Montana 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 Dear [Medical Provider's Name], I hope this letter finds you in good health. I am writing to kindly request access to the medical records of [Patient's Full Name], as legally permitted under the Montana state laws relating to medical record disclosure. As an authorized representative of [Patient's Full Name], I am seeking these records for the purpose of [state the purpose — e.g., continuity of care, second opinion, personal records, insurance claim, legal matter, etc.]. It is crucial for us to have a comprehensive overview of their medical history, diagnostic reports, treatment plans, and any related information. To facilitate the process, I kindly request that you provide the following medical records within the timeframes stipulated by the Montana Mandated Health Records Access Laws: 1. Complete Medical History: This should include consultations, diagnoses, treatments, medications, laboratory results, and any other relevant information from [specific date range, if applicable]. 2. Specialist Consultation Reports: Please include any records pertaining to consultations with specialists such as [mention specific specialties if applicable]. 3. Radiology and Imaging Reports: Including X-rays, MRIs, CT scans, ultrasounds, and any other imaging examinations conducted. 4. Laboratory Test Results: All results of blood tests, urine tests, biopsies, genetic tests, and other laboratory analyses. 5. Surgical Records: Any documentation, reports, and operative notes related to surgical procedures undergone by the patient, including preoperative and post-operative reports. 6. Progress Notes and Treatment Plans: Comprehensive documentation of the patient's progress, including treatment plans, medication adjustments, and follow-up appointments. 7. Psychological Evaluation Reports (if applicable): If the patient has undergone any psychological evaluations, we kindly request access to the reports and assessments. I understand that there may be fees associated with the production of these records. If so, please inform me in advance of any costs, fees, or charges required for processing this request. You may reach me at the contact information provided below to inform me about the total fees and arrange the payment method, if applicable. Please note that under the Montana law, you are required to provide the records as soon as reasonably possible, preferably within the timeline specified by state regulations. However, if you anticipate any delays or require additional information, I kindly ask you to inform me promptly so that we can address any concerns and ensure the smooth retrieval of the requested records. I appreciate your attention to this matter and your cooperation in providing the necessary documentation. Maintaining accurate and up-to-date medical records is of utmost importance for the well-being of the patient, and I am confident that together, we can meet regulatory requirements and ensure the patient receives the best possible care. Thank you for your prompt attention to this matter. Should you require any additional information or documentation, please do not hesitate to contact me at your earliest convenience. Sincerely, [Your Full Name] [Your Contact Information] [Your Relationship to the Patient] (if applicable)

Subject: Request for Patient Medical Records Dear [Medical Provider's Name], I hope this letter finds you in good health. I am writing to kindly request access to the medical records of [Patient's Full Name], as legally permitted under the Montana state laws relating to medical record disclosure. As an authorized representative of [Patient's Full Name], I am seeking these records for the purpose of [state the purpose — e.g., continuity of care, second opinion, personal records, insurance claim, legal matter, etc.]. It is crucial for us to have a comprehensive overview of their medical history, diagnostic reports, treatment plans, and any related information. To facilitate the process, I kindly request that you provide the following medical records within the timeframes stipulated by the Montana Mandated Health Records Access Laws: 1. Complete Medical History: This should include consultations, diagnoses, treatments, medications, laboratory results, and any other relevant information from [specific date range, if applicable]. 2. Specialist Consultation Reports: Please include any records pertaining to consultations with specialists such as [mention specific specialties if applicable]. 3. Radiology and Imaging Reports: Including X-rays, MRIs, CT scans, ultrasounds, and any other imaging examinations conducted. 4. Laboratory Test Results: All results of blood tests, urine tests, biopsies, genetic tests, and other laboratory analyses. 5. Surgical Records: Any documentation, reports, and operative notes related to surgical procedures undergone by the patient, including preoperative and post-operative reports. 6. Progress Notes and Treatment Plans: Comprehensive documentation of the patient's progress, including treatment plans, medication adjustments, and follow-up appointments. 7. Psychological Evaluation Reports (if applicable): If the patient has undergone any psychological evaluations, we kindly request access to the reports and assessments. I understand that there may be fees associated with the production of these records. If so, please inform me in advance of any costs, fees, or charges required for processing this request. You may reach me at the contact information provided below to inform me about the total fees and arrange the payment method, if applicable. Please note that under the Montana law, you are required to provide the records as soon as reasonably possible, preferably within the timeline specified by state regulations. However, if you anticipate any delays or require additional information, I kindly ask you to inform me promptly so that we can address any concerns and ensure the smooth retrieval of the requested records. I appreciate your attention to this matter and your cooperation in providing the necessary documentation. Maintaining accurate and up-to-date medical records is of utmost importance for the well-being of the patient, and I am confident that together, we can meet regulatory requirements and ensure the patient receives the best possible care. Thank you for your prompt attention to this matter. Should you require any additional information or documentation, please do not hesitate to contact me at your earliest convenience. Sincerely, [Your Full Name] [Your Contact Information] [Your Relationship to the Patient] (if applicable)