Getting copies of your medical records should be straightforward. Yet many patients find this task challenging without the right approach. The proper letter can make all the difference in how quickly and completely healthcare providers respond to your request.
These sample letters will help you ask for your medical information with confidence. Each one addresses different situations you might face when seeking your health records. Read on to find the perfect template for your specific needs.
Sample Letters of Request for Medical Records
Here are fifteen professionally crafted letters you can adapt when requesting your medical records.
1. Basic Medical Records Request
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Doctor/Hospital Name]
[Doctor/Hospital Address]
[Doctor/Hospital City, State ZIP]
Subject: Request for Medical Records
Dear Dr. [Physician’s Last Name]/Medical Records Department:
This letter serves as my formal request for copies of my medical records from your facility. I was a patient under the care of Dr. [Physician’s Name] from [start date] to [end date].
Please provide the following records:
- Complete medical history
- Treatment notes
- Lab results
- Diagnostic test results
- Medication list
- Any other relevant records
These records are needed for [reason for request, such as “continuing care with a new provider” or “personal records”].
According to HIPAA regulations, I understand I have the right to access my medical information. Please provide these records within 30 days of receiving this request, as required by law.
Thank you for your prompt attention to this matter.
Sincerely,
[Your Signature]
[Your Printed Name]
2. Urgent Medical Records Request
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Doctor/Hospital Name]
[Doctor/Hospital Address]
[Doctor/Hospital City, State ZIP]
Subject: Urgent Request for Medical Records
Dear Medical Records Department:
I am writing to request my medical records on an urgent basis. Due to a scheduled specialist appointment on [date], I need these records as soon as possible.
As a patient who received care at your facility from [start date] to [end date], I am specifically requesting:
- Recent lab work (past 6 months)
- Imaging reports
- Specialist consultation notes
- Current medication list
My upcoming appointment with [doctor name/specialty] requires these records for proper continuity of care. Without them, my treatment may be delayed.
Please expedite this request and send the records to [specify delivery method – email, fax, mail, or pick-up]. My authorization form is attached.
Thank you for understanding the urgency of this situation.
With appreciation,
[Your Signature]
[Your Printed Name]
3. Request for Specific Test Results
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Laboratory/Medical Facility Name]
[Facility Address]
[Facility City, State ZIP]
Subject: Request for Specific Test Results
Dear Records Department:
This letter requests copies of specific test results from procedures performed at your facility. On [date], I underwent [name of test/procedure] ordered by Dr. [physician name].
I specifically need:
- Complete test results from [test name]
- Any related physician notes
- Radiologist/specialist interpretation
These results are needed by [date] for a follow-up appointment with [doctor name/specialty].
Please send these records via [preferred method] to the address/email listed above. I have attached a signed authorization form as required by your facility.
Thank you for your assistance with this targeted request.
Respectfully,
[Your Signature]
[Your Printed Name]
4. Pediatric Medical Records Request (By Parent/Guardian)
[Current Date]
[Your Name (Parent/Guardian)]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Doctor/Hospital Name]
[Doctor/Hospital Address]
[Doctor/Hospital City, State ZIP]
Subject: Request for Medical Records of Minor Child
Dear Medical Records Department:
As the parent and legal guardian of [Child’s Full Name], born on [Child’s Date of Birth], I am requesting copies of my child’s complete medical records.
My child received care at your facility from [start date] to [end date] under Dr. [Physician’s Name]. Please provide the following records:
- Immunization history
- Growth charts
- Well-visit notes
- Illness visits and treatments
- Allergy information
- Any specialist referrals or reports
These records are needed for [reason, such as “school registration” or “new pediatrician”].
I have included proof of my status as parent/legal guardian as required by HIPAA regulations for access to a minor’s medical records.
Please contact me with any questions about this request.
