Letter Requesting Medical Records

[Your Name]

[Your Address]

[City, State, Zip Code]

[Email Address]

[Phone Number]

[Today's Date]

[Name of Medical Records Department]

[Name of Hospital/Clinic]

[Address]

[City, State, Zip Code]

Subject: Request for Medical Records

Dear [Medical Records Department],

I hope this letter finds you well. I am writing to request a copy of my medical records from [Hospital/Clinic Name]. I was a patient at your facility from [Date of Admission] to [Date of Discharge/Last Visit].

To expedite the process, I have provided the relevant details below:

Patient Information:

- Full Name: [Your Full Name]

- Date of Birth: [Your Date of Birth]

- Address at the time of treatment: [Your Address at the Time of Treatment]

- Patient ID/Account Number (if available): [Patient ID/Account Number]

Treatment Details:

- Date of Admission: [Date of Admission]

- Date of Discharge/Last Visit: [Date of Discharge/Last Visit]

- Name of Attending Physician: [Name of Attending Physician, if known]

- Reason for Hospitalization/Visit: [Brief description of the reason for hospitalization/visit]

Please let me know the necessary steps to fulfill this request, including any fees associated with obtaining the medical records. If possible, I would prefer to receive the records in an electronic format via secure email or on a password-protected CD.

I understand that there may be certain processing time involved, but I kindly request that the records be provided to me at your earliest convenience. Should you require any additional information or documentation to complete this request, please do not hesitate to contact me.

Thank you for your prompt attention to this matter. I value the importance of having access to my medical history for personal and health-related reasons. Your cooperation is greatly appreciated.

If you have any questions, please feel free to reach out to me via email at [Your Email Address] or by phone at [Your Phone Number].

Sincerely,

[Your Full Name]

[Your Signature if sending a physical letter]