New Hampshire Sample Letter for Request for Medical Records: [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], I hope this letter finds you well. I am writing to request copies of my medical records from your establishment in accordance with the New Hampshire state law regarding patient access to medical information. As a resident of New Hampshire, I am aware that I have the right to review and obtain copies of my medical records for personal reference and further care. I kindly request that you provide copies of the following medical records: 1. Complete medical history: This includes all records related to my past and current medical conditions, diagnoses, treatments, surgeries, and medications. 2. Laboratory and diagnostic test results: Please include all test reports, such as blood work, X-rays, MRI/CT scans, ultrasounds, and any other relevant diagnostic tests. 3. Physicians' progress notes: I would appreciate copies of all notes taken by healthcare professionals during my visits, consultations, and procedures. 4. Immunization records: If available, kindly provide detailed information regarding the vaccines and immunizations I have received. 5. Allergies and sensitivities: Please include any records related to allergies, intolerances, or adverse reactions to medications or substances. 6. Mental health records: If applicable, I would like access to any mental health records, including therapy session notes and evaluations. 7. Billing and insurance information: Kindly include any records related to past invoices, receipts, and insurance claims for transparency and reference purposes. Please inform me of any fees associated with this request, as permitted by New Hampshire state law. I understand that reasonable costs may be applicable for the copying, mailing, and administrative services related to the release of my medical records. As prescribed by the state law, I request that the medical records be provided within 30 days from the receipt of this letter. If any further information or clarification is required, please do not hesitate to contact me at the phone number or email address provided above. Thank you for your attention to this matter. I greatly value and appreciate your assistance in promptly fulfilling this request. Your cooperation will contribute towards my ongoing healthcare management. Sincerely, [Your Name]
New Hampshire Sample Letter for Request for Medical Records
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How to fill out New Hampshire Sample Letter For Request For Medical Records?
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FAQ
Can I view my medical records? Yes. You have a legal right to see your own records. You do not have to explain why you want to see them.
An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.
Generally, only a patient can authorize the release of his or her own medical records. However, there are some exceptions to the rule and generally the following can sign a release: Parents of minor children. Legal guardian.
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...
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...
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..
Release Authorizations means firm, non-cancellable orders instructing UQM to release Products under the initial and subsequent Blanket Purchase Orders on specified dates subject to Lead Times.
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.
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...?
