Second letter requesting medical records

Description

When the first letter did not result in receipt of your requested medical records, use this letter template to make a second request. The letter reminds the recipient of their obligation to provide the records, with a deadline to provide them before taking legal action.

[Your Name]
[Street Address]
[City, ST  ZIP Code]
[Date]

[Doctor Name]
[Medical Practice or Hospital Name]
[Street Address]
[City, ST  ZIP Code]

Re: Second request for release of medical records for [Your Name], DOB: [date of birth], SSN: [Social Security Number]

Dear [Doctor Name]:

On [click to select a date], I sent you a written request asking for copies of my medical records related to treatment for [medical condition(s)] rendered by you or under your supervision from [click here to select a date] through [click here to select a date]. Since then, [number]days have passed and I have not yet received these records.
I am hereby making a second request that you send me these records immediately. I remind you that under the laws of this state, Statute #[number], you are legally obligated to provide copies of my medical records upon my request.
If I have not received the records by [click here to select a date], I will have no choice but to retain an attorney to obtain my medical records for me. By law, you will then be liable for the attorney fees that I incur. I trust that this step will not be necessary.
Please mail the information to:
[Recipient Name]
[Street Address]
[City, ST  ZIP Code]
As noted in my first request, I will be glad to pay for costs associated with providing me copies of my records.
Sincerely,
[Your Name]

Share on Facebook
Share on Twitter
Share on Google+

Related : Second letter requesting medical records

  • Letter requesting no release of medical recordsDescriptionThis letter template requests your healthcare provider not release any of your medical records to any person or organization. This privacy request is accompan ...
  • Application letter for seeking membership in societyFrom,Mr Patterson,B-12, Winston Arcade,Waterloo Archway,LondonTo,Mr Jonathan,Winston arcade society secretary,Winston Arcade,Waterloo Archway,LondonDear Mr Jonathan,I, M ...
  • Apology letter for late payment[Date][Recipient Name][Title][Company Name][Street Address][City, ST ZIP Code]Dear [Recipient Name]:Due to an oversight on our part, this month’s payment, in the am ...
  • Welcome letter for new business associateSubject: Welcoming to become part of our Retailer ChainDear Ricky,We welcome you as our new retailer for our line of Sports Merchandise. We are happy that you agreed to ...
  • letter to insurance company requesting coverageHealth insurance letter is written by person who has taken an insurance policy from any of the insurance company. By writing health insurance appeal letter the person ca ...
  • How to Write a College Acceptance LetterWhile in some cases acceptance letters are to be written as a form of courtesy to inform somebody of your acceptance but on other hand form some instances it i ...
  • Break up letter to husband with divorce paperJune 2, 2012Name/Title Mary RoeAddress 795 E DragramCity, State, Zip Code Tucson, AZ, 85705Dear Brad,I hope you know why I am writing this  ...
  • Love letter with birthday wishesDear Ethan,Wish you a very Happy Birthday!!!This birthday I would like to tell you my feeling for you, Ethan I love you and want ...
  • Letter with salary requirementsDescriptionSend this letter template to potential employers in response to a request for salary requirements. The letter details your salary requirements and requests an ...
  • Invitation letter for launching new magazineLincoln P. Miller3012 Little Acres Lane Mattoon, IL 61938Date: 03 September 2010Subject: Business event invitation letterDear Sir,It is indeed a great pleasure to i ...