Second letter to request copies of medical records

Here is a sample second letter to request copies of medical records. You have to customize this letter with required information to be suitable for your purpose.

Alex J. Roberts
[Street Address]
[City, ST  ZIP Code]
[Date]

Mark k. Anderson
[Medical Practice or Hospital Name]
[Street Address]
[City, ST  ZIP Code

RE: Release of medical records for User
DOB: [date], SSN: [Social Security Number]

Dear Mr. Anderson,

On [date], I sent you a written request asking for copies of my medical records related to treatment for [medical conditions] rendered by you or under your supervision from [date] through [date]. Since then, [number] days have passed and I have not yet received these records.

I am hereby making a second request that you send me these records immediately. I remind you that under the laws of this state, Statute #[number], you are legally obligated to provide copies of my medical records upon my request.

If I have not received the records by [date], I will have no choice but to retain an attorney to obtain my medical records for me. By law, you will then be liable for the attorney fees that I incur. I trust that this step will not be necessary.

Please mail the information to:
[Your Name or Name of Party to Receive Records]
[Street Address]
[City, ST  ZIP Code]

As noted in my first request, I will be glad to pay for costs associated with providing me copies of my records.

Sincerely,
Alex J. Roberts
--------------------------------------------------------------------------------------
Related searches: how to write Sample Letter to Request Medical Records, can i request copies of medical records, letter requesting copies of military personnel records sample

0 التعليقات:

Post a Comment