Sample Letter for Requesting Medical Records in Wyoming [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Healthcare Provider's Name] [Address] [City, State, ZIP Code] Subject: Request for Medical Records Dear [Healthcare Provider's Name], I am writing to formally request a complete copy of my medical records maintained by your facility in accordance with the applicable laws and regulations in the State of Wyoming. I kindly ask for your prompt attention to this matter and your compliance with my request. To facilitate the process, I have included the necessary information below: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Address: [Your Complete Address— - Contact Number: [Your Phone Number] — Email Address: [Your Email Address] 2. Treatment Dates: Please provide records from [Start Date] to [End Date] or include a complete copy of my medical records if possible. 3. Authorization: I authorize the release of my medical records to [Your Name]. If there are necessary fees associated with processing this request, please inform me in advance. Please note that even if there are fees, they should not exceed the fees outlined in the Wyoming statutes and should not pose an impediment to access my medical records. I would prefer to receive the medical records electronically via a secure email attachment, if possible. However, if that is not feasible, please inform me of the available options for collection or delivery. If you require any additional information or forms to process my request, kindly inform me as soon as possible. I am ready to provide any necessary details to expedite this process. I understand that you have a legal obligation to respond to my request within a reasonable timeframe, as defined by the Wyoming state regulations. If, for any reason, my request cannot be fulfilled within the required time frame, please inform me promptly regarding the reason for the delay. Thank you for your time and attention to this matter. I look forward to receiving a prompt and satisfactory response. Sincerely, [Your Name]
Wyoming Sample Letter for Request for Medical Records
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