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Sample Letter Of Request

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    Looking for sample letter of request? You can write to ask for information from a company or an individual in letter of request.

    People may write in to hospital or clinic to request for their copies of medical record and such action was backed by Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations.

    Anyway, you should introduce yourself first in letter of request and state the purpose of your letter in the first paragraph with direct and polite tone.

    Keep the letter of request brief and straight to the point with a specific objective. Avoid abbreviations or jargon when writing letter of request if possible.

    At last, do a proofread and eliminate grammar and spelling errors in letter of request.

    Letter Of Request Example

    (Sender Name)
    (Sender Title/Position)
    (Sender Organization Name)
    (Sender Street Address)
    (City, State, Zip Code)

    (Date)

    (Recipient Name)
    (Recipient Title/Position)
    (Recipient Organization Name)
    (Recipient Street Address)
    (City, State, Zip Code)

    RE: (Medical Identification Number)

    To Whom It May Concern:

    The purpose of this letter is to request copies of my medical records as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations.

    I was treated in your office between (date from) to (date to). I would like to request copies of the all the health records related to my treatment.

    Appreciate if you can mail the request to my billing address as registered under my Medical Identification Number.

    Please contact me at xxx-xxxx-xxxx-xx if you need any further clarification for my request. Thanks in advance.

    Sincerely,

    _______________
    (Name)

    Download Sample Medical Request Letter here.

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