Wake North Carolina Sample Letter for Request for Patient Medical Records

• Category: Letters - Nonlegal - Medical
• State: Multi-State
• County: Wake
• 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. Sample Letter for Request for Patient Medical Records in Wake North Carolina [Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Name of Healthcare Provider] [Address] [City, State, ZIP] Subject: Request for Patient Medical Records Dear Sir/Madam, I hope this letter finds you well. I am writing to request copies of the medical records of [Patient's Full Name], who was under the care of your healthcare facility in Wake, North Carolina. I am [Patient's Legal Guardian/Patient's Spouse/Other relevant relationship to the patient] and I have the patient's written consent to request these records on their behalf. To assist you in locating the records efficiently, please find the relevant information below: — Patient's Full Name: [Patient's Full Name] — Patient's Date of Birth: [Patient's Date of Birth] — Patient's Address at the time of treatment: [Patient's Address at the time of treatment] — Date(s) of Treatment: [Date(s) of Treatment] Please provide copies of the following medical records: 1. Medical history, including but not limited to: — Initial assessment andiagnosissi— - Progress notes — Treatment plans and procedure— - Laboratory and diagnostic test results — Prescription and medication record— - Surgical and operative reports (if applicable) — Discharge summary (if applicable) 2. Radiology reports, including X-rays, MRI scans, CT scans, and ultrasounds (if applicable). 3. Consultation reports from specialists involved in the patient's treatment (if applicable). 4. Any other relevant medical documents or reports related to the patient's condition. As per the Health Insurance Portability and Accountability Act (HIPAA) and North Carolina state law, I understand that I may be charged a reasonable fee for the cost of producing these records. If any fees apply, please inform me in advance. Please send the requested records to the address mentioned above or provide instructions on how I can obtain them from your facility. I kindly request that you respond to this letter within 30 days to ensure a timely process. Should you have any questions or require further information, please do not hesitate to contact me at the provided contact details. Thank you for your attention to this matter. I look forward to receiving a prompt response and the requested medical records. Sincerely, [Your Name] --- Different types of Wake North Carolina Sample Letter for Request for Patient Medical Records may include specific variations for: 1. Patients seeking their own medical records. 2. Legal representatives or attorneys requesting records on behalf of the patient. 3. Guardians or family members requesting records for a minor or incapacitated patient. 4. Insurance representatives requesting medical records for claim purposes. 5. Researchers or healthcare professionals requiring patient records for studies or continuing education.

Sample Letter for Request for Patient Medical Records in Wake North Carolina [Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Name of Healthcare Provider] [Address] [City, State, ZIP] Subject: Request for Patient Medical Records Dear Sir/Madam, I hope this letter finds you well. I am writing to request copies of the medical records of [Patient's Full Name], who was under the care of your healthcare facility in Wake, North Carolina. I am [Patient's Legal Guardian/Patient's Spouse/Other relevant relationship to the patient] and I have the patient's written consent to request these records on their behalf. To assist you in locating the records efficiently, please find the relevant information below: — Patient's Full Name: [Patient's Full Name] — Patient's Date of Birth: [Patient's Date of Birth] — Patient's Address at the time of treatment: [Patient's Address at the time of treatment] — Date(s) of Treatment: [Date(s) of Treatment] Please provide copies of the following medical records: 1. Medical history, including but not limited to: — Initial assessment andiagnosissi— - Progress notes — Treatment plans and procedure— - Laboratory and diagnostic test results — Prescription and medication record— - Surgical and operative reports (if applicable) — Discharge summary (if applicable) 2. Radiology reports, including X-rays, MRI scans, CT scans, and ultrasounds (if applicable). 3. Consultation reports from specialists involved in the patient's treatment (if applicable). 4. Any other relevant medical documents or reports related to the patient's condition. As per the Health Insurance Portability and Accountability Act (HIPAA) and North Carolina state law, I understand that I may be charged a reasonable fee for the cost of producing these records. If any fees apply, please inform me in advance. Please send the requested records to the address mentioned above or provide instructions on how I can obtain them from your facility. I kindly request that you respond to this letter within 30 days to ensure a timely process. Should you have any questions or require further information, please do not hesitate to contact me at the provided contact details. Thank you for your attention to this matter. I look forward to receiving a prompt response and the requested medical records. Sincerely, [Your Name] --- Different types of Wake North Carolina Sample Letter for Request for Patient Medical Records may include specific variations for: 1. Patients seeking their own medical records. 2. Legal representatives or attorneys requesting records on behalf of the patient. 3. Guardians or family members requesting records for a minor or incapacitated patient. 4. Insurance representatives requesting medical records for claim purposes. 5. Researchers or healthcare professionals requiring patient records for studies or continuing education.