Writing a Medical Records Request Letter (with Sample)
Use this sample medical records request letter as a template for your formal notification. Last updated on January 17th, 2019
Everyone has the right to request access to their own medical history. It is easy to get a copy by writing a letter to a doctor’s office or hospital. There are several reasons why an individual would write a medical records request letter.
Common Reasons For Requesting Medical Records
Making an insurance claim
Changing healthcare provider
Moving out of state
Keeping a personal medical record
Getting a second opinion
Filing a medical malpractice lawsuit
Include as Much Information as Possible
To make it easy for the hospital or doctor’s office to find the records, the individual should include as much information as possible such as full name or names if the name changed because of marriage or adoption, date of birth, current address and phone number as well as previous address if that was the address used during the time of treatment. If the individual only wants certain records, they should list the records they want, so they are not charged for records they don’t need. The most common records requested from a treating physician are:
Bills and receipts
Results of CAT, DKG, DDG, NMR and fetal monitoring tests
Diagnostic test result
The records most often requested from a hospital or clinic are:
Emergency room records
Pre and post-operative reports
According to the Health Insurance Portability and Accountability Act (HIPAA) and the Department of Health and Human Service regulations guidelines the doctor or hospital being requested to give medical records may charge a reasonable fee for copying the records. They may also charge for postage if the individual requests the records be sent to a specific address.
The guidelines also allow the healthcare provider to respond to requests for records within 30 days with an additional 30 day extension for a good reason. States may also have laws that require a lower fee or time difference for responding.
Medical Release Form
Many doctors and hospitals require that patients fill out a medical release form. The individual should call the office and ask if this is required because it will save time for the person looking for the records, thereby saving time for the individual requesting. The form can be filled out, signed and included in the letter requesting the records.
The records can be sent to the individual’s residence, another doctor’s office or to an insurance company. However, an individual can only request their own medical records. If they want to request a family member’s records, they will need written permission from the family member.
If they would like to request the medical records of a deceased person, they will need the permission of the next of kin. Each hospital may have different regulations for handling next-of-kin applications, so the person should call the hospital to find out their regulations.
Here is a sample medical records request letter. It should be written in formal business style and sent by certified mail. Since there is a time frame for the healthcare provider to answer, it is wise for the individual to have proof of the time the letter was received.
Sample Medical Records Request Letter Individual’s Name Individual’s Address City, State, Zip Code
Name of Healthcare provider Name of Hospital or other Facility if applicable Address of Healthcare provider City, State, Zip Code
RE: Requesting copies of my medical records. ID number: NUMBER
Dear Name of Healthcare Provider,
I am writing this letter to request copies of any medical records of mine that you have. I have understood that according to the Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations, I am entitled to have copies of my medical records.
I was treated in your FACILITY from DATE to DATE. I would like copies of all of my blood test results, imaging studies, operative reports, as well as notes from doctors and nurses, consultations with specialists, referrals and any other record in my medical file.
I understand you may charge a reasonable fee for copying the records, as well as for postage to mail the reports to the above address. However, you will not charge for time spent locating the records.
I hope to receive the above records within 30 days as specified under HIPAA or receive a letter stating the reason for any delay. I can be reached at 555-123-4567 or a [email protected] if you have any questions.
Thank you for your time attending to this matter.
Signature of Individual Printed name of Individual List of enclosures if an addressed envelope is enclosed or a medical release form