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
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How to fill out Minnesota Sample Letter For Request For Medical Records?
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