Kansas 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] [Medical Provider's Name] [Medical Provider's Address] [City, State, ZIP] Subject: Request for Medical Records Dear [Medical Provider's Name], I hope this letter finds you in good health. I am writing to formally request copies of my medical records from your esteemed facility, [Medical Provider's Name]. I have been a patient at your establishment and would greatly appreciate having access to my complete medical history for personal reference and continuity of care. As I aim to obtain a comprehensive and accurate record, please provide me with the following medical records: 1. Consultation Reports: Any reports or summaries from consultations with healthcare professionals, including specialists, hospitals, and clinics. 2. Medical Test Results: Copies of all test results, such as blood work, imaging scans (X-rays, MRIs, CT scans), biopsy reports, electrocardiogram (ECG) results, etc. 3. Surgical Reports: Detailed information regarding any surgical procedures I may have undergone, including operative notes, anesthesia records, discharge summaries, and postoperative care instructions. 4. Treatment Plans: Documentation outlining the recommended treatment plans, including prescribed medications, therapies, or any special procedures. 5. Progress Notes: Complete medical notes and records generated during my visits, including descriptions of symptoms, diagnoses, treatment approaches, and any modifications made to my treatment over time. 6. Immunization History: A record of all immunizations administered to me, including dates, types, and batch numbers. 7. Allergies and Reactions: Documentation of any known allergies or adverse drug reactions that are pertinent to my medical history. As required by law, please provide these records within 30 days from the receipt of this letter. If copying fees apply, kindly inform me in advance. If by any chance, my medical records have been transferred to another facility, I kindly request guidance on how to appropriately retrieve them. To expedite the process, I have enclosed a completed Release of Medical Records form, authorizing the disclosure of my medical records to me. If any additional forms or verifications are necessary, kindly inform me, and I will promptly provide them to ensure a smooth retrieval process. I appreciate your prompt attention to this matter and look forward to receiving the requested records. In case of any questions or concerns, please do not hesitate to contact me via the provided phone number or email address. Thank you for your cooperation and for your commitment to maintaining accurate and confidential medical records. Your efforts are critical in ensuring my continuous care and overall well-being. Yours sincerely, [Your Name]

[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Medical Provider's Name] [Medical Provider's Address] [City, State, ZIP] Subject: Request for Medical Records Dear [Medical Provider's Name], I hope this letter finds you in good health. I am writing to formally request copies of my medical records from your esteemed facility, [Medical Provider's Name]. I have been a patient at your establishment and would greatly appreciate having access to my complete medical history for personal reference and continuity of care. As I aim to obtain a comprehensive and accurate record, please provide me with the following medical records: 1. Consultation Reports: Any reports or summaries from consultations with healthcare professionals, including specialists, hospitals, and clinics. 2. Medical Test Results: Copies of all test results, such as blood work, imaging scans (X-rays, MRIs, CT scans), biopsy reports, electrocardiogram (ECG) results, etc. 3. Surgical Reports: Detailed information regarding any surgical procedures I may have undergone, including operative notes, anesthesia records, discharge summaries, and postoperative care instructions. 4. Treatment Plans: Documentation outlining the recommended treatment plans, including prescribed medications, therapies, or any special procedures. 5. Progress Notes: Complete medical notes and records generated during my visits, including descriptions of symptoms, diagnoses, treatment approaches, and any modifications made to my treatment over time. 6. Immunization History: A record of all immunizations administered to me, including dates, types, and batch numbers. 7. Allergies and Reactions: Documentation of any known allergies or adverse drug reactions that are pertinent to my medical history. As required by law, please provide these records within 30 days from the receipt of this letter. If copying fees apply, kindly inform me in advance. If by any chance, my medical records have been transferred to another facility, I kindly request guidance on how to appropriately retrieve them. To expedite the process, I have enclosed a completed Release of Medical Records form, authorizing the disclosure of my medical records to me. If any additional forms or verifications are necessary, kindly inform me, and I will promptly provide them to ensure a smooth retrieval process. I appreciate your prompt attention to this matter and look forward to receiving the requested records. In case of any questions or concerns, please do not hesitate to contact me via the provided phone number or email address. Thank you for your cooperation and for your commitment to maintaining accurate and confidential medical records. Your efforts are critical in ensuring my continuous care and overall well-being. Yours sincerely, [Your Name]