Download Second Letter Requesting Medical Records for Free

Comparing with other kinds of templates, the Second Letter Requesting Medical Records is a relatively casual and simple one, but it contains the core points of a request which can express the idea clearly. You can download this file and fill the specific content in the corresponding position according to your real conditions. This template is free for your reference. If you are interested in this template, you can visit our website to get it.

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[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 ], 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
through 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 , 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,
Second Letter Requesting Medical Records
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