Requesting Copies of Tests

 

Your letterhead

Your address, City ST Zip
your phone, fax

Doctor's Address

Date

Dear Dr. _______________,

Please send me a copy of the test results for all the tests done DATE, PLACE

Please send another copy to this doctor (if you agree to release your results to Dr. Siguel; otherwise, place the appropriate doctor(s) here).

            Edward Siguel
            PO Box 10187 Dept E
            Gaithersburg, MD 20898

Thank you. Sincerely,

Your Signature
Your address,
Phone, Fax

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Notes.

In some cases you may want results faxed. Usually it is better to get a mailed copy because the numbers are easier to read.

Requesting Copies of Medical Records

 

Your letterhead

Your address, City ST Zip
your phone, fax

Medical Records Department
MEDICAL CENTER
Address

Date

To Whom It May Concern;

Please provide me with a complete copy of the following medical records. Notice that I do not need a copy of every single page in my medical records, but only selected pages as indicated below:

  1. Test results such as blood tests. A complete copy of all test results.
  2. X-rays and similar diagnostic tests. Only the interpretation and summary report written by the appropriate physician. I do not need copies of the X-rays.
  3. Surgical procedures. I only need a copy of the summary of the surgical procedure. I do not need detailed records of the operation such as anesthesia, blood pressure, medications.
  4. Copies of the admission and discharge summary reports.
  5. Copies of the initial medical interview and letters from consultants.
  6. Copies of other summary reports written about my condition, such as copies of Cath. reports, PET scans, CAT scans, pathology reports and related material. Again, I need only the summary or interpretation report usually written in these cases by an appropriate physician.

Please submit a copy of my records and an appropriate bill to my address above as soon as possible.

Sincerely yours,
Your Signature

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© 1998 Edward Siguel. All rights reserved

modified 10/1/98