Permission to Access Records Letter
Permission to Access Records Letter
October 15, 2050
Virginia Auer
Records Manager
Springfield Medical Center
456 Elm Street
Springfield, IL 62701
Dear Virginia Auer,
I am writing to formally request access to my medical records held by Springfield Medical Center. Under the Health Insurance Portability and Accountability Act (HIPAA), I am entitled to request and obtain copies of these records.
The specific records I am requesting include:
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Complete medical history
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Copies of lab test results from 2045 to 2050
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Notes from my visits to Dr. Emily Brown
For your reference, my details are as follows:
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Full Name: [Your Name]
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Date of Birth: January 15, 1985
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Patient ID: 987654321
Please let me know if there are any forms or fees required for processing this request. I would appreciate a response within 30 days to confirm receipt of this request and to provide the records as requested.
Thank you for your attention to this matter. I look forward to your prompt response.
Sincerely,
[Your Name]
[Your Email]
