Subject: Request for Patient Medical Records — Urgent [Your Name] [Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Healthcare Provider's Name] [Department] [Address] [City, State, ZIP Code] Dear [Healthcare Provider's Name], I hope this letter finds you well. I am writing to request the medical records for [Patient's Full Name], who was under the care of your esteemed institution. I understand the significance of patient privacy and ensure that the requested information will be used solely for valid purposes related to the patient's healthcare. To assist you in efficiently retrieving the necessary data, I have included the following details regarding the patient: 1. Patient's Full Name: [Full Name] 2. Date of Birth: [Date of Birth] 3. Social Security Number: [Social Security Number] (optional, if available) 4. Health Insurance Provider: [Insurance Provider] 5. Policy Number: [Policy Number] I kindly request the following medical records: 1. Complete medical history, including but not limited to diagnoses, illnesses, treatments, surgeries, and procedures. 2. Laboratory reports, including blood tests, urinalysis, pathology results, etc. 3. Radiology reports, such as X-rays, MRI, CT scan findings, etc. 4. Progress notes and consultation reports from referring physicians or specialists. 5. Prescription medication history, including dosage, frequency, and duration. 6. Immunization records. 7. Any discharge summaries or documentation related to hospital admissions or emergency room visits. Please provide the requested records in a digital format, if possible, to expedite the process. If the records cannot be supplied electronically, please advise me of the necessary steps to obtain the physical copies. As per the federal regulations outlined in HIPAA (Health Insurance Portability and Accountability Act) and the HITCH (Health Information Technology for Economic and Clinical Health) Act, I understand there may be a reasonable fee for the retrieval and duplication of medical records. Kindly inform me of the associated costs, if any, and provide a breakdown of the charges before proceeding. Due to the urgency of the matter, I kindly request your prompt attention to this request. As the records are required for ongoing medical treatment, I would appreciate it if you could process my request within [specify a reasonable timeframe, e.g., ten business days] from the date of this letter. Please feel free to contact me at [Your Phone Number] or [Your Email Address] should you require any additional information or if there are any concerns regarding this request. Thank you in advance for your assistance and cooperation. I eagerly anticipate receiving the requested medical records within the specified timeframe. Sincerely, [Your Full Name] [Patient's Full Name (if different)] [Patient's Date of Birth (if different)] [Relationship to the Patient] (e.g., parent, legal guardian, attorney)
New York Sample Letter for Request for Patient Medical Records
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How to fill out New York Sample Letter For Request For Patient Medical Records?
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The NYS Department of Health, however, requires medical doctors to retain records for any adult patients for 6 years. Minor patients are kept for 6 years and until one year after the minor reaches the age of 18 (whichever is longer). For hospitals, medical records must be kept for six years from the date of discharge.
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...
Notice:Use the Open FOIL NY online form: Agency Code.Mail a written request to: Records Access Office.E-mail a written request to: foil@health.ny.gov.Fax a written request to: (518) 486-9144.Submit a request for records in person:
Before you write a request letter, one should know to whom the letter is addressed....Here is the simple format of the request letter:Date.Recipient Name, designation and address.Subject.Salutation (Dear Sir/Mam, Mr./Mrs./Ms.)Body of the letter.Gratitude.Closing the letter (Your's Sincerely)Your Name and Signature.
According to HIPAA, patients have the right to request their records. Other individuals can also request records on behalf of a patient. These include a parent, legal guardian, patient advocate or caregiver with written permission from the patient.
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...?
How to Request Your Medical Records. Most practices or facilities will ask you to fill out a form to request your medical records. This request form can usually be collected at the office or delivered by fax, postal service, or email. If the office doesn't have a form, you can write a letter to make your request.
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.
Open with a professional greetingWriting a professional greeting, followed by a comma, is a friendly way to start your request letter. The word 'Dear', followed by your recipient's title and surname suits most letters of request. If your recipient is someone you know well, you may address them by their first name.
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...
