Request Letter for Medical Records
August 8, 2095
Dr. John Smith
Medical Records Department
Springfield Medical Center
456 Oak Avenue
Springfield, IL 62701
Dear Dr. Smith,
I am writing to request copies of my medical records from Springfield Medical Center. I have been a patient at your facility and require these records for personal use and continuity of care with my new healthcare provider.
Below are my details for reference: |
Please include the following records in the request: Complete Medical History Laboratory Results Radiology Reports Surgical Reports Medication History
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I understand there may be a fee associated with processing this request. Please inform me of any costs, and I will promptly provide payment. If possible, I would prefer the records to be sent electronically to my email address: [Your Email]. Alternatively, you may mail the records to the address listed above.
Should you require any further information or have questions regarding this request, please contact me at 555 - 1234 - 789. Thank you for your prompt attention to this matter.
Sincerely,
[Your Name]
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