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] [Date] [Recipient's Name] [Recipient's Address] [City, State, ZIP] Subject: Request for Release of Medical Records in Social Security Disability Action Dear [Recipient's Name], I hope this letter finds you in good health. I am writing in regard to my ongoing Social Security Disability claim and kindly request your assistance in releasing my medical records to the Social Security Administration (SSA). As an essential part of my disability case, access to my medical records is crucial for the timely evaluation and determination of my eligibility for Social Security Disability benefits. I, [Your Name], am I pursuing my Social Security Disability claim based on my medical condition that substantially hinders my ability to engage in gainful employment. Therefore, it is vital that the SSA has complete and accurate access to my medical records to evaluate the severity and impact of my disability on my daily life. To facilitate the release of my medical records, I have obtained the necessary medical records release form, which is enclosed with this letter. I kindly ask you to complete the form with the relevant information, sign it, and return it to the address mentioned above. It is important to include any supporting documentation or diagnostic reports related to my medical condition. Additionally, please ensure that the release covers the period starting from [specific date] to the present. The requested medical records include, but are not limited to, the following: — Doctor's notes and progress report— - Hospitalization records — Surgical report— - Laboratory and test results (including blood work, MRI, CT scans, X-rays) — Mental health evaluations and treatments — Medication and treatmenhistoryor— - Therapist/counselor notes, if applicable — All other medical or psychological records relevant to my disability claim Please be assured that I fully understand the confidential nature of my medical records and the importance of maintaining their privacy. I authorize you to release these records to the SSA for the sole purpose of evaluating my Social Security Disability claim. Any information released will be handled in strict compliance with applicable privacy laws and regulations. To expedite the process, I kindly request that you send the completed medical records release form directly to the attention of the SSA at the address provided below: [Social Security Administration Address] [City, State, ZIP] I would greatly appreciate your prompt attention to this matter as it significantly impacts the progress and review of my Social Security Disability claim. If you require any additional information or have any questions regarding this request, please do not hesitate to contact me at [Your Phone Number] or [Your Email Address]. Thank you for your understanding and cooperation. Your cooperation in this matter will be invaluable in helping me receive the benefits I am entitled to. I look forward to a positive outcome to my claim and appreciate your assistance in advancing my Social Security Disability case. Yours sincerely, [Your Name]
[Your Name] [Your Address] [City, State, ZIP] [Date] [Recipient's Name] [Recipient's Address] [City, State, ZIP] Subject: Request for Release of Medical Records in Social Security Disability Action Dear [Recipient's Name], I hope this letter finds you in good health. I am writing in regard to my ongoing Social Security Disability claim and kindly request your assistance in releasing my medical records to the Social Security Administration (SSA). As an essential part of my disability case, access to my medical records is crucial for the timely evaluation and determination of my eligibility for Social Security Disability benefits. I, [Your Name], am I pursuing my Social Security Disability claim based on my medical condition that substantially hinders my ability to engage in gainful employment. Therefore, it is vital that the SSA has complete and accurate access to my medical records to evaluate the severity and impact of my disability on my daily life. To facilitate the release of my medical records, I have obtained the necessary medical records release form, which is enclosed with this letter. I kindly ask you to complete the form with the relevant information, sign it, and return it to the address mentioned above. It is important to include any supporting documentation or diagnostic reports related to my medical condition. Additionally, please ensure that the release covers the period starting from [specific date] to the present. The requested medical records include, but are not limited to, the following: — Doctor's notes and progress report— - Hospitalization records — Surgical report— - Laboratory and test results (including blood work, MRI, CT scans, X-rays) — Mental health evaluations and treatments — Medication and treatmenhistoryor— - Therapist/counselor notes, if applicable — All other medical or psychological records relevant to my disability claim Please be assured that I fully understand the confidential nature of my medical records and the importance of maintaining their privacy. I authorize you to release these records to the SSA for the sole purpose of evaluating my Social Security Disability claim. Any information released will be handled in strict compliance with applicable privacy laws and regulations. To expedite the process, I kindly request that you send the completed medical records release form directly to the attention of the SSA at the address provided below: [Social Security Administration Address] [City, State, ZIP] I would greatly appreciate your prompt attention to this matter as it significantly impacts the progress and review of my Social Security Disability claim. If you require any additional information or have any questions regarding this request, please do not hesitate to contact me at [Your Phone Number] or [Your Email Address]. Thank you for your understanding and cooperation. Your cooperation in this matter will be invaluable in helping me receive the benefits I am entitled to. I look forward to a positive outcome to my claim and appreciate your assistance in advancing my Social Security Disability case. Yours sincerely, [Your Name]