Updated: September 8, 2026 | Published: September 8, 2026
By Andre BradleyMedical Records Request Letter: 3 Free Templates You Can Copy
When you need copies of your medical records, a clear written request can help you get the correct documents without unnecessary delays. You may need your records because you are changing doctors, getting a second opinion, reviewing your treatment history, handling an insurance issue, preparing for a legal matter, or simply keeping your own healthcare files organized.
In many situations, you have a right under HIPAA to inspect and receive copies of health information maintained by healthcare providers and health plans covered by the HIPAA Privacy Rule. You generally do not have to explain why you want your own records.
Before you send your request, determine whether you are asking for records for yourself or authorizing the provider to send them to somebody else. If another person, attorney, physician, insurance company, or organization will receive the information, you may also need a Medical Release Letter or the healthcare provider’s authorization form.
Below, you will find three copy-ready medical records request letter templates, the information you should include, mistakes that can delay your request, and answers to the most common questions about obtaining your records.
Medical Records Request Decision Quiz
1. Who should receive the medical records?
2. How much of your medical record do you actually need?
3. Do you know the dates of treatment?
4. How would you prefer to receive the records?
5. Does the provider have its own medical records request form?
6. Are you requesting records because of a legal, insurance, or billing matter?
7. Have you checked all delivery and identifying information?
Your Next Step
Review your seven answers and choose the medical records request template below that most closely matches your situation. Before sending it, replace every placeholder with your information and follow the healthcare provider's records-request procedure.Quick Answer: How Do You Write a Medical Records Request Letter?
To write a medical records request letter, you should:
- Identify yourself clearly.
- Include your date of birth and other identifying information requested by the provider.
- State exactly which records you want.
- Include the dates of treatment when possible.
- Specify whether you want paper or electronic copies.
- State where the records should be sent.
- Sign and date your request if required.
- Keep a copy of everything you send.
- Follow the provider’s medical-records request procedure when one is available.
You can request your entire record or limit your request to specific documents, such as laboratory results, physician notes, imaging reports, discharge summaries, medication records, operative reports, billing records, or records covering a particular period.
Choose Your Medical Records Template Fast
Template: Request Copies of Your Own Medical Records
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Medical Records Department
[Hospital, Clinic, or Provider Name]
[Address]
[City, State, ZIP Code]
Subject: Request for Copy of Medical Records
Dear Medical Records Representative,
I am writing to request copies of my medical records maintained by your facility.
My full name is [Your Full Name], and my date of birth is [Date of Birth]. My patient or medical record number is [Number, if known].
Please provide [describe the records you want] covering the period from [Beginning Date] through [Ending Date].
I would prefer to receive the records by [secure electronic delivery, patient portal, mail, or another available method].
Please send the records to [delivery information].
If there is an allowable fee, please notify me before processing the request if the total charge will exceed [Amount].
If you require additional identification or documentation, please contact me at [Phone Number] or [Email Address].
Thank you for your assistance.
Sincerely,
[Your Signature]
[Your Printed Name]
Template: Send Your Records to a New Doctor
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Medical Records Department
[Current Provider Name]
[Address]
[City, State, ZIP Code]
Subject: Request to Transfer Medical Records
Dear Medical Records Representative,
I am requesting that copies of my medical records be provided for continuity of care.
My full name is [Your Full Name], my date of birth is [Date of Birth], and my medical record number is [Number, if known].
Please provide my relevant medical records covering [Beginning Date] through [Ending Date], including physician notes, laboratory results, imaging reports, medication history, treatment plans, discharge summaries, and other relevant treatment records.
Please send the records to:
[New Doctor's Name]
[Medical Practice Name]
[Address]
[City, State, ZIP Code]
[Secure Fax or Approved Delivery Information]
If you require an additional authorization or release form, please contact me at [Phone Number] or [Email Address].
Thank you for your assistance with my transition of care.
Sincerely,
[Your Signature]
[Your Printed Name]
Template: Legal or Insurance Medical Records Request
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Medical Records Department
[Hospital, Clinic, or Provider Name]
[Address]
[City, State, ZIP Code]
Subject: Formal Request for Medical Records
Dear Medical Records Representative,
I am requesting copies of medical records relating to my treatment at your facility.
My full name is [Your Full Name], my date of birth is [Date of Birth], and my medical record number is [Number, if known].
