Medical Records Request Template

Dear [Medical Records Department], I Hope This Letter Finds You Well.

Each template addresses the core elements of a medical record request: I am writing to request a copy of my medical records from [hospital/clinic name]. I am requesting my medical records for reasons related to my health insurance. This document is a written communication between the patient, their authorized representative, and the healthcare provider.

I Was A Patient At Your Facility From [Date Of Admission] To [Date Of Discharge/Last Visit].

Learn how to write an urgent request letter with our free template. You sign a medical record request form when you need or want to formally request and authorize the release of medical records from a healthcare provider or facility. Save time and effort with our free sample letter requesting medical records. I have included a signed authorization of medical records release form with this letter.

This Medical Records Request Document Is Used By A Patient To Request That A Healthcare Provider Who Has Treated Them Release Their Medical Records To A Specific Recipient.

Writing a successful medical records request letter (free templates) in this guide, i'll share my insights, three unique templates, and tips from my personal experience to help you write an effective medical records request letter. Fill out the template online and download it as a pdf or word document. Identification of the requester and the physician, the specific time frame and types of records requested, the method of delivery, and any legal or procedural considerations. Medical records contain sensitive and personal information.

The Purpose Of This Letter Is To Request Copies Of My Medical Records As Allowed By The Health Insurance Portability And Accountability Act (Hipaa) And Department Of Health And Human Services Regulations.