Rhode Island Sample Letter for Request for Patient Medical Records

• Category: Letters - Nonlegal - Medical
• State: Multi-State
• Control #: US-0328LR
• Format: Word; Rich Text

Description

This form is a sample letter in Word format covering the subject matter of the title of the form. Rhode Island Sample Letter for Requesting Patient Medical Records Subject: Requesting Release of Medical Records for [Patient's Name] [Your Name] [Your Address] [City, State, ZIP] [Phone Number] [Email Address] [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 formally request the release of medical records for the purpose of [state the reason, e.g., ongoing treatment, second opinion, personal records, legal matters] for the patient, [Patient's Full Name], born on [Patient's Date of Birth]. I understand that according to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, patients have the right to access their medical records. Therefore, I kindly request you to provide me with copies of the following information: 1. A complete copy of [Patient's Full Name]'s medical records, including but not limited to: a. Physicians' progress notes b. Laboratory test results c. Radiology reports d. Surgical reports e. Pathology reports f. Medication history g. Allergies and adverse reactions h. Immunization records i. Consultation reports j. Discharge summaries k. Psychiatric evaluation and treatment records (if applicable) 2. Any additional information relevant to [Patient's Full Name]'s medical history, including: a. Correspondence with other healthcare providers b. Insurance claims and billing records c. Referral requests and records d. Medical imaging (X-rays, CT scans, MRI scans, etc.) e. Rehabilitation and physical therapy notes (if applicable) f. Home healthcare records (if applicable) g. Social work and mental health consultation notes (if applicable) To ensure an accurate and efficient processing of my request, I have enclosed a signed Authorization for Release of Medical Information form and proof of [Patient's Full Name]'s identification, such as a copy of their driver's license or passport. If there are any fees associated with the retrieval and copying of these medical records, please inform me in advance. I am prepared to cover any reasonable costs for this request. Please provide the requested medical records within the timeframe specified by Rhode Island state law, which requires medical providers to respond within thirty (30) days. Should you require any further information or have any questions regarding this request, please do not hesitate to contact me at the provided phone number or via email. I kindly ask for regular updates on the status of my request. Thank you for your prompt attention and cooperation in this matter. I appreciate your assistance in ensuring the continuity of care for [Patient's Full Name]. Sincerely, [Your Name]

Rhode Island Sample Letter for Requesting Patient Medical Records Subject: Requesting Release of Medical Records for [Patient's Name] [Your Name] [Your Address] [City, State, ZIP] [Phone Number] [Email Address] [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 formally request the release of medical records for the purpose of [state the reason, e.g., ongoing treatment, second opinion, personal records, legal matters] for the patient, [Patient's Full Name], born on [Patient's Date of Birth]. I understand that according to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, patients have the right to access their medical records. Therefore, I kindly request you to provide me with copies of the following information: 1. A complete copy of [Patient's Full Name]'s medical records, including but not limited to: a. Physicians' progress notes b. Laboratory test results c. Radiology reports d. Surgical reports e. Pathology reports f. Medication history g. Allergies and adverse reactions h. Immunization records i. Consultation reports j. Discharge summaries k. Psychiatric evaluation and treatment records (if applicable) 2. Any additional information relevant to [Patient's Full Name]'s medical history, including: a. Correspondence with other healthcare providers b. Insurance claims and billing records c. Referral requests and records d. Medical imaging (X-rays, CT scans, MRI scans, etc.) e. Rehabilitation and physical therapy notes (if applicable) f. Home healthcare records (if applicable) g. Social work and mental health consultation notes (if applicable) To ensure an accurate and efficient processing of my request, I have enclosed a signed Authorization for Release of Medical Information form and proof of [Patient's Full Name]'s identification, such as a copy of their driver's license or passport. If there are any fees associated with the retrieval and copying of these medical records, please inform me in advance. I am prepared to cover any reasonable costs for this request. Please provide the requested medical records within the timeframe specified by Rhode Island state law, which requires medical providers to respond within thirty (30) days. Should you require any further information or have any questions regarding this request, please do not hesitate to contact me at the provided phone number or via email. I kindly ask for regular updates on the status of my request. Thank you for your prompt attention and cooperation in this matter. I appreciate your assistance in ensuring the continuity of care for [Patient's Full Name]. Sincerely, [Your Name]