Wyoming 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] [Date] [Medical Provider's Name] [Medical Provider's Address] [City, State, ZIP Code] Subject: Request for Release of Medical Records in Social Security Disability Action Dear [Medical Provider's Name], I hope this letter finds you well. I am writing to request the release of my medical records, as permitted by law, for the purpose of pursuing my Social Security Disability claim. I understand the importance of providing accurate and comprehensive medical documentation to support my case, and I appreciate your cooperation in making these records available. To ensure the success of my Social Security Disability claim, it is crucial that all relevant medical records are provided to the Social Security Administration. Therefore, I kindly request that you release the following medical records pertaining to my condition: 1. Office visitation records: This includes all records of my visits to your office, consultations, treatments, and procedures performed, as well as any follow-up appointments made. 2. Diagnostic test results: Please provide all test results such as laboratory reports, X-rays, MRI scans, CT scans, and any other diagnostic tests performed in relation to my condition. 3. Hospitalization records: If I have been admitted to your facility, I request copies of all hospital records, including discharge summaries, surgical reports, and any other relevant documents related to my stay. 4. Specialist consultation records: If I have been referred to any specialists or have sought additional consultations, please include the records of these consultations, as they contribute to the overall documentation of my medical condition. 5. Prescription and medication details: I kindly ask for a comprehensive list of all prescribed medications, dosages, and any changes made to my medications throughout the duration of my treatment. Please note that I authorize the release of my medical records only for the purpose stated above. I understand that my request should be processed within 30 days of receipt, as required by the Health Insurance Portability and Accountability Act (HIPAA). If there are any charges associated with copying and sending these records, please inform me in advance. I am willing to cover reasonable costs for the production and delivery of my medical records. To ensure a prompt response, I have included a HIPAA-compliant medical records release form, duly completed and signed. Please find the form attached along with this letter. If your facility has an alternate procedure for requesting medical records for Social Security Disability purposes, kindly let me know, and I will comply accordingly. Thank you in advance for your attention to this matter. Your cooperation and assistance are greatly appreciated. Should there be any questions or further information required, please do not hesitate to reach me at [Your Phone Number] or [Your Email Address]. Sincerely, [Your Name]

[Your Name] [Your Address] [City, State, ZIP Code] [Date] [Medical Provider's Name] [Medical Provider's Address] [City, State, ZIP Code] Subject: Request for Release of Medical Records in Social Security Disability Action Dear [Medical Provider's Name], I hope this letter finds you well. I am writing to request the release of my medical records, as permitted by law, for the purpose of pursuing my Social Security Disability claim. I understand the importance of providing accurate and comprehensive medical documentation to support my case, and I appreciate your cooperation in making these records available. To ensure the success of my Social Security Disability claim, it is crucial that all relevant medical records are provided to the Social Security Administration. Therefore, I kindly request that you release the following medical records pertaining to my condition: 1. Office visitation records: This includes all records of my visits to your office, consultations, treatments, and procedures performed, as well as any follow-up appointments made. 2. Diagnostic test results: Please provide all test results such as laboratory reports, X-rays, MRI scans, CT scans, and any other diagnostic tests performed in relation to my condition. 3. Hospitalization records: If I have been admitted to your facility, I request copies of all hospital records, including discharge summaries, surgical reports, and any other relevant documents related to my stay. 4. Specialist consultation records: If I have been referred to any specialists or have sought additional consultations, please include the records of these consultations, as they contribute to the overall documentation of my medical condition. 5. Prescription and medication details: I kindly ask for a comprehensive list of all prescribed medications, dosages, and any changes made to my medications throughout the duration of my treatment. Please note that I authorize the release of my medical records only for the purpose stated above. I understand that my request should be processed within 30 days of receipt, as required by the Health Insurance Portability and Accountability Act (HIPAA). If there are any charges associated with copying and sending these records, please inform me in advance. I am willing to cover reasonable costs for the production and delivery of my medical records. To ensure a prompt response, I have included a HIPAA-compliant medical records release form, duly completed and signed. Please find the form attached along with this letter. If your facility has an alternate procedure for requesting medical records for Social Security Disability purposes, kindly let me know, and I will comply accordingly. Thank you in advance for your attention to this matter. Your cooperation and assistance are greatly appreciated. Should there be any questions or further information required, please do not hesitate to reach me at [Your Phone Number] or [Your Email Address]. Sincerely, [Your Name]