Medical Records Request Letter (HIPAA-Compliant)

This HIPAA-Compliant Medical Records Request Letter allows patients or authorized representatives to formally request copies of medical records from healthcare providers, hospitals, or clinics. Designed in clear, professional language, it references 45 CFR § 164.524 and helps ensure compliance with federal law.

Key features include:

• Fields for patient info, date of birth, and contact details

• Customizable section to specify records and date ranges requested

• Delivery method preferences (email, mail, or pickup)

• Fee disclosure request and 30-day compliance reminder

• Editable Microsoft Word format for immediate use

Ideal for patients managing their care, switching providers, or preparing for legal matters. A critical form for asserting your right to health record access.