Medical Record Request
[YOUR COMPANY NAME]
[YOUR COMPANY ADDRESS]
January 15, 2078
OmniTrick
Scottsdale, AZ 85250
Subject: Request for Medical Records
To Whom It May Concern,
I am writing to request copies of medical records for Salvador Green, whose details are as follows:
Date of Birth: March 12, 2055
Address: Scottsdale, AZ 85250
Please provide records for the following:
Type of Records: Annual physical exam reports, lab test results, and vaccination history
Date Range: January 1, 2070, to December 31, 2077
If there are any fees associated with fulfilling this request, please notify me in advance. I am happy to provide the required authorization or identification to facilitate this process.
I would prefer the records to be sent via email to [YOUR EMAIL] or mailed to:
[YOUR NAME]
[YOUR COMPANY NAME]
[YOUR COMPANY ADDRESS]
Please let me know if additional information is needed. I can be reached at [YOUR EMAIL] or [YOUR COMPANY NUMBER].
Thank you for your prompt attention to this matter.
Sincerely,
[YOUR NAME]
Director of Patient Advocacy
[YOUR COMPANY NAME]
Enclosures:
Medical Record Templates @ Template.net
