Writing a Simple Medical Release Letter (with Sample) Use this sample medical release letter as a template for your formal release letter. Last updated on January 15th, 2019
There are many situations in which a person may be required to send a medical release letter. Moving to another state, changing doctors, filing insurance claims or simply wanting a copy of all medical documents are reasons that cause people to request their medical records from hospitals and doctor’s offices.
Other reasons people may want a copy of their medical records are:
Filing for disability
Joining a class-action lawsuit
Applying for membership in an experimental medical program
Record of prescribed drugs
In some cases, people need to keep track of treatments and test that they have had as well as illnesses, surgical procedures and office visits.
According to the Health Insurance Portability and Accountability Act (HIPAA), patients are allowed to request a copy or summary of their medical records with a medical release letter. They will most probably be charged a fee for this. The fee may vary by state. The medical facility is not required to provide patients with the original documents.
The more information that is included in a medical release letter, the easier it will be for the records department or doctor’s office to find the reports. Name, address, date of birth, phone number and, if possible, file number. It will also help to include a list of the reports required.
For example, blood tests, physical therapy reports, operative reports, hospital stays and imaging studies are a few of the type of records that are in a medical file. If possible, the date the test was taken should also be included. The time frame that the patient was receiving treatment or staying in the hospital should also be mentioned.
Notes are also a big part of a person’s medical record. These notes include progress notes, postoperative notes, operative notes, postpartum notes, delivery notes, admission and discharge notes. The address where the information is to be sent should be clearly stated. This may be the patient’s home address, another doctor’s office or an insurance company.
Medical Release Form
Most doctor’s offices and hospitals require a medical release form to be filled out and returned to the proper department. This can be obtained before writing the letter and given as an enclosure.
A patient can only request his or her own medical records, and they need not state the reason they want the records. They may not request the records of anyone else without the written permission of that person even if it is a family member. If the person whose records they want is deceased, they need the permission of the next of kin.
The letter should be sent by certified mail. This will give proof to the sender when the letter was sent and that it was received. According to HIPAA rules, the hospital or doctor’s office is allowed 30 days to respond, and they can ask for another 30-day extension if they give a good reason. This time limit also varies by state. It is a good idea for patients to look up their state requirements for applying to get their medical records.
Here is a sample letter for release of medical records.
Medical Release Letter Sample Date
Applicant’s Name Applicant’s Address City, State, Zip Code
Doctor or Hospital’s Name Address City, State, Zip Code
RE: Medical identification number and Date of Birth
Dear Doctor’s Name or Hospital Records Department,
I am writing this letter to request copies of my medical records that are in Name of Hospital or Doctor’s Office. I understand that the Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations allow me to have these copies.
I received treatment in your facilities from Date, Year to Date, Year. I would like to have copies of all my records that relate to this treatment. This may include the medical history I previously provided to you, consultations with specialists and test results.
I will be happy to pay a fee for copying the records and for postage to send them to the above address.
According to the HIPAA, I can expect to receive my medical records within 30 days. It this is not possible, kindly inform me in writing and tell me when to expect the records.
If you have any questions or require more information, call me at 555 123 4567 or email me at [email protected]
Thank you for your time.
Sincerely, Signature Name in print Medical release form enclosed