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
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How to fill out Maryland Sample Letter For Request For Medical Records?
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FAQ
The subject line of your request should be "FOIL Request". Please inform me of the cost of providing paper copies of the following records include as much detail about the records as possible, including relevant dates, names, descriptions, etc..
If the patient wrote a personal letter requesting records, make sure the following patient information was in the original request:Date of birth.Name.Social Security number.Contact information (address and phone number)Email address.Dates of service and specific records requested (tests, discharge notes, etc.)More items...
What information should be included in a patient's medical records?The initial health history and physical examination from the doctor.Consultation reports from specialists, as well as any notes.Operative reports / Medical procedure reports.More items...?
You shouldn't generally charge patients if they ask for a copy of their records. Under data protection law, patients have a right of access to their personal data - including their medical records. They can ask for a copy of this data by making a subject access request.
How long does the physician have to keep my medical records? Maryland law requires that medical records be maintained for at least 5 years from the date the record or report was created.
Gaining Access to Your Records In either case, you have a right under Maryland law to obtain a copy of the record. To do so, you must make a written request. This signed and dated request must state your name, the name of your health care provider and the party who should receive your records.
Patients do not own their medical records and are not entitled to keep the originals but under the Data Protection Act 1998, they do have the right to view their records and have copies of them.
If the patient wrote a personal letter requesting records, make sure the following patient information was in the original request:Date of birth.Name.Social Security number.Contact information (address and phone number)Email address.Dates of service and specific records requested (tests, discharge notes, etc.)More items...
