Houston Texas Sample Letter for Medical Records Release in Social Security Disability Action

• Category: Letters - Legal - Social Security
• State: Multi-State
• City: Houston
• 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 in good health. I am writing to request your assistance regarding the release of my medical records pertinent to my Social Security Disability Action. I am a resident of Houston, Texas, and my disability claim is currently being reviewed by the Social Security Administration (SSA) for disability benefits. As part of the SSA's evaluation process, it is imperative that I provide them with all relevant medical evidence related to my condition. In this regard, I kindly request your prompt cooperation in releasing my comprehensive medical records for the period of [specific time frame, e.g., the past five years]. These records will serve as essential supporting documentation for my disability claim. Please find enclosed a copy of the SSA's medical records release form. If your facility requires the use of its own form, kindly provide me with the appropriate form to complete. I have also enclosed a self-addressed stamped envelope for your convenience in returning the requested medical records. To ensure accuracy and completeness, I would appreciate it if you could include the following information within the released medical records: 1. Laboratory reports 2. Diagnostic imaging (X-rays, MRIs, CT scans, etc.) 3. Surgical reports (if applicable) 4. Physician progress notes 5. Treatment plans and summaries 6. Medication history and prescriptions 7. Psychological evaluations and assessments (if applicable) 8. Rehabilitation therapy records (if applicable) I understand that your office may charge a reasonable fee for the copying and postage expenses associated with this request. If there are any applicable fees, please notify me in advance. I would appreciate a phone call or an email to discuss the estimated costs before proceeding with the release of my medical records. I am available at [your contact information] if you require any further clarification or information. Furthermore, I greatly appreciate your prompt attention to this matter and the invaluable assistance you provide in supporting my Social Security Disability Action. Thank you very much for your cooperation and understanding. Your cooperation in fulfilling this request will contribute significantly to the timely adjudication of my case. 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 in good health. I am writing to request your assistance regarding the release of my medical records pertinent to my Social Security Disability Action. I am a resident of Houston, Texas, and my disability claim is currently being reviewed by the Social Security Administration (SSA) for disability benefits. As part of the SSA's evaluation process, it is imperative that I provide them with all relevant medical evidence related to my condition. In this regard, I kindly request your prompt cooperation in releasing my comprehensive medical records for the period of [specific time frame, e.g., the past five years]. These records will serve as essential supporting documentation for my disability claim. Please find enclosed a copy of the SSA's medical records release form. If your facility requires the use of its own form, kindly provide me with the appropriate form to complete. I have also enclosed a self-addressed stamped envelope for your convenience in returning the requested medical records. To ensure accuracy and completeness, I would appreciate it if you could include the following information within the released medical records: 1. Laboratory reports 2. Diagnostic imaging (X-rays, MRIs, CT scans, etc.) 3. Surgical reports (if applicable) 4. Physician progress notes 5. Treatment plans and summaries 6. Medication history and prescriptions 7. Psychological evaluations and assessments (if applicable) 8. Rehabilitation therapy records (if applicable) I understand that your office may charge a reasonable fee for the copying and postage expenses associated with this request. If there are any applicable fees, please notify me in advance. I would appreciate a phone call or an email to discuss the estimated costs before proceeding with the release of my medical records. I am available at [your contact information] if you require any further clarification or information. Furthermore, I greatly appreciate your prompt attention to this matter and the invaluable assistance you provide in supporting my Social Security Disability Action. Thank you very much for your cooperation and understanding. Your cooperation in fulfilling this request will contribute significantly to the timely adjudication of my case. Sincerely, [Your Name]