Kings New York Sample Letter for Request for Medical Records

• Category: Letters - Nonlegal - Requests
• State: Multi-State
• County: Kings
• Control #: US-0546LR
• Format: Word; Rich Text

Description

Sample Letter for Request for Medical Records Dear [Healthcare Provider/Patient Records Department], I hope this letter finds you well. I am writing to request a copy of my medical records from Kings New York for [specific date(s) or period] for the purpose of [explain the reason why you need the records]. As a patient at Kings New York, I understand the importance of maintaining complete and accurate medical records. I kindly ask for your assistance in providing me with the following information: 1. Patient Information: Funnymanam— - Date of birth - Address - Phone number — Email address (if available— - Social Security Number (optional) 2. Dates of Service: — Specify the specific date(s) or period during which the medical services were rendered. 3. Specific Medical Records: — Please include all relevant medical records, such as: — Progress note— - Consultation notes - Test or lab results — X-ray or imaging report— - Surgical reports — Medication history and prescription— - Immunization records — Allergies and adverse reaction— - Discharge summary (if applicable) — Any other relevant documentation 4. Purpose of Request: — Explain the reason why you need your medical records: — Continuity of care with a new healthcare provider — Personal health recormanagementen— - Insurance claims or disability benefits — Legal purpose— - Research purposes - Other (specify your reason) 5. Preferred Format: — Please let me know if the records can be provided in a digital format (PDF, secure online portal, or CD) or if a physical copy is required. If there are any associated costs for providing the records, please inform me in advance. 6. Authorization and Signature: — If necessary, please provide any required authorization forms or documents that need to be completed. Kindly provide instructions on how to return the completed request form and where it should be sent. I understand that there may be fees associated with processing this request, and I am willing to cover reasonable expenses. If you could provide an estimated cost or inform me of any charges in advance, it would be greatly appreciated. Please reach out to me at [phone number] or [email address] if there are any further requirements or if additional information is necessary. I kindly request that you acknowledge receipt of this letter and provide an estimated timeline regarding when I can expect to receive the requested records. Thank you for your attention to this matter and your assistance in assisting me with obtaining my medical records from Kings New York. I appreciate your dedication to maintaining patient confidentiality and ensuring the continuity of care. Sincerely, [Your Full Name] [Your Date of Birth] [Your Address] [Your Phone Number] [Your Email Address]

Dear [Healthcare Provider/Patient Records Department], I hope this letter finds you well. I am writing to request a copy of my medical records from Kings New York for [specific date(s) or period] for the purpose of [explain the reason why you need the records]. As a patient at Kings New York, I understand the importance of maintaining complete and accurate medical records. I kindly ask for your assistance in providing me with the following information: 1. Patient Information: Funnymanam— - Date of birth - Address - Phone number — Email address (if available— - Social Security Number (optional) 2. Dates of Service: — Specify the specific date(s) or period during which the medical services were rendered. 3. Specific Medical Records: — Please include all relevant medical records, such as: — Progress note— - Consultation notes - Test or lab results — X-ray or imaging report— - Surgical reports — Medication history and prescription— - Immunization records — Allergies and adverse reaction— - Discharge summary (if applicable) — Any other relevant documentation 4. Purpose of Request: — Explain the reason why you need your medical records: — Continuity of care with a new healthcare provider — Personal health recormanagementen— - Insurance claims or disability benefits — Legal purpose— - Research purposes - Other (specify your reason) 5. Preferred Format: — Please let me know if the records can be provided in a digital format (PDF, secure online portal, or CD) or if a physical copy is required. If there are any associated costs for providing the records, please inform me in advance. 6. Authorization and Signature: — If necessary, please provide any required authorization forms or documents that need to be completed. Kindly provide instructions on how to return the completed request form and where it should be sent. I understand that there may be fees associated with processing this request, and I am willing to cover reasonable expenses. If you could provide an estimated cost or inform me of any charges in advance, it would be greatly appreciated. Please reach out to me at [phone number] or [email address] if there are any further requirements or if additional information is necessary. I kindly request that you acknowledge receipt of this letter and provide an estimated timeline regarding when I can expect to receive the requested records. Thank you for your attention to this matter and your assistance in assisting me with obtaining my medical records from Kings New York. I appreciate your dedication to maintaining patient confidentiality and ensuring the continuity of care. Sincerely, [Your Full Name] [Your Date of Birth] [Your Address] [Your Phone Number] [Your Email Address]