Louisiana 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 [Medical Provider/Healthcare Facility], Subject: Request for Patient Medical Records I hope this letter finds you well. I am writing to formally request the patient medical records for [patient's full name] in accordance with the applicable laws and regulations, including the Louisiana Public Records Act and the Health Insurance Portability and Accountability Act (HIPAA). Patient Information: Full Name: [Patient's Full Name] Date of Birth: [Patient's Date of Birth] Social Security Number: [Patient's SSN, if known] Please provide the following medical records for the aforementioned patient: 1. Medical History: Any available documentation regarding the patient's medical history, including prior illnesses, surgeries, allergies, and chronic conditions. 2. Diagnostic Reports: Copies of all diagnostic reports such as X-rays, MRIs, CT scans, ultrasounds, laboratory test results, biopsies, and pathology reports. 3. Treatment Records: Comprehensive details of the patient's treatment plan, including prescriptions, medications administered, dosage information, and any past and ongoing therapies. 4. Progress Notes: A complete record of progress notes from all healthcare providers involved in the patient's care, including physicians, nurses, specialists, or therapists. 5. Surgical Records: Any documentation related to past surgeries performed on the patient, including pre-operative evaluations, operative notes, anesthesia records, and post-operative reports. 6. Psychological Evaluations: Copies of any psychological evaluations or assessments carried out on the patient, including reports from psychiatrists, psychologists, or licensed counselors. 7. Immunization Records: A complete history of the patient's immunizations, including the dates and types of vaccines administered. 8. Consultation Records: Any records from consultations or referrals made by the patient's primary healthcare provider to specialists or other healthcare professionals. 9. Informed Consent Forms: Copies of signed informed consent forms for procedures or treatments performed on the patient, if applicable. 10. Billing and Insurance Information: Copies of relevant billing and insurance-related documentation, including itemized bills, payment receipts, and insurance claims. I understand that there may be applicable fees associated with obtaining these records, including reasonable copying and postage charges. Please inform me of any such fees in advance and provide an invoice if necessary. If it is more convenient for your organization, I am open to receiving the medical records electronically via secure email transfer, encrypted CD/DVD, or through a secure online portal if one is available. I kindly request that you provide the requested medical records within [state the specific timeframe, e.g., 30 days] from the date of this letter, as mandated by Louisiana state law. Thank you for your prompt attention to this matter. Should you have any questions or require further information, please do not hesitate to contact me at [your contact information]. I appreciate your assistance in ensuring comprehensive and well-informed healthcare for the patient. Sincerely, [Your Name] [Your Contact Information]

Dear [Medical Provider/Healthcare Facility], Subject: Request for Patient Medical Records I hope this letter finds you well. I am writing to formally request the patient medical records for [patient's full name] in accordance with the applicable laws and regulations, including the Louisiana Public Records Act and the Health Insurance Portability and Accountability Act (HIPAA). Patient Information: Full Name: [Patient's Full Name] Date of Birth: [Patient's Date of Birth] Social Security Number: [Patient's SSN, if known] Please provide the following medical records for the aforementioned patient: 1. Medical History: Any available documentation regarding the patient's medical history, including prior illnesses, surgeries, allergies, and chronic conditions. 2. Diagnostic Reports: Copies of all diagnostic reports such as X-rays, MRIs, CT scans, ultrasounds, laboratory test results, biopsies, and pathology reports. 3. Treatment Records: Comprehensive details of the patient's treatment plan, including prescriptions, medications administered, dosage information, and any past and ongoing therapies. 4. Progress Notes: A complete record of progress notes from all healthcare providers involved in the patient's care, including physicians, nurses, specialists, or therapists. 5. Surgical Records: Any documentation related to past surgeries performed on the patient, including pre-operative evaluations, operative notes, anesthesia records, and post-operative reports. 6. Psychological Evaluations: Copies of any psychological evaluations or assessments carried out on the patient, including reports from psychiatrists, psychologists, or licensed counselors. 7. Immunization Records: A complete history of the patient's immunizations, including the dates and types of vaccines administered. 8. Consultation Records: Any records from consultations or referrals made by the patient's primary healthcare provider to specialists or other healthcare professionals. 9. Informed Consent Forms: Copies of signed informed consent forms for procedures or treatments performed on the patient, if applicable. 10. Billing and Insurance Information: Copies of relevant billing and insurance-related documentation, including itemized bills, payment receipts, and insurance claims. I understand that there may be applicable fees associated with obtaining these records, including reasonable copying and postage charges. Please inform me of any such fees in advance and provide an invoice if necessary. If it is more convenient for your organization, I am open to receiving the medical records electronically via secure email transfer, encrypted CD/DVD, or through a secure online portal if one is available. I kindly request that you provide the requested medical records within [state the specific timeframe, e.g., 30 days] from the date of this letter, as mandated by Louisiana state law. Thank you for your prompt attention to this matter. Should you have any questions or require further information, please do not hesitate to contact me at [your contact information]. I appreciate your assistance in ensuring comprehensive and well-informed healthcare for the patient. Sincerely, [Your Name] [Your Contact Information]