Sample letter medical records 2025

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I received treatment at [facility name] from [start date] to [end date]. I request copies of all health records related to my treatment. I understand you may charge a reasonable fee for copying these records, but will not charge for the time spent locating the records.
I, the undersigned, authorize the release of, or request access to the information specified below from the medical record(s) of the above name patient. I understand that my records are confidential and cannot be disclosed without my written authorization, except when otherwise permitted by law.
5 Steps to Prepare a Release Letter Step 1: Format Your Letter. Set up the format of the letter in the standard business format. Step 2: Information About the Release. Step 3: Maintaining the Tone. Step 4: Make it Short and Crisp. Step 5: Logo of the Company and the Name.
Long passages of text tend not be read. Stick to short sentences and try to make paragraphs about one topic only. Diagnosis summaries and current situation headings are often very helpful but only if they are revised following a consultation. They should not be copied directly from a previous letter.
They should include: 1) All relevant clinical findings. 2) A record of the decisions made and actions agreed as well as the identity of who made the decisions and agreed the actions. 3) A record of the information given to patients. 4) A record of any drugs prescribed or other investigations or treatments performed.
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Dear: [Contact Name/Medical Director], I am writing on behalf of my patient, [Patient First and Last Name] to document the medical necessity for treatment with [DRUG NAME]. This letter provides information about the patients medical history, diagnosis and a summary of the treatment plan.
Releasing Your Medical Records Format your letter. You can set up your letter like a standard business letter. Draft the authorization. State the time period for disclosures. Identify what information to release. Identify how long your authorization is effective. Include other general provisions. Sign the release.

medical record request letter