Sample Letter Requesting A Copy Of Your Medical Records
TO BE TYPED OR WRITTEN LEGIBLY ON YOUR STATIONARY OR A PLAIN PIECE OF PAPER
Dr. Michael Perez
331 W. 43rd St.
New York, NY 10029
Attn: Beth Wright, Medical Records Department
Re: Medical records request
Dear Ms Wright,
Per our telephone conversation, I am requesting a copy of my medical records. I am specifically requesting all doctor's notes, lab tests and x-ray reports from December 1998 to the present.
I will be moving in six weeks and wish to supply my new physician with my medical information. (This sentence is optional, as you do not have to provide a reason for your request. You may be requesting the records for many reasons, ranging from acquiring a second opinion to insurance purposes). Please mail the records as soon as possible to.
Dr. Norma Jean Wilson
861 Strathmore Avenue.
Baltimore, MD 21215
Please send me a copy of your cover note for my file.
Thank you for your assistance.
Signature (include full name, no notarization required)