Rhode Island 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 — [Your Full Name— - [Date of Birth] [Your Full Name] [Your Full Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Medical Provider's Name] [Medical Provider's Address] [City, State, ZIP Code] Dear [Medical Provider's Name], I hope this letter finds you in good health and high spirits. I am writing to request copies of my complete medical records in accordance with the applicable laws and regulations under the Rhode Island Health Insurance Portability and Accountability Act (HIPAA). As a resident of Rhode Island, I want to ensure that I have access to my medical information for personal and future healthcare purposes. To assist you in locating my records, I am providing the following information: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Date of Birth] — Social Security Number: [SSN— - Address at the time of receiving treatment: [Previous Address] 2. Timeframe: I would appreciate receiving all medical records pertaining to my healthcare from [Specify Start Date] to [Specify End Date]. If this timeframe is too extensive, please provide records from the past [Specify Number of Years]. I understand that there might be charges associated with this request, and I am ready to cover any reasonable fees in advance. 3. Types of Medical Records Requested: [List the specific types of medical records you are seeking, for example:] — Physician notes and progress report— - Hospitalization and discharge summaries — Laboratory test result— - Radiology and imaging reports — Surgical and operative report— - Medication records — Consultation note— - Treatment plans and referrals — Immunization record— - Any other relevant medical documentation 4. Preferred Format: I kindly request that the provided medical records be in a digital format (PDF or electronically readable) for ease of access and future reference. If it is not possible, please inform me of the available alternatives. 5. Release Authorization: I have filled out the attached HIPAA-compliant authorization form, granting consent for the release of my medical records. Please let me know if any additional documentation is required. 6. Deadlines: As per the HIPAA regulations, I understand that the medical records must be provided within 30 days from the date of this written request. If this timeline cannot be met, please inform me promptly with an estimated date of delivery or any reasons for the delay. I would like to express my sincere gratitude in advance for your prompt attention to this matter. Your cooperation in providing my requested medical records will significantly contribute to my overall healthcare management. Should you have any questions or require any further information, please do not hesitate to contact me at the information provided above. Thank you for your time and cooperation. Sincerely, [Your Full Name]

Subject: Request for Medical Records — [Your Full Name— - [Date of Birth] [Your Full Name] [Your Full Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Medical Provider's Name] [Medical Provider's Address] [City, State, ZIP Code] Dear [Medical Provider's Name], I hope this letter finds you in good health and high spirits. I am writing to request copies of my complete medical records in accordance with the applicable laws and regulations under the Rhode Island Health Insurance Portability and Accountability Act (HIPAA). As a resident of Rhode Island, I want to ensure that I have access to my medical information for personal and future healthcare purposes. To assist you in locating my records, I am providing the following information: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Date of Birth] — Social Security Number: [SSN— - Address at the time of receiving treatment: [Previous Address] 2. Timeframe: I would appreciate receiving all medical records pertaining to my healthcare from [Specify Start Date] to [Specify End Date]. If this timeframe is too extensive, please provide records from the past [Specify Number of Years]. I understand that there might be charges associated with this request, and I am ready to cover any reasonable fees in advance. 3. Types of Medical Records Requested: [List the specific types of medical records you are seeking, for example:] — Physician notes and progress report— - Hospitalization and discharge summaries — Laboratory test result— - Radiology and imaging reports — Surgical and operative report— - Medication records — Consultation note— - Treatment plans and referrals — Immunization record— - Any other relevant medical documentation 4. Preferred Format: I kindly request that the provided medical records be in a digital format (PDF or electronically readable) for ease of access and future reference. If it is not possible, please inform me of the available alternatives. 5. Release Authorization: I have filled out the attached HIPAA-compliant authorization form, granting consent for the release of my medical records. Please let me know if any additional documentation is required. 6. Deadlines: As per the HIPAA regulations, I understand that the medical records must be provided within 30 days from the date of this written request. If this timeline cannot be met, please inform me promptly with an estimated date of delivery or any reasons for the delay. I would like to express my sincere gratitude in advance for your prompt attention to this matter. Your cooperation in providing my requested medical records will significantly contribute to my overall healthcare management. Should you have any questions or require any further information, please do not hesitate to contact me at the information provided above. Thank you for your time and cooperation. Sincerely, [Your Full Name]