Free Request Letter to Transfer Medical Record

October 19, 2055

Medical Records Department
Springfield Medical Center
456 Health St.
Springfield, IL 62701

Dear Medical Records Department,

I hope this message finds you well. I am writing to formally request the transfer of my medical records from Springfield Medical Center to Riverdale Health Clinic. This transfer is necessary as I am in the process of transitioning my medical care to a new healthcare provider.

For your reference, my full name is [Your Name], and my date of birth is January 1, 2050. The specific records I need transferred include, but are not limited to, consultation notes, imaging results, laboratory reports, and any other pertinent medical documentation related to my care at your facility.

Please send the records to the following address:

Riverdale Health Clinic
123 Wellness Way
Riverdale, NY 10471

Should there be any fees associated with this request, please inform me in advance. I am willing to comply with any necessary authentication procedures to facilitate this transfer, ensuring the security and confidentiality of my medical information.

I appreciate your prompt attention to this matter as it is crucial to ensure continuity of care. If you have any questions or require additional information, please feel free to contact me at [Your Email].

Thank you for your cooperation.

Warm regards,

[Your Name]

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