You can use this Sample Medical Information letter to ask for your medical request from a hospital or an institute that has recently treated you.
[Sender’s Name]
[Sender’s Address]
[Date]
[Name of the Institute]
[Institute’s Address]
[Subject: Mention the subject here in bold formatting],
Dear [Reciver’s Name],
I am writing you this letter to request copies of my medical records, pursuant to my rights as depicted by the Department of Health and Human Services Regulations.
This letter confirms that I received treatment from you in your office [mention the institute’s name] on the dates [Mention the dates of your treatments]. Consequently, I request you to provide me the copies of all medical procedures carried out on the mentioned dates.
I understand the institute may charge me a fee for copying the records, and I am compliant. Nevertheless, I will not comply and pay for the time spent finding the records.
I request that you send the required documents to the address mentioned above at the earliest. I shall remain thankful for your services and for considering my request to provide me with the required medical information.
Sincerely,
[Sender’s Name]
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Letter Sending Information
