Wyoming 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 [Healthcare Provider], I am writing to request copies of my medical records as a patient under your care. As I am relocating to Wyoming, it is essential that I have access to these records for the continuity of my healthcare. I appreciate your assistance in providing these documents so that I can ensure the proper management of my medical needs. Please find below the relevant details for the request: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Current Address: [Your Current Address] — Previous Address (if applicable): [Your Previous Address] 2. Medical Facility Information: — Name of Healthcare Provider: [Healthcare Provider's Name] — Address of Healthcare Provider: [Healthcare Provider's Address] — Contact Number: [Healthcare Provider's Phone Number] 3. Date Range of Medical Records Requested: — Start Date: [Start Date— - End Date: [End Date] 4. Specific Medical Records Requested: — Laboratory Test Result— - Imaging Reports (X-rays, CT scans, MRI scans, etc.) — Consultation Note— - Surgical Reports - Prescriptions and Medication History — Progress Notes 5. Purpose of Request— - Continuity of Care in Wyoming — Establishing a new treatinphysiciania— - Personal health record management Please inform me of any fees associated with this request, including copying and postage charges, if applicable. I am willing to fulfill any payment obligations required to obtain my medical records promptly. As per the Wyoming State law regarding the release of medical records, I kindly request that you provide the records within the mandated timeframe of 10 business days. If you are unable to fulfill this request within the specified time frame, please notify me promptly with an estimated timeline for completion. If there are any additional forms or documentation required to process this request, please inform me, and I will promptly provide them to facilitate the process. Thank you for your attention to this matter. I value the importance of having accurate and up-to-date medical records, and I greatly appreciate your assistance in ensuring their seamless transfer to Wyoming. Sincerely, [Your Name] Keywords: Wyoming, sample letter, request, patient, medical records, healthcare provider, relocation, continuity of care, laboratory test results, imaging reports, consultation notes, surgical reports, prescriptions, medication history, progress notes, fees, payment obligations, Wyoming State law, release of medical records, timeframe, forms, documentation.

Dear [Healthcare Provider], I am writing to request copies of my medical records as a patient under your care. As I am relocating to Wyoming, it is essential that I have access to these records for the continuity of my healthcare. I appreciate your assistance in providing these documents so that I can ensure the proper management of my medical needs. Please find below the relevant details for the request: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Current Address: [Your Current Address] — Previous Address (if applicable): [Your Previous Address] 2. Medical Facility Information: — Name of Healthcare Provider: [Healthcare Provider's Name] — Address of Healthcare Provider: [Healthcare Provider's Address] — Contact Number: [Healthcare Provider's Phone Number] 3. Date Range of Medical Records Requested: — Start Date: [Start Date— - End Date: [End Date] 4. Specific Medical Records Requested: — Laboratory Test Result— - Imaging Reports (X-rays, CT scans, MRI scans, etc.) — Consultation Note— - Surgical Reports - Prescriptions and Medication History — Progress Notes 5. Purpose of Request— - Continuity of Care in Wyoming — Establishing a new treatinphysiciania— - Personal health record management Please inform me of any fees associated with this request, including copying and postage charges, if applicable. I am willing to fulfill any payment obligations required to obtain my medical records promptly. As per the Wyoming State law regarding the release of medical records, I kindly request that you provide the records within the mandated timeframe of 10 business days. If you are unable to fulfill this request within the specified time frame, please notify me promptly with an estimated timeline for completion. If there are any additional forms or documentation required to process this request, please inform me, and I will promptly provide them to facilitate the process. Thank you for your attention to this matter. I value the importance of having accurate and up-to-date medical records, and I greatly appreciate your assistance in ensuring their seamless transfer to Wyoming. Sincerely, [Your Name] Keywords: Wyoming, sample letter, request, patient, medical records, healthcare provider, relocation, continuity of care, laboratory test results, imaging reports, consultation notes, surgical reports, prescriptions, medication history, progress notes, fees, payment obligations, Wyoming State law, release of medical records, timeframe, forms, documentation.