Medical Records Release Letter

Medical Records Release Letter

A letter template authorizing one physician to release the patient's medical files to another.

Downloaded > 8,750 times

Get Started

Description

123 Main St., Apt. #5
Anytown, CA 95928
(555) 555-1212
[email protected]

November 8, 2008

Anytown Medical Center
345 Goodhealth Place
Anytown, CA 95928

Dear Dr. Goodcare:

I am writing to authorize you to release my medical records to the office of Dr. Nice. He has expressed a desire to see my files to gain a more complete picture of my ongoing digestive problems.

Please send the files at your earliest convenience to: 134 Nice Way, Anytown, CA 95928.

Sincerely,

Danny Daniels

People who printed this business form template also printed...