New York Sample Letter for Medical Records Release in Social Security Disability Action

• Category: Letters - Legal - Social Security
• State: Multi-State
• Control #: US-0959LTR
• Format: Word; Rich Text

Description

This form is a sample letter in Word format covering the subject matter of the title of the form. Subject: Request for Medical Records Release in Social Security Disability Action Dear [Medical Provider's Name], I hope this letter finds you well. I am writing to request the release of my medical records pertaining to my Social Security Disability Action. I understand that the accurate and complete documentation of my medical history is crucial in supporting my disability claim. Therefore, I kindly ask for your assistance in providing the necessary records. It is important to note that my Social Security Disability Action is taking place in the state of New York. As such, I require a specifically tailored New York Sample Letter for Medical Records Release to comply with the legal and procedural requirements of this jurisdiction. The requested medical records must cover the relevant period of time mentioned in my disability claim, which is from [start date] to [end date]. In order to facilitate the handling of this request, I have included the following details needed for proper identification and record retrieval: 1. Patient Information: — Full name: [Your Full Name— - Date of birth: [Your Date of Birth] — Social Security number: [Your SSN] 2. Medical Provider Information: — Name of medical facility or practice: [Medical Facility/Practice Name] — Address: [Street Address, City, State, and ZIP Code] — Contact number: [Medical Facility/Practice Phone Number] — Contact person: [Contact Person's Name] — Date of request: [Current Date] 3. Authorization Details: — I authorize the release of my medical records to the Social Security Administration and its representatives solely for the purpose of evaluating my disability claim. — I understand that this authorization extends to all medical records pertaining to my disability, including but not limited to, doctor's notes, laboratory results, imaging reports, treatment summaries, and any other relevant documentation. 4. Preferred Method of Delivery: — Please inform me of the delivery method for the medical records, whether through digital means such as encrypted email, secure file transfer, or any other secured method, or via mail. I kindly request that you adhere to the Health Insurance Portability and Accountability Act (HIPAA) guidelines regarding the timely processing of medical records release requests. If there are any fees associated with providing these records, please let me know in advance. I appreciate your attention to this matter, and thank you for your cooperation. This documentation will substantially contribute to the evaluation and success of my Social Security Disability Action. 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 for your prompt attention to this request. Sincerely, [Your Full Name] [List any other types of New York Sample Letter for Medical Records Release in Social Security Disability Action below:] — New York Sample Letter for Medical Records Release for Appeal in Social Security Disability Action — New York Sample Letter for Medical Records Release for Administrative Hearing in Social Security Disability Action — New York Sample Letter for Medical Records Release for Request for Reconsideration in Social Security Disability Action — New York Sample Letter for Medical Records Release for Request for a Consultative Examination in Social Security Disability Action.

Subject: Request for Medical Records Release in Social Security Disability Action Dear [Medical Provider's Name], I hope this letter finds you well. I am writing to request the release of my medical records pertaining to my Social Security Disability Action. I understand that the accurate and complete documentation of my medical history is crucial in supporting my disability claim. Therefore, I kindly ask for your assistance in providing the necessary records. It is important to note that my Social Security Disability Action is taking place in the state of New York. As such, I require a specifically tailored New York Sample Letter for Medical Records Release to comply with the legal and procedural requirements of this jurisdiction. The requested medical records must cover the relevant period of time mentioned in my disability claim, which is from [start date] to [end date]. In order to facilitate the handling of this request, I have included the following details needed for proper identification and record retrieval: 1. Patient Information: — Full name: [Your Full Name— - Date of birth: [Your Date of Birth] — Social Security number: [Your SSN] 2. Medical Provider Information: — Name of medical facility or practice: [Medical Facility/Practice Name] — Address: [Street Address, City, State, and ZIP Code] — Contact number: [Medical Facility/Practice Phone Number] — Contact person: [Contact Person's Name] — Date of request: [Current Date] 3. Authorization Details: — I authorize the release of my medical records to the Social Security Administration and its representatives solely for the purpose of evaluating my disability claim. — I understand that this authorization extends to all medical records pertaining to my disability, including but not limited to, doctor's notes, laboratory results, imaging reports, treatment summaries, and any other relevant documentation. 4. Preferred Method of Delivery: — Please inform me of the delivery method for the medical records, whether through digital means such as encrypted email, secure file transfer, or any other secured method, or via mail. I kindly request that you adhere to the Health Insurance Portability and Accountability Act (HIPAA) guidelines regarding the timely processing of medical records release requests. If there are any fees associated with providing these records, please let me know in advance. I appreciate your attention to this matter, and thank you for your cooperation. This documentation will substantially contribute to the evaluation and success of my Social Security Disability Action. 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 for your prompt attention to this request. Sincerely, [Your Full Name] [List any other types of New York Sample Letter for Medical Records Release in Social Security Disability Action below:] — New York Sample Letter for Medical Records Release for Appeal in Social Security Disability Action — New York Sample Letter for Medical Records Release for Administrative Hearing in Social Security Disability Action — New York Sample Letter for Medical Records Release for Request for Reconsideration in Social Security Disability Action — New York Sample Letter for Medical Records Release for Request for a Consultative Examination in Social Security Disability Action.