Free Enhanced Usability Fax Sheet Template
Enhanced Usability Fax Sheet
FAX |
Date: March 11, 2050
To: [Recipient's Name]
Address: [Recipient's Address]
Re: Request for Medical Records
Fax Number: (555) 555-5555
From: [Your Name]
Hospital: [Your Company Name]
Fax Number: (555) 123-4567
_____________________________________________________________________________________
Message
Dear [Recipient's Name],
We acknowledge your recent request for access to your medical records at [Your Company Name]. Your proactive approach to managing your healthcare is commendable, and we are committed to ensuring a smooth and efficient process for you.
To facilitate the prompt retrieval of your medical records, please find the necessary instructions outlined below:
Kindly complete the enclosed Authorization for Release of Medical Records form. Ensure that all required fields are accurately filled out, including your full name, date of birth, contact information, and the specific records you are requesting.
Attach a legible copy of a valid government-issued photo identification (e.g., driver's license, passport) to your completed authorization form. This step is essential to verify your identity and safeguard the confidentiality of your medical information.
Return the completed authorization form along with a copy of your identification via fax (555) 123-4567 or by mail to [Your Company Address] . Alternatively, you may deliver the documents in person to our [Your Company Name] during our operating hours.
Please allow 5-7 business days for processing your request. We strive to fulfill all requests promptly, but processing times may vary depending on the volume of requests and the complexity of your medical records.
Should you have any inquiries or require assistance throughout the process, please do not hesitate to contact our dedicated [Your Company Name] at [Your Company Number] during our office hours.
Your trust in [Your Company Name] is greatly valued, and we assure you of our utmost dedication to maintaining the confidentiality and accuracy of your medical records.
Thank you for choosing [Your Company Name] for your healthcare needs.
_____________________________________________________________________________________
Sincerely,
[YOUR NAME]
[YOUR POSITION]
[YOUR COMPANY NAME]
