New Mexico 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 [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Recipient's Name] [Healthcare Facility Name] [Facility Address] [City, State, ZIP Code] Subject: Request for Medical Records Dear [Recipient's Name], I hope this letter finds you well. I am writing to request copies of my medical records in accordance with my rights under the Health Insurance Portability and Accountability Act (HIPAA) and the New Mexico State law. I have been a patient at your facility and would like to obtain a comprehensive set of my medical records for personal reference and continuity of care. To facilitate the process, I have provided the necessary information below: Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Medical Record Number (if known): [If Applicable] Records Requested: Please provide copies of the following medical records pertaining to my care: 1. Inpatient records 2. Outpatient records 3. Consultation records from specialists 4. Laboratory test results 5. Radiology reports 6. Surgical records 7. Immunization records 8. Pathology reports 9. Progress notes 10. Medication history and prescriptions 11. Allergies and adverse reactions 12. Discharge summaries 13. Any additional relevant medical documentation Authorization: In compliance with HIPAA regulations and New Mexico State law, I am enclosing a signed HIPAA release form with this letter. This form authorizes the release of my medical records to me or my designated representative. Preferred Format and Delivery Method: Please provide the requested records in a paper format. If digital copies are available, such as a PDF file, I would greatly appreciate receiving them electronically via email at [Your Email Address]. If this is not feasible, kindly inform me of the available alternative methods of delivery. Fees and Processing Time: I am aware that a reasonable fee may apply for this service as permitted by law. Please inform me in advance of any applicable charges, and I will promptly submit the necessary payment. Additionally, I kindly request an estimated timeline for the completion of the record retrieval process. If you have any questions or require further information, please do not hesitate to contact me at [Your Phone Number] or via email at [Your Email Address]. I would greatly appreciate your prompt attention to this matter, as I am in need of these records for personal health management purposes. Thank you for your time and assistance. I look forward to a positive response and a smooth process. Sincerely, [Your Full Name]

[Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Recipient's Name] [Healthcare Facility Name] [Facility Address] [City, State, ZIP Code] Subject: Request for Medical Records Dear [Recipient's Name], I hope this letter finds you well. I am writing to request copies of my medical records in accordance with my rights under the Health Insurance Portability and Accountability Act (HIPAA) and the New Mexico State law. I have been a patient at your facility and would like to obtain a comprehensive set of my medical records for personal reference and continuity of care. To facilitate the process, I have provided the necessary information below: Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Medical Record Number (if known): [If Applicable] Records Requested: Please provide copies of the following medical records pertaining to my care: 1. Inpatient records 2. Outpatient records 3. Consultation records from specialists 4. Laboratory test results 5. Radiology reports 6. Surgical records 7. Immunization records 8. Pathology reports 9. Progress notes 10. Medication history and prescriptions 11. Allergies and adverse reactions 12. Discharge summaries 13. Any additional relevant medical documentation Authorization: In compliance with HIPAA regulations and New Mexico State law, I am enclosing a signed HIPAA release form with this letter. This form authorizes the release of my medical records to me or my designated representative. Preferred Format and Delivery Method: Please provide the requested records in a paper format. If digital copies are available, such as a PDF file, I would greatly appreciate receiving them electronically via email at [Your Email Address]. If this is not feasible, kindly inform me of the available alternative methods of delivery. Fees and Processing Time: I am aware that a reasonable fee may apply for this service as permitted by law. Please inform me in advance of any applicable charges, and I will promptly submit the necessary payment. Additionally, I kindly request an estimated timeline for the completion of the record retrieval process. If you have any questions or require further information, please do not hesitate to contact me at [Your Phone Number] or via email at [Your Email Address]. I would greatly appreciate your prompt attention to this matter, as I am in need of these records for personal health management purposes. Thank you for your time and assistance. I look forward to a positive response and a smooth process. Sincerely, [Your Full Name]