Please provide [describe the records] for treatment received between [Beginning Date] and [Ending Date].
Please include relevant physician notes, diagnostic test results, laboratory reports, imaging reports, treatment records, medication records, discharge summaries, and billing records as applicable.
Please provide the records by [Preferred Delivery Method] and send them to [Your Name or Authorized Recipient and Delivery Information].
If additional authorization is necessary before releasing the records to the designated recipient, please contact me promptly.
Thank you for your assistance.
Sincerely,
[Your Signature]
[Your Printed Name]
Template: Request Specific Medical Records Only
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Medical Records Department
[Provider Name]
[Address]
Subject: Request for Specific Medical Records
Dear Medical Records Representative,
I am requesting copies of specific records from my treatment at your facility.
My name is [Your Full Name], and my date of birth is [Date of Birth]. My medical record number is [Number, if known].
Please provide the following records:
[List the exact documents you need.]
The applicable treatment dates are [Beginning Date] through [Ending Date].
Please provide the records by [Preferred Delivery Method] and send them to [Delivery Information].
Please contact me at [Phone Number] or [Email Address] if additional information is needed.
Thank you for your assistance.
Sincerely,
[Your Signature]
[Your Printed Name]
Why You May Need a Medical Records Request Letter
You may need copies of your records for many different reasons.
For example, you may be:
- Changing doctors
- Seeking a second medical opinion
- Moving to another state
- Reviewing your treatment history
- Applying for disability or insurance benefits
- Preparing for a legal claim
- Reviewing a medical bill
- Coordinating care between specialists
- Checking your records for errors
- Creating a personal health file
- Helping an authorized family member manage medical care
If you discover billing problems while reviewing your records, you may also find this Medical Billing Dispute Letter useful.
The more precisely you identify the records you need, the easier it may be for the provider’s medical-records department to process your request.
What Medical Records Can You Request?
Depending on what your provider maintains, you may request records such as:
- Office visit notes
- Physician notes
- Hospital records
- Laboratory results
- X-ray reports
- MRI and CT scan reports
- Medical images
- Operative reports
- Discharge summaries
- Medication lists
- Immunization records
- Treatment plans
- Pathology reports
- Specialist consultations
- Billing records
- Insurance-related records
HIPAA generally gives you access to protected health information about you contained in a provider’s or health plan’s designated record set, subject to limited exceptions. For example, psychotherapy notes maintained separately from the regular medical record generally are treated differently under the HIPAA access rules.
If you are not sure what documents exist, you can request your complete medical record for a specified period instead of trying to list every individual document.
Medical Records Request vs. Medical Release Letter
These two documents are related, but they are not always the same thing.
A medical records request tells a healthcare provider that you want access to your information.
A medical release or authorization generally gives permission for medical information to be disclosed to another person or organization.
For example:
If you want the records mailed directly to you, you are primarily requesting access to your records.
If you want your hospital to send your records directly to a new physician, attorney, family member, or another organization, additional authorization requirements may apply.
Under the HIPAA right of access, you can direct a covered entity to send your information to another person or entity. The request must meet applicable requirements, including clearly identifying the recipient and where the information should be sent.
Your provider may have its own medical-records request or authorization form. Using that form can sometimes make processing easier, although HIPAA does not allow unreasonable procedures to become barriers to your access.
What to Include in Your Medical Records Request Letter
Your request should make it easy for the records department to identify you and determine exactly what you want.
1. Your Full Name
Use the same name that appears in the healthcare provider’s records.
If your name has changed, you can include your previous name as well.
2. Your Date of Birth
Your date of birth helps distinguish your record from another patient’s record.
3. Your Contact Information
Include your:
- Address
- Telephone number
- Email address
4. Your Patient or Medical Record Number
Include your patient number or medical record number if you know it.
Do not delay your request simply because you do not know the number.
5. The Records You Want
Be specific.
Instead of writing:
“Please send my medical records.”
You could write:
“Please provide copies of my office notes, laboratory results, imaging reports, medication history, and discharge summaries covering January 1, 2024 through August 31, 2026.”
6. Your Preferred Format
State whether you want:
- Paper copies
- Electronic copies
- Records through a patient portal
- Another available electronic format
HHS guidance states that patients can generally request copies in the form and format requested when the information is readily producible that way.
