any other imaging reports that have been conducted on me. 4. Medication records: Please provide a list of medications I have been prescribed, including dosage instructions, start and stop dates, and any medication allergies or adverse reactions documented. 5. Consultation and referral notes: If I have been referred to other healthcare providers, please include any correspondence or notes related to these consultations. 6. Surgical records: If I have undergone any surgeries or medical procedures at your facility, please include detailed operative notes, postoperative records, and discharge summaries. 7. Progress notes: Please provide all progress notes from my visits to your facility, including notes from physicians, nurses, therapists, or any other healthcare professionals involved in my care. 8. Immunization records: If you have records of the immunizations I have received, please include them in the medical records. To ensure compliance with the relevant laws and regulations surrounding the release of medical records, please find enclosed the necessary authorization forms. If there are any additional forms or fees required, kindly inform me at your earliest convenience. I understand that there may be charges associated with copying and mailing these records, and I am prepared to cover these expenses. Please send the requested medical records to the following address: [Your Full Name] [Your Address] [City, State, ZIP Code] I appreciate your prompt attention to this matter. If you require any further information or have any questions regarding this request, please do not hesitate to contact me at [Your contact information]. Thank you for your cooperation, and I look forward to receiving the requested medical records. Sincerely, [Your Full Name]