Virgin Islands 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. Dear [Medical Records Department], I hope this letter finds you well. I am writing to request copies of my medical records from my time as a patient at [Hospital/Clinic Name] in the Virgin Islands. My visit dates were [specific dates or duration]. I am seeking these records for personal reference and to provide them to my current healthcare providers. I kindly request that you provide me with copies of the following documents: 1. Complete medical history: This should include all medical conditions, treatments, and diagnoses recorded during my visits. Please include any relevant test results, such as laboratory reports, X-rays, CT scans, MRIs, and ultrasounds. 2. Progress notes: Please provide the progress notes made by the attending physicians, nurses, and therapists during my visits. These notes may contain important information about the nature of my visits, observations made by the healthcare providers, and any prescribed medications or treatments. 3. Operative reports: If any surgical procedures were performed during my visits, I kindly request copies of the operative reports. These reports typically detail the procedure performed, the surgeon's notes, and any postoperative care instructions. 4. Consultation reports: If any consultations were sought with other healthcare professionals, I request copies of their reports. These reports may provide additional insight into the treatment decisions made during my visits. 5. Discharge summary: If I was discharged from the facility, I kindly request a complete copy of the discharge summary. This summary should include information on the reason for the discharge, any prescribed medications, recommended follow-up care, and any significant findings or treatments during my stay. To fulfill my request efficiently, I have enclosed a completed authorization form as required by HIPAA regulations. Please find it attached to this letter. If there are any additional forms I need to complete or fees associated with obtaining my records, please inform me at your earliest convenience. Please provide the requested medical records within 30 days of receiving this letter, as mandated by HIPAA. However, if there is a need for an extension, kindly notify me in writing, providing an estimated timeframe for the completion of my request. Thank you for your attention to this matter. If you need any further information or require assistance with my request, please do not hesitate to contact me at [your contact information]. I appreciate your prompt attention to my request and look forward to receiving copies of my medical records. Sincerely, [Your Name] [Your Address] [City, State, ZIP] [Phone Number] [Email Address] [Enclosures: Authorization form]

Dear [Medical Records Department], I hope this letter finds you well. I am writing to request copies of my medical records from my time as a patient at [Hospital/Clinic Name] in the Virgin Islands. My visit dates were [specific dates or duration]. I am seeking these records for personal reference and to provide them to my current healthcare providers. I kindly request that you provide me with copies of the following documents: 1. Complete medical history: This should include all medical conditions, treatments, and diagnoses recorded during my visits. Please include any relevant test results, such as laboratory reports, X-rays, CT scans, MRIs, and ultrasounds. 2. Progress notes: Please provide the progress notes made by the attending physicians, nurses, and therapists during my visits. These notes may contain important information about the nature of my visits, observations made by the healthcare providers, and any prescribed medications or treatments. 3. Operative reports: If any surgical procedures were performed during my visits, I kindly request copies of the operative reports. These reports typically detail the procedure performed, the surgeon's notes, and any postoperative care instructions. 4. Consultation reports: If any consultations were sought with other healthcare professionals, I request copies of their reports. These reports may provide additional insight into the treatment decisions made during my visits. 5. Discharge summary: If I was discharged from the facility, I kindly request a complete copy of the discharge summary. This summary should include information on the reason for the discharge, any prescribed medications, recommended follow-up care, and any significant findings or treatments during my stay. To fulfill my request efficiently, I have enclosed a completed authorization form as required by HIPAA regulations. Please find it attached to this letter. If there are any additional forms I need to complete or fees associated with obtaining my records, please inform me at your earliest convenience. Please provide the requested medical records within 30 days of receiving this letter, as mandated by HIPAA. However, if there is a need for an extension, kindly notify me in writing, providing an estimated timeframe for the completion of my request. Thank you for your attention to this matter. If you need any further information or require assistance with my request, please do not hesitate to contact me at [your contact information]. I appreciate your prompt attention to my request and look forward to receiving copies of my medical records. Sincerely, [Your Name] [Your Address] [City, State, ZIP] [Phone Number] [Email Address] [Enclosures: Authorization form]