Minnesota 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. Subject: Request for Patient Medical Records Keywords: Minnesota, sample letter, detailed description, request, patient medical records Dear [Healthcare Provider's Name], I am writing to request a copy of my medical records as a patient at your esteemed medical facility in Minnesota. I would greatly appreciate your assistance in providing me with all relevant medical records pertaining to my past and current medical conditions, treatments, diagnoses, and any other pertinent information. As a responsible individual, I am proactive about managing my healthcare and enclose a signed authorization form, as required by Minnesota state laws, granting permission for the release of my medical records. Please find the attached form duly filled out, enabling you to proceed with the retrieval and release of my medical history. In order to ensure accuracy and completeness, I kindly request that you provide me with the following medical records from the time period encompassing [specify relevant date range]: 1. Consultation notes from all healthcare professionals, including physicians, specialists, and nurses. 2. Laboratory and diagnostic test results such as blood work, radiology reports, X-rays, MRI scans, etc. 3. Treatment plans, including prescribed medications, dosages, and recommendations. 4. Surgical reports, if applicable, including preoperative and post-operative notes. 5. Any/all progress notes, including explanations of diagnoses and medical assessments. 6. Immunization records. 7. All correspondence and reports from other healthcare providers related to my medical condition(s). 8. Psychological or psychiatric evaluations and any associated reports. I understand that reasonable fees may apply for the retrieval and copying of my medical records, as allowed by Minnesota law. Kindly inform me of the associated costs in advance, and I am prepared to reimburse you accordingly. Please note that under the Minnesota Health Records Act, medical providers are required to respond to medical records requests within the legally stipulated timeframe. I kindly request that you provide the requested medical records within 30 days of your receipt of this letter, as mandated by state regulations. Should you require any additional information or have any questions regarding my request, please do not hesitate to contact me at the phone number or email address provided below. I am available at your convenience to discuss further details or address any concerns related to this matter. Thank you very much for your prompt attention to this request. I greatly appreciate your cooperation in providing me with the necessary medical records to support my ongoing medical care and treatment. Sincerely, [Your Name] [Your Contact Information]

Subject: Request for Patient Medical Records Keywords: Minnesota, sample letter, detailed description, request, patient medical records Dear [Healthcare Provider's Name], I am writing to request a copy of my medical records as a patient at your esteemed medical facility in Minnesota. I would greatly appreciate your assistance in providing me with all relevant medical records pertaining to my past and current medical conditions, treatments, diagnoses, and any other pertinent information. As a responsible individual, I am proactive about managing my healthcare and enclose a signed authorization form, as required by Minnesota state laws, granting permission for the release of my medical records. Please find the attached form duly filled out, enabling you to proceed with the retrieval and release of my medical history. In order to ensure accuracy and completeness, I kindly request that you provide me with the following medical records from the time period encompassing [specify relevant date range]: 1. Consultation notes from all healthcare professionals, including physicians, specialists, and nurses. 2. Laboratory and diagnostic test results such as blood work, radiology reports, X-rays, MRI scans, etc. 3. Treatment plans, including prescribed medications, dosages, and recommendations. 4. Surgical reports, if applicable, including preoperative and post-operative notes. 5. Any/all progress notes, including explanations of diagnoses and medical assessments. 6. Immunization records. 7. All correspondence and reports from other healthcare providers related to my medical condition(s). 8. Psychological or psychiatric evaluations and any associated reports. I understand that reasonable fees may apply for the retrieval and copying of my medical records, as allowed by Minnesota law. Kindly inform me of the associated costs in advance, and I am prepared to reimburse you accordingly. Please note that under the Minnesota Health Records Act, medical providers are required to respond to medical records requests within the legally stipulated timeframe. I kindly request that you provide the requested medical records within 30 days of your receipt of this letter, as mandated by state regulations. Should you require any additional information or have any questions regarding my request, please do not hesitate to contact me at the phone number or email address provided below. I am available at your convenience to discuss further details or address any concerns related to this matter. Thank you very much for your prompt attention to this request. I greatly appreciate your cooperation in providing me with the necessary medical records to support my ongoing medical care and treatment. Sincerely, [Your Name] [Your Contact Information]