Request for Medical Records Templates

Need to request your medical records? Check out these free templates that you can use to request your medical records from healthcare providers. Save time and effort!

Template 1: Request for Medical Records from a Healthcare Provider





[Your Name]
[Your Address]
[City, State ZIP Code]
[Date]

[Healthcare Provider’s Name]
[Healthcare Provider’s Address]
[City, State ZIP Code]

Re: Request for Medical Records

Dear [Healthcare Provider’s Name],


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I am writing to request a copy of my medical records from your facility. I was a patient at [facility name] between [start date] and [end date]. I require these records for personal reasons, including but not limited to reviewing my medical history and sharing it with my new healthcare provider.

Please inform me of the necessary steps to obtain my medical records from your facility. If there are any fees associated with the request, please let me know the cost and provide me with a breakdown of the charges.

I understand that there may be a waiting period before the records are available, but I would appreciate it if you could expedite the process as much as possible. Please inform me if there is anything else I need to provide to complete the request.

Thank you for your time and assistance.

Sincerely,

[Your Name]

Template 2: Request for Medical Records from a Specialist

[Your Name]
[Your Address]
[City, State ZIP Code]
[Date]

[Specialist’s Name]
[Specialist’s Address]
[City, State ZIP Code]

Re: Request for Medical Records

Dear [Specialist’s Name],

I am writing to request a copy of my medical records related to my treatment at your facility. I was a patient between [start date] and [end date], and I require these records for personal reasons, including but not limited to reviewing my medical history and sharing it with my new healthcare provider.

I request that you provide me with a complete copy of my medical records, including all lab results, imaging studies, and progress notes.

Please inform me of the necessary steps to obtain my medical records from your facility. If there are any fees associated with the request, please let me know the cost and provide me with a breakdown of the charges.

I understand that there may be a waiting period before the records are available, but I would appreciate it if you could expedite the process as much as possible. Please inform me if there is anything else I need to provide to complete the request.

Thank you for your time and assistance.

Sincerely,

[Your Name]

Template 3: Request for Medical Records from a Hospital

[Your Name]
[Your Address]
[City, State ZIP Code]
[Date]

[Hospital’s Name]
[Hospital’s Address]
[City, State ZIP Code]

Re: Request for Medical Records

Dear [Hospital’s Name],

I am writing to request a copy of my medical records related to my hospitalization at your facility. I was admitted to your hospital between [start date] and [end date], and I require these records for personal reasons, including but not limited to reviewing my medical history and sharing it with my new healthcare provider.

Please inform me of the necessary steps to obtain my medical records from your facility. If there are any fees associated with the request, please let me know the cost and provide me with a breakdown of the charges.

I understand that there may be a waiting period before the records are available, but I would appreciate it if you could expedite the process as much as possible. Please inform me if there is anything else I need to provide to complete the request.

Thank you for your time and assistance.

Sincerely,

[Your Name]

Frequently Asked Questions (FAQs)

Q: What are medical records? 

A: Medical records are a collection of documents that contain a patient’s health history, including diagnoses, treatments, medications, lab results, imaging studies, and other pertinent information.

Q: Why would I need to request my medical records? 

Answer: There are several reasons why you may need to request your medical records, including transferring care to a new healthcare provider, seeking a second opinion, applying for disability benefits, or participating in a clinical trial.

Q: How do I request my medical records? 

Answer: To request your medical records, you can usually start by contacting the healthcare provider or facility where you received care. 

They may have specific forms or procedures for requesting records. You may also need to provide proof of identity and sign a release form.

Q: What information do I need to provide when requesting my medical records? 

Answer: When requesting your medical records, you will typically need to provide your name, date of birth, social security number, and the dates of the care you received. 

You may also need to provide proof of identity, such as a driver’s license or passport.

Q: Is there a cost associated with requesting my medical records? 

Answer: There may be a cost associated with requesting your medical records, as healthcare providers are allowed to charge a reasonable fee to cover the cost of copying and mailing the records. 

However, some states have laws that limit the amount that healthcare providers can charge for medical record requests.

Q: How long does it take to receive my medical records? 

Answer: The time it takes to receive your medical records will vary depending on the healthcare provider or facility and the complexity of your request. 

Some providers may have a standard timeframe for processing requests, while others may take longer. It’s important to be patient and follow up as necessary to ensure that your request is fulfilled in a timely manner