Thank you for your help,
[Your Signature]
[Your Printed Name]
[Relationship to Child]
5. Request to Transfer Records to New Provider
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Current Doctor/Hospital Name]
[Current Doctor/Hospital Address]
[Current Doctor/Hospital City, State ZIP]
Subject: Transfer of Medical Records to New Provider
Dear Dr. [Current Physician’s Last Name]/Medical Records Department:
As I am relocating to [new location], I need to transfer my medical records to my new healthcare provider. This letter authorizes the release of my complete medical records to:
[New Doctor’s Name]
[New Practice Name]
[New Practice Address]
[New Practice City, State ZIP]
[New Practice Phone Number]
[New Practice Fax Number]
Please include all records from [start date] to present, including:
- Medical history
- Diagnostic test results
- Treatment plans
- Medication history
- Recent lab work
- Imaging reports
I have scheduled my first appointment with my new provider for [date], so receiving these records before then would be greatly appreciated.
Thank you for your years of excellent care and your assistance with this transition.
Sincerely,
[Your Signature]
[Your Printed Name]
6. Request for Deceased Family Member’s Records
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Doctor/Hospital Name]
[Doctor/Hospital Address]
[Doctor/Hospital City, State ZIP]
Subject: Request for Deceased Family Member’s Medical Records
Dear Medical Records Department:
I am writing to request the medical records of my [relationship] [Deceased’s Full Name], who passed away on [date of death]. As the [executor of the estate/next of kin], I am legally authorized to access these records.
The deceased was a patient at your facility from [approximate dates] under the care of Dr. [Physician’s Name]. Please provide all available medical records, specifically:
- Medical history
- Hospital admission and discharge records
- Surgical reports
- Treatment notes
- Cause of death information (if applicable)
These records are needed for [estate settlement/insurance purposes/family medical history documentation].
I have enclosed the following required documentation:
- Death certificate
- Proof of my relationship to the deceased
- Letters testamentary/court appointment as executor (if applicable)
Please contact me if additional documentation is required to process this request.
With gratitude for your assistance,
[Your Signature]
[Your Printed Name]
[Relationship to Deceased]
7. Request for Correcting Errors in Medical Records
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Doctor/Hospital Name]
[Doctor/Hospital Address]
[Doctor/Hospital City, State ZIP]
Subject: Request to Amend Medical Record Information
Dear Dr. [Physician’s Last Name]/Medical Records Department:
After reviewing copies of my medical records received on [date], I have discovered information that needs correction. This letter serves as my formal request to amend these records under HIPAA regulations.
The following information appears to be incorrect:
- [Specify page/date/section] states [incorrect information]. The correct information is [correct information].
- [Additional errors as needed]
This correction is important because [explain why the correction matters to your care].
Supporting documentation for these corrections is attached, including [list any documents you’re including that support your claim].
Please add this letter to my medical record and make the requested amendments. Under HIPAA, I understand you must act on this request within 60 days.
Thank you for your attention to ensuring my medical records are accurate.
Respectfully,
[Your Signature]
[Your Printed Name]
8. Records Request for Insurance Claim Support
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Doctor/Hospital Name]
[Doctor/Hospital Address]
[Doctor/Hospital City, State ZIP]
Subject: Medical Records Request for Insurance Claim
Dear Medical Records Department:
I am requesting specific medical records to support an insurance claim currently under review. These records relate to treatment I received at your facility on [date(s)] for [condition/procedure].
Specifically, I need:
- Initial consultation notes
- Diagnostic codes (ICD-10)
- Procedure codes (CPT)
- Treatment plan documentation
- Medical necessity statements
- Any pre-authorization documentation
My insurance claim number is [claim number], and the insurance company has requested these documents by [deadline date].
Please send these records directly to:
[Insurance Company Name]
[Claims Department]
[Address]
[City, State ZIP]
[Fax Number if applicable]
[Reference/Claim Number]
A copy of my signed authorization for release of information is enclosed.
Thank you for your prompt assistance with this time-sensitive matter.
