Description
When the first letter did not result in receipt of your requested medical records, use this letter template to make a second request. The letter reminds the recipient of their obligation to provide the records, with a deadline to provide them before taking legal action.
[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 [click to select a date] , 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 [click here to select a date] through [click 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 [click here to select a date] , 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,
[Your Name]
