Rhode Island 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. [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Recipient's Name] [Recipient's Address] [City, State, ZIP Code] Subject: Rhode Island Sample Letter for Medical Records Release in Social Security Disability Action Dear [Recipient's Name], I hope this letter finds you well. I am writing to request the release of my medical records in relation to my Social Security Disability Action, as per the provisions outlined in the State of Rhode Island. Enclosed, please find the necessary documents to facilitate the release. As you may be aware, obtaining accurate and up-to-date medical records is crucial to support my disability claim. Therefore, I request your cooperation in promptly releasing the following medical records to the specified individuals: 1. Primary Care Physician: [Name of Physician] Medical Practice: [Name of Practice] Address: [Street Address, City, State, ZIP Code] Contact Information: [Phone Number, Email Address] 2. Specialist Doctor: [Name of Specialist] Medical Practice: [Name of Practice] Address: [Street Address, City, State, ZIP Code] Contact Information: [Phone Number, Email Address] 3. Hospital Records: [Name of Hospital] Department: [Name of Department or Ward] Address: [Street Address, City, State, ZIP Code] Contact Information: [Phone Number, Email Address] I would greatly appreciate it if you could authorize the aforementioned medical professionals to release and provide copies of my medical records for the duration specified by the Social Security Administration (SSA). It is essential that the records encompass the relevant time frame, including all treatment records, diagnostic reports, surgical procedures, medications prescribed, clinical notes, laboratory results, and any additional pertinent information. As required by the SSA, please ensure that the records are sent directly to my attorney, whose details are provided below: [Attorney's Name] [Attorney's Address] [City, State, ZIP Code] [Attorney's Email Address] [Attorney's Phone Number] I authorize the release of the above-mentioned medical records for the sole purpose of supporting my Social Security Disability Action. Moreover, I understand that any costs incurred for the duplication and transmission of these records shall be borne by me, and I am willing to provide payment promptly. If there are any further documents, forms, or fees required in order to facilitate this request, please do not hesitate to inform me. If necessary, I am available to provide additional consent forms or complete any necessary paperwork promptly. Thank you for your attention to this matter. Your cooperation and prompt response will significantly contribute to the successful resolution of my Social Security Disability claim. Should you require any additional information or have any questions, please feel free to contact me at your convenience. I once again express my sincerest appreciation for your assistance in this matter. Yours faithfully, [Your Name]

[Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Recipient's Name] [Recipient's Address] [City, State, ZIP Code] Subject: Rhode Island Sample Letter for Medical Records Release in Social Security Disability Action Dear [Recipient's Name], I hope this letter finds you well. I am writing to request the release of my medical records in relation to my Social Security Disability Action, as per the provisions outlined in the State of Rhode Island. Enclosed, please find the necessary documents to facilitate the release. As you may be aware, obtaining accurate and up-to-date medical records is crucial to support my disability claim. Therefore, I request your cooperation in promptly releasing the following medical records to the specified individuals: 1. Primary Care Physician: [Name of Physician] Medical Practice: [Name of Practice] Address: [Street Address, City, State, ZIP Code] Contact Information: [Phone Number, Email Address] 2. Specialist Doctor: [Name of Specialist] Medical Practice: [Name of Practice] Address: [Street Address, City, State, ZIP Code] Contact Information: [Phone Number, Email Address] 3. Hospital Records: [Name of Hospital] Department: [Name of Department or Ward] Address: [Street Address, City, State, ZIP Code] Contact Information: [Phone Number, Email Address] I would greatly appreciate it if you could authorize the aforementioned medical professionals to release and provide copies of my medical records for the duration specified by the Social Security Administration (SSA). It is essential that the records encompass the relevant time frame, including all treatment records, diagnostic reports, surgical procedures, medications prescribed, clinical notes, laboratory results, and any additional pertinent information. As required by the SSA, please ensure that the records are sent directly to my attorney, whose details are provided below: [Attorney's Name] [Attorney's Address] [City, State, ZIP Code] [Attorney's Email Address] [Attorney's Phone Number] I authorize the release of the above-mentioned medical records for the sole purpose of supporting my Social Security Disability Action. Moreover, I understand that any costs incurred for the duplication and transmission of these records shall be borne by me, and I am willing to provide payment promptly. If there are any further documents, forms, or fees required in order to facilitate this request, please do not hesitate to inform me. If necessary, I am available to provide additional consent forms or complete any necessary paperwork promptly. Thank you for your attention to this matter. Your cooperation and prompt response will significantly contribute to the successful resolution of my Social Security Disability claim. Should you require any additional information or have any questions, please feel free to contact me at your convenience. I once again express my sincerest appreciation for your assistance in this matter. Yours faithfully, [Your Name]