New Jersey Sample Letter for Request for Medical Records

• Category: Letters - Nonlegal - Requests
• State: Multi-State
• Control #: US-0546LR
• Format: Word; Rich Text

Description

Sample Letter for Request for Medical Records Subject: Request for Medical Records — [Patient's Name] Dear [Hospital/Clinic/Care Provider's Name], I hope this letter finds you well. I am writing to formally request the release of medical records for [Patient's Name], in accordance with the laws and regulations of the state of New Jersey. As per my rights as [patient/legal guardian], I am entitled to access and obtain copies of [Patient's Name]'s complete medical history. It is crucial to gather these records for [patient's ongoing care/medical review purposes/second opinion]. I kindly request your assistance in promptly providing the following documents: 1. Comprehensive Medical Records: This includes all records from each department involved in [Patient's Name]'s medical care, such as general medical history, specialist consultations, surgical reports, diagnostic test results (X-rays, MRI, CT scans, ultrasounds, etc.), immunization records, laboratory reports, progress notes, discharge summaries, medication history, and any other relevant information. 2. Treatment Summary: A concise summary of the treatment plans, procedures, prescribed medications, recommended therapies, and any modifications made during the course of treatment. 3. Radiology Reports and Images: Copies of all radiology reports, including X-rays, MRI scans, CT scans, ultrasounds, mammograms, or any other imaging studies. Kindly provide both the written reports and accompanying images. 4. Laboratory Reports: Copies of all laboratory reports, including blood work, urine tests, biopsy reports, pathology reports, genetic testing, and any other lab tests performed. 5. Allergies and Medication Records: Records of any known allergies, adverse reactions, or sensitivities to medications should also be included. 6. Consultation and Referral Notes: Any reports or notes from specialists, consultants, or referrals made during the course of treatment. 7. Insurance Information: Copies of any insurance claim forms, pre-authorization documents, or bills submitted to insurance companies on behalf of the patient. In compliance with New Jersey state law, I understand that I may be charged a reasonable fee for copying the medical records. If this is the case, please inform me of the cost before proceeding. To ensure swift processing of this request, please include the patient's full name, date of birth, address, contact number, and any other relevant identification information on each page of the medical records. If it is not possible to provide the records in their entirety within the standard timeframe, please advise me of what material can be made available in the interim, followed by the remaining records later. Kindly acknowledge receipt of this letter and provide an estimated timeline for fulfilling this request. Please address any correspondence related to this request to the following address: [Your Full Name] [Your Address] [City, State, ZIP] [Phone Number] [Email Address] Your assistance in this matter is greatly appreciated. I look forward to receiving the requested medical records promptly. Should you require any further information or have any questions, please do not hesitate to contact me at your earliest convenience. Thank you for your attention to this matter. Sincerely, [Your Name] [Patient's Name]

Subject: Request for Medical Records — [Patient's Name] Dear [Hospital/Clinic/Care Provider's Name], I hope this letter finds you well. I am writing to formally request the release of medical records for [Patient's Name], in accordance with the laws and regulations of the state of New Jersey. As per my rights as [patient/legal guardian], I am entitled to access and obtain copies of [Patient's Name]'s complete medical history. It is crucial to gather these records for [patient's ongoing care/medical review purposes/second opinion]. I kindly request your assistance in promptly providing the following documents: 1. Comprehensive Medical Records: This includes all records from each department involved in [Patient's Name]'s medical care, such as general medical history, specialist consultations, surgical reports, diagnostic test results (X-rays, MRI, CT scans, ultrasounds, etc.), immunization records, laboratory reports, progress notes, discharge summaries, medication history, and any other relevant information. 2. Treatment Summary: A concise summary of the treatment plans, procedures, prescribed medications, recommended therapies, and any modifications made during the course of treatment. 3. Radiology Reports and Images: Copies of all radiology reports, including X-rays, MRI scans, CT scans, ultrasounds, mammograms, or any other imaging studies. Kindly provide both the written reports and accompanying images. 4. Laboratory Reports: Copies of all laboratory reports, including blood work, urine tests, biopsy reports, pathology reports, genetic testing, and any other lab tests performed. 5. Allergies and Medication Records: Records of any known allergies, adverse reactions, or sensitivities to medications should also be included. 6. Consultation and Referral Notes: Any reports or notes from specialists, consultants, or referrals made during the course of treatment. 7. Insurance Information: Copies of any insurance claim forms, pre-authorization documents, or bills submitted to insurance companies on behalf of the patient. In compliance with New Jersey state law, I understand that I may be charged a reasonable fee for copying the medical records. If this is the case, please inform me of the cost before proceeding. To ensure swift processing of this request, please include the patient's full name, date of birth, address, contact number, and any other relevant identification information on each page of the medical records. If it is not possible to provide the records in their entirety within the standard timeframe, please advise me of what material can be made available in the interim, followed by the remaining records later. Kindly acknowledge receipt of this letter and provide an estimated timeline for fulfilling this request. Please address any correspondence related to this request to the following address: [Your Full Name] [Your Address] [City, State, ZIP] [Phone Number] [Email Address] Your assistance in this matter is greatly appreciated. I look forward to receiving the requested medical records promptly. Should you require any further information or have any questions, please do not hesitate to contact me at your earliest convenience. Thank you for your attention to this matter. Sincerely, [Your Name] [Patient's Name]