7. Delivery Instructions
Clearly identify where the records should go.
For example:
“Please send the records to my mailing address listed above.”
Or:
“Please provide the records electronically through your secure patient portal.”
If you are requesting disclosure directly to another person, make sure you satisfy the provider’s authorization or HIPAA access requirements.
8. Your Signature and Date
Sign and date your request when required.
A provider may require a written request and may take reasonable steps to verify your identity.
Template 1: General Medical Records Request Letter
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Medical Records Department
[Hospital, Clinic, or Provider Name]
[Address]
[City, State, ZIP Code]
Subject: Request for Copy of Medical Records
Dear Medical Records Representative,
I am writing to request copies of my medical records maintained by your facility.
My identifying information is as follows:
Patient Name: [Your Full Name]
Date of Birth: [Your Date of Birth]
Patient or Medical Record Number: [Number, if known]
Please provide the following records:
[Describe the records you are requesting, such as complete medical records, physician notes, laboratory results, imaging reports, medication records, treatment summaries, or billing records.]
Dates of Treatment: [Beginning Date] through [Ending Date]
I would prefer to receive these records by [secure electronic delivery/patient portal/mail/other available method].
Please send the records to:
[Your Mailing Address, Email Address, Portal Account, or Other Delivery Information]
If there is an allowable fee associated with providing these copies, please notify me before processing the request if the charge will exceed [Amount, if desired].
If you require additional information or a facility-specific form, please contact me at [Phone Number] or [Email Address].
Thank you for your assistance.
Sincerely,
[Your Signature]
[Your Printed Name]
Template 2: Medical Records Request for a New Doctor or Continuity of Care
If you are transferring care, you may need both a records request and a Medical Release Letter depending on how your provider handles the transfer.
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Medical Records Department
[Current Provider or Hospital Name]
[Address]
[City, State, ZIP Code]
Subject: Request for Medical Records for Continuity of Care
Dear Medical Records Representative,
I am requesting copies of my medical records so that my healthcare information can be available for my continuing medical care.
My information is:
Patient Name: [Your Full Name]
Date of Birth: [Your Date of Birth]
Medical Record Number: [Number, if known]
Please provide records covering the period from [Beginning Date] through [Ending Date], including, where available:
- Physician notes
- Laboratory results
- Imaging reports
- Medication history
- Treatment plans
- Operative reports
- Discharge summaries
- Specialist reports
- Other relevant treatment records
Please send the requested information to:
[New Physician’s Name]
[Medical Practice Name]
[Address]
[City, State, ZIP Code]
[Secure Fax or Other Approved Delivery Information]
I authorize the records to be sent as directed above to the extent permitted by the applicable request and authorization requirements.
If you require your facility’s authorization form or additional verification, please contact me at [Phone Number] or [Email Address].
Thank you for helping make my transition of care as smooth as possible.
Sincerely,
[Your Signature]
[Your Printed Name]
Template 3: Medical Records Request for Legal, Insurance, or Documentation Purposes
If you need records for a legal dispute, insurance matter, accident claim, disability application, or another documentation purpose, request only the records that are relevant unless your circumstances require your complete file.
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Medical Records Department
[Hospital, Clinic, or Provider Name]
[Address]
[City, State, ZIP Code]
Subject: Formal Request for Medical Records
Dear Medical Records Representative,
I am writing to request copies of medical records relating to my treatment at your facility.
My identifying information is:
Patient Name: [Your Full Name]
Date of Birth: [Your Date of Birth]
Patient or Medical Record Number: [Number, if known]
Please provide the following records:
[Clearly identify the records.]
Treatment Dates: [Beginning Date] through [Ending Date]
Please include any relevant:
- Physician and specialist notes
- Diagnostic test results
- Laboratory reports
- Imaging reports
- Operative reports
- Treatment records
- Medication records
- Discharge summaries
- Billing records
Please provide these records by [Preferred Delivery Method].
Please send them to:
[Your Name or Authorized Recipient]
[Address or Other Delivery Information]
If additional authorization is necessary before the records can be released to the designated recipient, please contact me promptly so that I can complete the appropriate documentation.
Thank you for your attention to this request.
Sincerely,
[Your Signature]
[Your Printed Name]
How Long Should You Wait for Your Medical Records?
You should not assume every medical-records request will take several weeks.
Many providers can make records available through a patient portal or electronic health record system much sooner.
