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Second Letter Requesting Medical Records


Second Letter Requesting Medical Records
[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]
Second Letter Requesting Medical Records