Oakland Michigan Sample Letter for Request for Medical Records

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

Description

Sample Letter for Request for Medical Records Dear [Medical Provider's Name], I am writing to request copies of my medical records from your facility as I am moving to Oakland, Michigan and will be changing my primary care provider. I want to ensure continuity of care and have all my medical information readily available for my new healthcare provider in Oakland, Michigan. Please find below the details required for the processing of my medical record request: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Address: [Your Current Address— - Phone Number: [Your Phone Number] — Email Address: [Your Email Address] 2. Purpose of Request: I am relocating to Oakland, Michigan and need access to my complete medical records to facilitate a smooth transition to a new primary care provider. Having access to my medical history, including diagnoses, treatment plans, medications, and previous test results, will benefit both me and my future medical team in ensuring the continuation of appropriate care and treatment. 3. Authorization and HIPAA Compliance: To comply with the Health Insurance Portability and Accountability Act (HIPAA), I have completed the necessary authorization form granting permission for the release of my medical records. Please let me know if any additional forms or actions are required to proceed with the record transfer. 4. Types of Medical Records Requested: I kindly request copies of the following medical records: — Complete medical history, including progress notes, consultation notes, and discharge summaries — Laboratory and radiology reports, including imaging studies (X-rays, CT scans, MRI) — Immunization record— - Medication history, including prescribed medications and dosage information — Allergies and adverse reaction— - Operative reports and surgical notes, if applicable — Any other relevant medical documentation related to my health condition 5. Delivery Method: Please inform me of the available options for obtaining these medical records. If there are any associated fees, kindly provide the necessary details for payment. I can arrange for a pick-up, or if feasible, I would appreciate the records being securely sent to my new healthcare provider in Oakland, Michigan directly. 6. Contact Information: If you require further information, please do not hesitate to contact me. I can be reached at the provided phone number or email address. Your prompt attention to this matter is greatly appreciated. Thank you for your assistance in facilitating the transfer of my medical records. I look forward to your prompt response. Sincerely, [Your Full Name]

Dear [Medical Provider's Name], I am writing to request copies of my medical records from your facility as I am moving to Oakland, Michigan and will be changing my primary care provider. I want to ensure continuity of care and have all my medical information readily available for my new healthcare provider in Oakland, Michigan. Please find below the details required for the processing of my medical record request: 1. Patient Information: — Full Name: [Your Full Name— - Date of Birth: [Your Date of Birth] — Address: [Your Current Address— - Phone Number: [Your Phone Number] — Email Address: [Your Email Address] 2. Purpose of Request: I am relocating to Oakland, Michigan and need access to my complete medical records to facilitate a smooth transition to a new primary care provider. Having access to my medical history, including diagnoses, treatment plans, medications, and previous test results, will benefit both me and my future medical team in ensuring the continuation of appropriate care and treatment. 3. Authorization and HIPAA Compliance: To comply with the Health Insurance Portability and Accountability Act (HIPAA), I have completed the necessary authorization form granting permission for the release of my medical records. Please let me know if any additional forms or actions are required to proceed with the record transfer. 4. Types of Medical Records Requested: I kindly request copies of the following medical records: — Complete medical history, including progress notes, consultation notes, and discharge summaries — Laboratory and radiology reports, including imaging studies (X-rays, CT scans, MRI) — Immunization record— - Medication history, including prescribed medications and dosage information — Allergies and adverse reaction— - Operative reports and surgical notes, if applicable — Any other relevant medical documentation related to my health condition 5. Delivery Method: Please inform me of the available options for obtaining these medical records. If there are any associated fees, kindly provide the necessary details for payment. I can arrange for a pick-up, or if feasible, I would appreciate the records being securely sent to my new healthcare provider in Oakland, Michigan directly. 6. Contact Information: If you require further information, please do not hesitate to contact me. I can be reached at the provided phone number or email address. Your prompt attention to this matter is greatly appreciated. Thank you for your assistance in facilitating the transfer of my medical records. I look forward to your prompt response. Sincerely, [Your Full Name]