Description
Follow up on a request for copies of your medical records with this letter template. The letter states a legal requirement to provide the records, and sets a deadline for receipt, after which time an attorney will be hired to obtain the records.
User
[City, ST ZIP Code]
[Date]
[Doctor Name]
[Medical Practice or Hospital Name]
[Street Address]
[City, ST ZIP Code
RE: Release of medical records for User
DOB:[date] , SSN: [Social Security Number]
DOB:
Dear [Doctor Name] :
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,
User
