Medical Records Request Letter
Medical Records Request Letter
August 8, 2095
Dr. John Smith
Medical Records Department
Springfield Medical Center
456 Oak Avenue
Springfield, IL 62701
Dear Dr. Smith,
Subject: Request for Medical Records
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:
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Full Name: Jane Doe
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Date of Birth: January 15, 2050
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Patient ID: 789456123
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Dates of Service: January 2071 - June 2095
Please include the following records in the request:
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Complete Medical History
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Laboratory Results
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Radiology Reports
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Surgical Reports
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Medication History
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: [email protected]. Alternatively, you may mail the records to my address listed above.
Should you require any further information or have questions regarding this request, please contact me at 222 555 7777.
Thank you for your prompt attention to this matter.
Sincerely,
Jane Doe
