Learn how to write a dental records request letter. Use our sample dental records request letter as a template for your request letter.
Sample Dental Records Request Letter
1219 Wooden Road
Pleasant Hill, NJ, 08046
May 18, 2022
2400 Cherry Road
Pleasant Hill, NJ, 08046
RE: Requesting copies of my dental records. ID number: #234654
Dear Dr. Benson,
I am writing this letter to request copies of any dental 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 dental records.
I was treated in your dental office from 01/01/2018 to 04/01/2022. I would like copies of all of my dental records including, consultations with specialists, referrals and any other record in my 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 555-153-4567 or a email@example.com if you have any questions.
Thank you for your time attending to this matter.
List of enclosures if an addressed envelope is enclosed or a medical release form
Frequently Asked Questions (FAQs)
1. What is a dental records request?
Answer: A dental records request is a formal request for copies of a patient’s dental records, typically made by a dental professional, insurance company or patient themselves.
2. How can a patient request their own dental records?
Answer: A patient can request their own dental records by contacting their previous dental office and submitting a written request, which should include their name, date of birth, and treatment dates. They may also be required to provide proof of identification and sign a consent form.
3. What information is included in a patient’s dental records?
Answer: A patient’s dental records typically include information such as their dental history, treatment plan, x-rays, and notes from their dental visits.
4. How long does it take for a dental office to fulfill a records request?
Answer: It typically takes a dental office 7 to 14 business days to fulfill a records request, but it can take longer if the request is more complex or if the office is busy.
5. Is there a fee for requesting dental records?
Answer: Some dental offices may charge a fee for dental records requests, but it varies by office and state. The fee may be waived if the patient is unable to pay.