Sincerely,
[Your Signature]
[Your Printed Name]
[Insurance ID Number]
9. Mental Health Records Request
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Mental Health Provider/Facility Name]
[Provider Address]
[Provider City, State ZIP]
Subject: Request for Mental Health Treatment Records
Dear Dr. [Provider’s Last Name]/Records Department:
I am writing to request copies of my mental health treatment records. I received care at your facility from [start date] to [end date].
I understand that mental health records have additional privacy protections. With that understanding, I am specifically requesting:
- Treatment summary
- Medication history
- Progress notes
- Diagnosis information
- Treatment plan
These records are needed for [continuing care with a new provider/personal records/disability application].
Please note that this request specifically [does/does not] include psychotherapy notes, which I understand may require a separate authorization under HIPAA regulations.
I have attached the specialized authorization form required for mental health records. Please contact me if additional forms are needed.
Thank you for your professional handling of this sensitive request.
With appreciation,
[Your Signature]
[Your Printed Name]
10. Electronic Copy of Medical Records Request
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Doctor/Hospital Name]
[Doctor/Hospital Address]
[Doctor/Hospital City, State ZIP]
Subject: Request for Electronic Copy of Medical Records
Dear Medical Records Department:
This letter requests an electronic copy of my medical records as permitted under HIPAA regulations. As a patient who received care at your facility from [start date] to [end date], I prefer to receive my records in digital format.
Please provide my complete medical records in electronic form, including:
- Visit summaries
- Lab results
- Diagnostic imaging reports
- Medication lists
- Treatment plans
- Any other relevant medical information
According to HIPAA, I can request these records in the electronic format of my choosing if your system can readily produce it. My preferred format is [PDF/encrypted USB drive/secure email/access through patient portal].
Please send the electronic records to my email address listed above, or contact me to arrange secure electronic delivery.
Thank you for accommodating this request for digital records.
Regards,
[Your Signature]
[Your Printed Name]
11. Medical Records Request for Legal Proceedings
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Doctor/Hospital Name]
[Doctor/Hospital Address]
[Doctor/Hospital City, State ZIP]
Subject: Medical Records Request for Legal Proceedings
Dear Medical Records Custodian:
This letter serves as a formal request for certified copies of my complete medical records for use in pending legal proceedings. I received treatment at your facility from [start date] to [end date] under Dr. [Physician’s Name].
Please provide certified copies of:
- All medical records
- Test results
- Imaging studies
- Treatment notes
- Billing records
- Any correspondence related to my care
These records have been requested by my legal counsel for [type of legal matter – e.g., “personal injury litigation,” “disability hearing”].
Due to court deadlines, these records are needed by [date]. Please ensure all records are certified as official copies, complete, and unaltered.
The legal authorization and subpoena (if applicable) are attached. All applicable fees for copying and certification will be paid promptly.
Thank you for your professional assistance with this legal matter.
Respectfully,
[Your Signature]
[Your Printed Name]
12. Medical Records Request for Second Opinion
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Current Doctor/Hospital Name]
[Current Doctor/Hospital Address]
[Current Doctor/Hospital City, State ZIP]
Subject: Medical Records Request for Second Opinion Consultation
Dear Dr. [Current Physician’s Last Name]/Medical Records Department:
I am writing to request copies of my recent medical records for the purpose of obtaining a second opinion regarding my diagnosis of [condition] and treatment options.
I have scheduled a consultation with Dr. [Second Opinion Physician] on [date], and need the following records for this appointment:
- Initial diagnosis documentation
- Test results confirming diagnosis
- Current treatment plan
- Recent lab work and imaging (past 3 months)
- Consultation notes from specialists
- Medication history related to this condition
Please note that seeking a second opinion is standard medical practice and does not reflect dissatisfaction with the care I’ve received. This consultation will help me make fully informed decisions about my health.
I authorize you to send these records directly to:
[Second Opinion Doctor’s Name]
[Practice Name]
[Address]
[City, State ZIP]
[Fax Number]
Thank you for supporting my health decision-making process.
