Maryland 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 Maryland Sample Letter for Request for Medical Records: [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Name of Medical Facility/Organization] [Address of Medical Facility/Organization] [City, State, ZIP Code] Attn: [Medical Records Department/Health Information Management] Subject: Request for Release/Copy of Medical Records Dear Sir/Madam, I hope this letter finds you well. I am writing to formally request the release/copy of my medical records from [Medical Facility/Organization] for myself, [Your Full Name], in accordance with Maryland State laws and the federal Health Insurance Portability and Accountability Act (HIPAA). I received treatment at your facility during the period of [Specify Dates] for the following medical conditions: [List Medical Conditions, if known]. To ensure the continuity of my healthcare, it is vital that I have access to my complete medical history, including test results, diagnoses, treatment plans, imaging reports, surgical records, and any other relevant documentation that pertains to my medical care. Please find the necessary details for processing my request below: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth (DD/MM/YYY): [Your Date of Birth] — Social Security Number (Last 4 digits): [Last 4 Digits of Your SSN] — Current Address: [Your Current Address] 2. Authorization: — I authorize the release of my complete medical records, including any psychotherapy notes or substance abuse records, if applicable, to be sent to me, or as directed below, in compliance with the applicable laws and regulations. — Please make sure to mention if any restrictions or limitations apply to the release of my medical records. 3. Delivery/Copy Method: — I request the medical records to be delivered to me in electronic/hard copy format. — If electronic format is available, please provide the records in a secure and encrypted format. — If hard copy format is the only option, please inform me of any associated fees or costs. 4. Contact Information: — Preferred Method of Contact: [Phone/Email] — Phone Number: [Your Phone Number— - Email Address: [Your Email Address] — Best Time to Contact: [Preferred Contact Time, if applicable] Please provide me with the necessary forms, release of information documents, or any other required paperwork that needs to be completed for the processing of this request. If there are any fees associated with retrieving and copying the medical records, please inform me in advance. I understand that Maryland State regulations require medical providers to respond to a request for medical records within 21 days. I kindly request that you acknowledge receipt of this letter and provide an estimated time frame for when I can expect the records to be delivered. Thank you for your prompt attention to this matter. Should you require any additional information or have any questions regarding my request, please do not hesitate to reach me using the contact details provided above. I look forward to receiving my medical records promptly. Your cooperation in ensuring the privacy and security of my health information is greatly appreciated. Sincerely, [Your Full Name] Keywords: Maryland, sample letter, request, medical records, Maryland State laws, Health Insurance Portability and Accountability Act (HIPAA), medical facility, medical organization, treatment, medical conditions, test results, diagnoses, treatment plans, imaging reports, surgical records, documentation, patient information, authorization, delivery method, contact information, response time, fees, privacy, security.

Maryland Sample Letter for Request for Medical Records: [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Name of Medical Facility/Organization] [Address of Medical Facility/Organization] [City, State, ZIP Code] Attn: [Medical Records Department/Health Information Management] Subject: Request for Release/Copy of Medical Records Dear Sir/Madam, I hope this letter finds you well. I am writing to formally request the release/copy of my medical records from [Medical Facility/Organization] for myself, [Your Full Name], in accordance with Maryland State laws and the federal Health Insurance Portability and Accountability Act (HIPAA). I received treatment at your facility during the period of [Specify Dates] for the following medical conditions: [List Medical Conditions, if known]. To ensure the continuity of my healthcare, it is vital that I have access to my complete medical history, including test results, diagnoses, treatment plans, imaging reports, surgical records, and any other relevant documentation that pertains to my medical care. Please find the necessary details for processing my request below: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth (DD/MM/YYY): [Your Date of Birth] — Social Security Number (Last 4 digits): [Last 4 Digits of Your SSN] — Current Address: [Your Current Address] 2. Authorization: — I authorize the release of my complete medical records, including any psychotherapy notes or substance abuse records, if applicable, to be sent to me, or as directed below, in compliance with the applicable laws and regulations. — Please make sure to mention if any restrictions or limitations apply to the release of my medical records. 3. Delivery/Copy Method: — I request the medical records to be delivered to me in electronic/hard copy format. — If electronic format is available, please provide the records in a secure and encrypted format. — If hard copy format is the only option, please inform me of any associated fees or costs. 4. Contact Information: — Preferred Method of Contact: [Phone/Email] — Phone Number: [Your Phone Number— - Email Address: [Your Email Address] — Best Time to Contact: [Preferred Contact Time, if applicable] Please provide me with the necessary forms, release of information documents, or any other required paperwork that needs to be completed for the processing of this request. If there are any fees associated with retrieving and copying the medical records, please inform me in advance. I understand that Maryland State regulations require medical providers to respond to a request for medical records within 21 days. I kindly request that you acknowledge receipt of this letter and provide an estimated time frame for when I can expect the records to be delivered. Thank you for your prompt attention to this matter. Should you require any additional information or have any questions regarding my request, please do not hesitate to reach me using the contact details provided above. I look forward to receiving my medical records promptly. Your cooperation in ensuring the privacy and security of my health information is greatly appreciated. Sincerely, [Your Full Name] Keywords: Maryland, sample letter, request, medical records, Maryland State laws, Health Insurance Portability and Accountability Act (HIPAA), medical facility, medical organization, treatment, medical conditions, test results, diagnoses, treatment plans, imaging reports, surgical records, documentation, patient information, authorization, delivery method, contact information, response time, fees, privacy, security.