Medical Records Request Letter

The Medical Records Request Letter is a formal communication sent by a patient or their authorized representative to request the patient's medical records from their healthcare provider, clinic, hospital, or other medical facility. The purpose is to request access to and copies of the individual's medical records.

The patient here is a person who has received medical treatment, diagnosis, or undergone any medical procedure. Sometimes, the patient might require their medical record for several reasons, including insurance claims, to continue medical care with a different healthcare provider, for legal or personal reasons, or other reasons.

Note: This document is used both to request and authorize the healthcare provider to release the patient's medical records or information.

A patient's medical records is a sensitive personal information that can only be released to the patient or the patient's authorized representative. Hence, while patients can directly seek their medical records from their healthcare providers, that may not be the case at all times. Sometimes, the patient can authorize another person to collect their medical records on their behalf due to some reason. In this case, the representative must obtain written authorization from the patient.

How to use this document

In this document, there are two parts. The first part is a letter from the patient to the healthcare provider asking them to release the medical records. This part has important details like the patient's contact info, why the patient is making the request, and any other names the records might be under.

The second part is a form called "Authorization of Medical Records Release." The Authorization of Medical Records Release form will only be used when a patient's authorized representative is requesting the patient's records. This is because it grants the patient's representative the approval to release the patient's medical records to the patient's representative. This form is often used to ensure that the patient's health information is only shared with the consent of the patient. It contains information such as the patient's details, the recipient's name and contact, and permission for releasing sensitive health info, like diagnosis or mental health treatment.

Due to privacy concerns, healthcare providers often have strict rules about sharing medical records. They might have their form for patients to use. However, the form in this document is a general one that should work in many situations.

After filling out this document, the patient should sign both the letter and the Authorization form. There are two places to sign on the Authorization form: one for releasing specific sensitive records and another for the entire form.

As noted above, either the patient or the patient's representative can send the document. After signing this letter, a signed copy of the document should be sent to the patient's healthcare provider. The patient or their representative should keep a copy for their personal records.

Applicable laws

In general, the right to access medical records is often governed by privacy and data protection laws, such as the Nigerian Data Protection Regulation (NDPR) of 2019. In addition, the National Health Act of 2014 makes provisions for access and protection of health information.

How to modify the template

You fill out a form. The document is created before your eyes as you respond to the questions.

At the end, you receive it in Word and PDF formats. You can modify it and reuse it.