Medical records request letter
Ask a provider for a copy of your health records in writing. Say which records, the dates and how you want to receive them; the letter is laid out so the records office can act on it without calling you back. Many offices take these requests by fax.
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How to use this template
- Step 1
Enter your name, date of birth and contact details. If you are asking for someone else, choose who is asking and add the patient's name.
- Step 2
Add the provider's name and, if you have it, the records office's fax number.
- Step 3
Choose which records you need, the format and where to send them.
- Step 4
Download the PDF, sign it (print it, or use the free Fill & Sign tool), and fax it with a copy of your ID.
Tips
- Ask whether they have their own form
- Many providers have an authorization or request form. A letter is usually accepted, but if they send you their form, fill it in and fax it back; it is quicker than arguing about the format.
- Be specific when you can
- "Lab results from January to June 2025" is processed faster than "everything", and copy fees, where they apply, are often lower for a smaller request.
- Keep the confirmation
- Save the fax confirmation and note the date you sent it. If nothing arrives, call and give them the date.
Questions
How long does a provider have to send my records?
Under HIPAA, covered providers in the US generally have to act on a patient's request within 30 days, with one 30-day extension if they tell you why in writing. Some states set shorter deadlines. Check HHS's guidance on the right of access or your state's rules for the details that apply to you.
Can they charge me for copies?
Providers may charge a reasonable, cost-based fee for copies under HIPAA, and state rules can limit it further. Asking for an electronic copy is often the cheapest option. The letter asks them to tell you about any fee first.
Do I need to sign the letter?
Yes, sign it. Most records offices want a signature and a copy of photo ID before they release anything. You can print, sign and scan it, or add your signature with the free Fill & Sign PDF tool.
Can I request records for a family member?
You can if you are their parent or guardian (for a minor) or their personal representative, for example under a health care power of attorney or as an executor. Choose that option and enclose the document that shows it. Otherwise, the patient has to sign an authorization.
Other fax templates
- Authorization letterLet someone act for you on one task, like picking up documents.
- Cancellation letterCancel a subscription, membership or service in writing.
- Change of address letterTell a bank, insurer or office your new address.
- General business letterA plain, correctly laid out letter for anything else.