Health Records Request Letter
November 27, 2090
To: Ms. Sarah Lim
Medical Records Department
Springfield General Hospital
456 Health Way
Springfield, IL 62701
Dear Ms. Lim,
I am writing to formally request a copy of my health records under the Health Insurance Portability and Accountability Act (HIPAA). I would like to receive the following documents:
Complete medical history and treatment records
Lab results and imaging reports from January 1, 2090, to December 31, 2090
Consultation notes and discharge summaries from all visits during that period
For verification purposes, my details are as follows:
Please send the requested records to the address listed above. Alternatively, if electronic delivery is available, you may email them to my email address at [Your Email].
If there are any fees associated with processing this request, kindly inform me beforehand. I would appreciate it if you could confirm receipt of this letter and provide an estimated timeline for when I can expect to receive the requested documents.
Thank you for your attention to this matter. I look forward to your prompt response.
Sincerely,
[Your Name]
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