Sincerely,
[Your Signature]
[Your Printed Name]
13. Request for Records Spanning Multiple Departments
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Hospital/Medical Center Name]
[Hospital Address]
[Hospital City, State ZIP]
Subject: Comprehensive Records Request Across Multiple Departments
Dear Medical Records Department:
I am requesting my complete medical records from multiple departments within your medical center. As a patient who has received various types of care at your facility, I need records from several specialty areas.
Please provide records from the following departments for the dates specified:
- Primary Care (Dr. [Name]): [date range]
- Cardiology (Dr. [Name]): [date range]
- Physical Therapy Department: [date range]
- Radiology Department: [date range]
- Laboratory Services: [date range]
For each department, please include:
- Visit notes
- Test results
- Treatment plans
- Specialist recommendations
- Follow-up instructions
I understand this request spans multiple departments and may take additional time to compile. My authorization form covers all departments within your medical system.
These records are needed by [date] for [reason for request].
Thank you for coordinating this comprehensive records collection.
With appreciation,
[Your Signature]
[Your Printed Name]
14. Request for Records for Disability Application
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[Doctor/Hospital Name]
[Doctor/Hospital Address]
[Doctor/Hospital City, State ZIP]
Subject: Medical Records Request for Disability Benefits Application
Dear Medical Records Department:
I am applying for disability benefits and need specific medical records to support my application. This request is time-sensitive as my application deadline is approaching.
As a patient under the care of Dr. [Physician’s Name] for my [condition] since [date of diagnosis], I need comprehensive documentation of my medical condition, including:
- Official diagnosis documentation
- Treatment history
- Functional capacity assessments
- Work restriction notes
- Specialist consultations
- Evidence of ongoing treatment
- Medication lists with side effects noted
- Recent test results showing current status
The disability determination service requires detailed medical evidence demonstrating how my condition limits my ability to work. Any physician statements regarding my limitations would be particularly helpful.
Please send these records directly to:
[Disability Determination Services]
[Address]
[City, State ZIP]
[Case Number if available]
A signed authorization form is attached. Thank you for your help with this important matter.
Sincerely,
[Your Signature]
[Your Printed Name]
[Social Security Number if needed for records identification]
15. Request for Records After Facility Closure
[Current Date]
[Your Name]
[Your Address]
[Your City, State ZIP]
[Your Phone Number]
[Your Email]
[State Medical Board/Records Custodian]
[Address]
[City, State ZIP]
Subject: Request for Medical Records from Closed Facility
Dear Records Custodian:
I am trying to obtain my medical records from [Name of Closed Facility], which permanently closed on [approximate date of closure]. As a former patient who received care there from [start date] to [end date], I need access to my medical history.
My research indicates that closed medical practices must transfer patient records to a custodian or notify patients where their records are stored. I have been unable to locate my records through my own efforts.
Please advise me on:
- The current location of records from this closed facility
- The process for requesting my records from the custodian
- Any time limitations for record retention I should be aware of
- Contact information for the custodian of these records
These records are particularly important because [explain specific need, such as “ongoing treatment for a chronic condition” or “family medical history documentation”].
Any guidance you can provide on locating these records would be greatly appreciated.
Thank you for your assistance with this challenging situation.
Respectfully,
[Your Signature]
[Your Printed Name]
[Date of Birth – for identification purposes]
Conclusion
Requesting your medical records should be straightforward when you use the right approach. These sample letters provide frameworks you can customize for your specific situation. Always keep copies of your request letters and follow up if you don’t receive a response within 30 days.
Your medical records belong to you, and healthcare providers are legally obligated to provide them within a reasonable timeframe. By clearly stating what you need and why, you increase the chances of a prompt and complete response to your request.
Don’t hesitate to advocate for your right to access your health information. A well-written request letter is your first step toward taking control of your medical care.