Subject: Request for Medical Records — Minnesota: [Your Name] [Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Healthcare Provider's Name] [Healthcare Provider's Address] [City, State, ZIP] Dear [Healthcare Provider's Name], RE: REQUEST FOR MEDICAL RECORDS I hope this letter finds you well. I am writing to request a copy of my medical records from [Healthcare Provider's Name] in accordance with the applicable laws and regulations regarding patient access to medical information. I have received medical treatment and sought healthcare services at your facility between [start date] and [end date]. To better manage my personal health and ensure continuity in my care, it is essential for me to have a comprehensive understanding of my medical history. Therefore, I kindly request that you furnish me with copies of the following medical records: 1. Outpatient visit records, including consultation notes, progress reports, and discharge summaries. 2. Laboratory test results, including blood tests, radiology reports, pathology reports, and diagnostic imaging records. 3. Medication history, prescription information, and pharmacy records. 4. Any operative or surgical reports, if applicable. 5. Immunization records and vaccination history. 6. Allergies and adverse reactions to medications or treatments. 7. Copies of referrals, specialist consultation notes, and correspondence. In order to expedite the process, I have attached a completed Authorization for Release of Protected Health Information form as required by the Health Insurance Portability and Accountability Act (HIPAA) and other relevant regulations. Additionally, I would appreciate it if you could provide me with the estimated fees associated with the retrieval and duplication of these records. If the fees exceed $___, please notify me in advance. As per Minnesota state law, please note that you are required to provide me with access to my medical records within 30 days from the date of this request. If this timeframe cannot be met, I kindly request that you notify me promptly, stating the reason for the delay and the expected date I can expect to receive the records. To facilitate the efficient processing of my request, I am available to pick up the requested records from your facility. Alternatively, I would appreciate it if you could provide the records in an electronic format, securely encrypted, to the email address stated above. Thank you for your attention to this matter. If you have any further questions or require additional information, please do not hesitate to contact me. I look forward to your prompt response and cooperation. Yours sincerely, [Your Name]
Minnesota Sample Letter for Request for Medical Records
Description
How to fill out Minnesota 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..
Open with a professional greetingWriting a professional greeting, followed by a comma, is a friendly way to start your request letter. The word 'Dear', followed by your recipient's title and surname suits most letters of request. If your recipient is someone you know well, you may address them by their first name.
I was treated in your office at your facility between fill in dates. I request copies of the following or all health records related to my treatment. Identify records requested, e.g. medical history form you provided; physician and nurses' notes; test results, consultations with specialists; referrals.
Call the Board of Medical Practice at (612) 617-2130 or 1-800-657-3709. Ask if they have any information on your doctor's current location.
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...
Before you write a request letter, one should know to whom the letter is addressed....Here is the simple format of the request letter:Date.Recipient Name, designation and address.Subject.Salutation (Dear Sir/Mam, Mr./Mrs./Ms.)Body of the letter.Gratitude.Closing the letter (Your's Sincerely)Your Name and Signature.
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...
To write a letter of request, start by greeting the recipient with Dear, followed by the person's last name and title, or To Whom It May Concern. Then, briefly explain who you are and why you're writing in the 1st paragraph. Next, provide additional context and details about your request in the 2nd paragraph.
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...?
