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How to Request Your Medical Records. Most practices or facilities will ask you to fill out a form to request your medical records. This request form can usually be collected at the office or delivered by fax, postal service, or email. If the office doesn't have a form, you can write a letter to make your request.

To obtain a copy of the medical records you must request the records from the medical care provider. To provide these medical records to you, your health care provider must follow government privacy laws called HIPAA. HIPAA is the Health Insurance Portability and Accountability Act of 1996.

To write a letter of request, start by greeting the recipient with Dear, followed by the person's last name and title, or To Whom It May Concern. Then, briefly explain who you are and why you're writing in the 1st paragraph. Next, provide additional context and details about your request in the 2nd paragraph.

Full name and address, postcode, date of birth, male or female. Previous name or address on medical records if this is different to current name and address. The name of the hospital (or NHS premises) ward or department, consultant and dates of admission or attendance.

I would like to state that I got admitted/ treatment for (Mention) on // (Date). I am writing this letter to request you for issuance of (Inform what record you want). As per hospital guidelines, I request you to issue a copy of my medical records. I need this for (Reason).

Patients do not own their medical records and are not entitled to keep the originals but under the Data Protection Act 1998, they do have the right to view their records and have copies of them.

How to fill out a health or medical record release form Patient information. Whose health records do you want?Clinic, hospital, care provider.Date of Services.Information to be released.Receiving party or destination of records.Purpose of release.Expiration date or duration of consent.Release instructions.

What information should be included in a patient's medical records? The initial health history and physical examination from the doctor. Consultation reports from specialists, as well as any notes. Operative reports / Medical procedure reports.

For inquiries or to make a medical records request, please call 704-336-6498 or email MedRec@mecknc.gov.

I was treated in your office at your facility between fill in dates. I request copies of the following or all health records related to my treatment. Identify records requested, e.g. medical history form you provided; physician and nurses' notes; test results, consultations with specialists; referrals.

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Mecklenburg North Carolina Sample Letter for Request for Patient Medical Records

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