44+ Sample Letter Request Medical Records Pics. Everyone has the right to request access to their own medical history. I understand i may be charged a fee that is reasonable for the copying of my medical records, however, i will not be charged for any time that is spent locating my records.
Below is a sample letter requesting medical records that you can download as a pdf template and fill out a copy of the letter for requesting medical records from your doctor.
This pdf template will tell you how to request medical records in writing, and also works as a generic medical records. Referrals).] if my request cannot be honored within thirty days, please inform me of this by letter and provide the date by which i might expect to receive my records. Tom peterson has undergone all the medical tests and is found to be fit both physically and mentally. If the office doesn't have a form, you can write a letter to make your request.