Under the HIPAA Privacy Rule, a covered entity generally must act on a qualifying access request no later than 30 calendar days after receiving it. If it cannot complete the request within that period, it may receive one additional 30-day extension, but it must provide you written notice during the original period explaining the delay and stating when it expects to complete the request.
Because 30 days is an outer limit rather than a recommended waiting period, you can politely follow up sooner when you expected electronic records or when the provider gave you a shorter estimated processing time.
Can You Be Charged for Medical Records?
You may be charged certain reasonable, cost-based fees for copies of your medical records.
Under HIPAA, allowable charges can include certain copying labor, supplies, and postage when applicable. Providers generally cannot use search-and-retrieval costs as part of the HIPAA access fee.
The amount can also be affected by how your request is structured, the format requested, and applicable state laws.
Before agreeing to a large charge, you can ask:
“Please provide an estimate of any fee associated with this request before the records are copied.”
You may also save time and money by requesting electronic records when appropriate.
What You Should Do Before Sending Your Request
Take a few minutes to verify the following.
Check the Provider’s Website
Many hospitals and medical practices publish instructions for requesting records.
You may find:
- A downloadable request form
- An online request portal
- A medical records department telephone number
- A secure fax number
- Identity verification instructions
- Electronic delivery options
Check Your Patient Portal
Some of the information you need may already be available.
You may be able to download:
- Test results
- Visit summaries
- Medication lists
- Immunization records
- Imaging reports
- Appointment records
Determine Exactly What You Need
Requesting your entire medical file is appropriate in some situations, but it is not always necessary.
For example, a new specialist might need your imaging reports, laboratory results, medication list, and recent physician notes rather than years of unrelated records.
Confirm the Destination
Double-check addresses, fax numbers, physician names, email addresses, and other delivery information.
Medical information is sensitive. A single incorrect digit in a fax number can create a serious problem.
Common Medical Records Request Letter Mistakes
Asking for “Everything” When You Need Only a Few Records
If you need only specific records, identify them.
A focused request may be easier to process and review.
Providing the Wrong Treatment Dates
Make sure the dates cover the treatment you are trying to document.
If you cannot remember exact dates, provide your best approximate period.
Leaving Out Identifying Information
Your name and date of birth are especially important.
The facility may request additional information to verify your identity.
Sending Your Request to the Wrong Department
Whenever possible, send the letter to the provider’s Health Information Management Department, Medical Records Department, or other department identified by the facility.
Assuming Your Reason Must Be Explained
When exercising your HIPAA right to access your own information, you generally are not required to justify why you want the records.
You may mention the reason when it helps explain what you need, but you do not need to provide unnecessary personal details.
Forgetting to Keep a Copy
Keep:
- Your original letter
- Any authorization
- Confirmation of delivery
- Emails
- Fax confirmations
- Reference numbers
- Names of people you speak with
This documentation becomes particularly useful if your request is delayed or disputed.
What to Do If Your Medical Records Are Incorrect
Receiving your records also gives you an opportunity to check them for accuracy.
If you believe information is incorrect or incomplete, you can ask the healthcare provider or health plan to amend the record.
The provider may not always agree with the requested change. However, HIPAA provides procedures for requesting amendments, and in certain circumstances you can have a statement of disagreement associated with the record.
Be specific about:
- The information you believe is incorrect
- Where it appears in the record
- What you believe the correct information should be
- Documentation supporting your position
What to Do If You Do Not Receive Your Records
Start by contacting the medical records department.
Provide:
- Your name
- Date of birth
- Date of your request
- Method used to submit it
- Confirmation or reference number
- Records requested
You can say:
“I’m following up on a medical records request I submitted on [Date]. Could you confirm that the request was received and tell me its current status?”
If you are requesting your records because of a dispute about treatment or service, you may also want to review this Complaint Letter to a Hospital.
If you believe a HIPAA-covered organization has improperly denied or delayed access to records you are legally entitled to receive, the HHS Office for Civil Rights provides a complaint process.
