New Hampshire 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. Dear [Healthcare Provider or Medical Record Clerk], I hope this letter finds you well. I am writing to request copies of the medical records for [patient's full name], who was under the care of your facility or organization. I am the legal representative [or parent, guardian, spouse, etc.] of the patient, and I am authorized to request these records on their behalf. The purpose of this request is to obtain a complete set of medical records for the aforementioned patient, including but not limited to: 1. Doctor's notes and progress reports 2. Lab results 3. X-rays, MRI scans, CT scans, and other radiology reports 4. Surgical records 5. Allergies/medication lists 6. Consultation reports 7. Discharge summaries 8. Immunization records 9. Any other relevant medical documents, such as billing records or insurance claims Please ensure that the provided copies of the medical records are legible and comprehensive, containing all relevant information from the time the patient was under your care. If there are any specific forms or formats required for submitting this request, kindly inform me in advance. I understand that there may be a fee associated with this request, as permitted by the laws and regulations of New Hampshire. If applicable, please provide me with information regarding the associated costs, payment methods, and any applicable deadlines for payment. If the requested documents contain sensitive information that cannot be shared with the patient, as permitted by law, please send them directly to my attention at the address provided below: [Your Full Name] [Your Address] [City, State, ZIP Code] Alternatively, if it is possible to provide the medical records electronically, please let me know and inform me of any required encryption or secure transmission methods. To facilitate the process, I have enclosed a signed Authorization for Release of Medical Records form, as required by law. If there are any additional forms or documents necessary to complete this request, kindly inform me so that I can promptly provide them. I kindly request your prompt attention to this matter and anticipate a response within the timeframe allowed by the laws of New Hampshire. If you require any additional information or have any questions, please do not hesitate to contact me at [your phone number] or [your email address]. Thank you in advance for your assistance and cooperation. Your efforts in providing these medical records are greatly appreciated and will contribute to the continuity of care for the patient. Sincerely, [Your Full Name] [Your Relationship to the Patient] [Your Contact Information] Keywords: New Hampshire, Sample Letter, Request for Patient Medical Records, healthcare provider, medical record clerk, legal representative, parent, guardian, spouse, doctor's notes, progress reports, lab results, radiology reports, surgical records, allergies, medication lists, consultation reports, discharge summaries, immunization records, billing records, insurance claims, legible, comprehensive, fee, payment methods, sensitive information, signed authorization form, prompt response, continuity of care.

Dear [Healthcare Provider or Medical Record Clerk], I hope this letter finds you well. I am writing to request copies of the medical records for [patient's full name], who was under the care of your facility or organization. I am the legal representative [or parent, guardian, spouse, etc.] of the patient, and I am authorized to request these records on their behalf. The purpose of this request is to obtain a complete set of medical records for the aforementioned patient, including but not limited to: 1. Doctor's notes and progress reports 2. Lab results 3. X-rays, MRI scans, CT scans, and other radiology reports 4. Surgical records 5. Allergies/medication lists 6. Consultation reports 7. Discharge summaries 8. Immunization records 9. Any other relevant medical documents, such as billing records or insurance claims Please ensure that the provided copies of the medical records are legible and comprehensive, containing all relevant information from the time the patient was under your care. If there are any specific forms or formats required for submitting this request, kindly inform me in advance. I understand that there may be a fee associated with this request, as permitted by the laws and regulations of New Hampshire. If applicable, please provide me with information regarding the associated costs, payment methods, and any applicable deadlines for payment. If the requested documents contain sensitive information that cannot be shared with the patient, as permitted by law, please send them directly to my attention at the address provided below: [Your Full Name] [Your Address] [City, State, ZIP Code] Alternatively, if it is possible to provide the medical records electronically, please let me know and inform me of any required encryption or secure transmission methods. To facilitate the process, I have enclosed a signed Authorization for Release of Medical Records form, as required by law. If there are any additional forms or documents necessary to complete this request, kindly inform me so that I can promptly provide them. I kindly request your prompt attention to this matter and anticipate a response within the timeframe allowed by the laws of New Hampshire. If you require any additional information or have any questions, please do not hesitate to contact me at [your phone number] or [your email address]. Thank you in advance for your assistance and cooperation. Your efforts in providing these medical records are greatly appreciated and will contribute to the continuity of care for the patient. Sincerely, [Your Full Name] [Your Relationship to the Patient] [Your Contact Information] Keywords: New Hampshire, Sample Letter, Request for Patient Medical Records, healthcare provider, medical record clerk, legal representative, parent, guardian, spouse, doctor's notes, progress reports, lab results, radiology reports, surgical records, allergies, medication lists, consultation reports, discharge summaries, immunization records, billing records, insurance claims, legible, comprehensive, fee, payment methods, sensitive information, signed authorization form, prompt response, continuity of care.