Advanced Medical Records Request Checklist
Section 1: Identify the Records You Need
Section 2: Check the Provider's Requirements
Section 3: Complete Your Request Correctly
Section 4: Choose the Delivery Method
Section 5: Authorization and Third-Party Requests
Section 6: Fees and Submission
Section 7: Follow Up and Review Your Records
Final Check Before You Submit
Make sure your request identifies you clearly, states exactly which records you need, gives the correct delivery information, and includes any required authorization. Keep your own copy and proof of submission so you can follow up if necessary.Frequently Asked Questions About Medical Records Request Letters
Q: How do you write a letter requesting medical records?
You should identify yourself, describe the records you need, provide the relevant treatment dates, state how you want the records delivered, and include your contact information.
If the records will be released to someone other than you, you should also determine whether you need a Medical Release Letter or the provider’s authorization form.
Q: Do you need to explain why you want your medical records?
Generally, no.
If you are exercising your HIPAA right to access your own health information, you generally cannot be required to provide a reason for wanting your records.
You can still mention that you need them for personal records, continuing treatment, an insurance matter, or another purpose when doing so helps clarify your request.
Q: Can you request your entire medical record?
In many circumstances, yes.
You can request a complete copy of health information within the applicable designated record set, subject to certain exceptions.
However, requesting only the records you actually need may make the documents easier for you to review.
Q: Can you request medical records electronically?
Yes, electronic access may be available.
You should state your preferred format in the request. Many providers also make at least some records available through secure patient portals.
Q: How long does a provider have to give you your records?
Under the HIPAA Privacy Rule, a covered entity generally must act on your access request within 30 calendar days. One additional 30-day extension may be available when the provider gives you the required written notice.
Many routine electronic requests are completed much sooner.
Q: Can a doctor refuse to give you your records because you owe money?
A provider generally cannot deny you access to records covered by your HIPAA access right simply because you have an unpaid medical bill.
If the amount of a bill itself is incorrect, consider using a Medical Billing Dispute Letter.
Q: Can you request medical records for another person?
You may be able to do so when you are the person’s legally recognized personal representative or have appropriate authorization.
The documentation required depends on the situation.
For example, the provider may request:
- Written patient authorization
- Guardianship documentation
- Power of attorney documentation
- Personal representative documentation
- Other legally required evidence of authority
Do not assume that being a spouse, adult child, sibling, or other relative automatically gives you unrestricted access.
Q: Can you have medical records sent directly to a new doctor?
Yes.
You can request that qualifying records be sent directly to another healthcare provider. Make sure you clearly provide the doctor’s name and correct delivery information.
You may also need to complete the provider’s Medical Release Letter or authorization process.
Q: What if your healthcare provider has its own records request form?
Use the provider’s form when it is convenient and contains everything needed for your request.
A provider may require written requests or its own form as long as its procedures do not create unreasonable barriers or delays to access.
Q: Can you request old medical records?
Potentially, yes, if the records are still maintained by the provider or an organization responsible for them.
How long records must be retained varies by state law, provider type, institution, and other requirements.
Contact the provider even if the treatment occurred years ago because older records may have been archived.
Q: What if you find an incorrect charge while reviewing your medical records?
Compare the medical documentation with the bill and insurance explanation of benefits.
If you believe you were charged incorrectly, document the specific charge and consider sending a formal Medical Billing Dispute Letter.
Q: What should you do if a hospital will not respond?
First, follow up with the medical records or Health Information Management Department and document each attempt.
If the problem involves broader concerns about the hospital’s service or treatment, you can also review this Complaint Letter to a Hospital.
If you believe your HIPAA access rights have been violated, you can review the complaint options available through the HHS Office for Civil Rights.
Final Thoughts
Requesting your medical records does not have to be complicated.
Your strongest request is specific, easy to verify, and clear about what you want and how you want to receive it.
Before sending your letter:
- Verify the provider’s records-request procedure.
- Identify the exact records you need.
- Include the relevant treatment dates.
- Choose your preferred delivery format.
- Double-check the recipient information.
- Sign the request if required.
- Keep a copy.
- Save proof that the request was submitted.
If your records need to be provided to another person or organization, review the requirements for a Medical Release Letter before submitting your request.
A few extra minutes spent making your request complete can prevent unnecessary emails, telephone calls, and processing delays later.
Disclaimer
This article provides general informational guidance and sample letters only. It is not medical or legal advice. HIPAA requirements, state laws, record-retention rules, fees, and authorization requirements can vary by situation and healthcare provider. Consult the appropriate healthcare organization, government agency, or qualified professional when you need advice about your specific circumstances.
