Need to request a copy of your medical records? You can use your healthcare provider's medical records request form, or submit a written request if the provider doesn't require a specific form. This article includes a fill-in template and a copy-and-paste request letter you can use to ask for office notes, lab results, imaging reports, medication records, and other health information.
A good request should identify you, specify the records and date range you want, and explain where you want the records sent. Before submitting it, check whether your doctor's office or hospital has its own form or patient portal process.
TL;DR: Key Takeaways
- A medical records request form tells a healthcare provider which records you want and where to send them.
- You can often request your own records through a provider's patient portal, medical records department, or written request.
- HIPAA generally gives individuals a right to access their protected health information in designated record sets, subject to limited exceptions.
- A medical records request isn't always the same thing as a medical records release or HIPAA authorization form.
- You can request specific records, such as office notes, lab results, imaging reports, medication lists, or billing information.
- Keeping a copy of your request can make it easier to follow up if the records are delayed or incomplete.
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For non-emergency care that can be handled remotely, a US-licensed clinician can review your symptoms and prescribe treatment when clinically appropriate. For questions about your records themselves (missing information, corrections, or the request process), contact the provider's medical records department or HHS Office for Civil Rights directly.
What is a medical records request form?
A medical records request form is a document that lets you ask a healthcare provider for a copy of health information they maintain about you. It identifies you as the patient, specifies which records you want, and directs where the records should be sent.
Under HIPAA, you generally have a right to access protected health information about yourself that a covered healthcare provider or health plan maintains, subject to limited exceptions.
Most requests can be handled in one of three ways: through a patient portal (if available), by submitting the provider's own medical records request form, or by sending a written request that includes the necessary information.
For a broader look at what's inside your medical records, see our guide on medical records: what's inside them, who legally owns them, and how to get your copy.
How to submit a medical records request
Here's what most people should know before submitting:
1. Check for a patient portal first. Many healthcare systems offer online access to records through a patient portal. This is often the fastest way to view recent records. For more, see our guide on how to view your medical records online for free.
2. Ask about the provider's preferred process. Some providers require their own form. Others accept a written request with the necessary information.
3. Be specific. Instead of asking for "all my records," specify what you want (office notes, lab results, imaging reports) and the date range.
4. Choose your delivery method. You can request records be sent electronically, by mail, or picked up in person.
5. Keep a copy of your request. This helps you follow up if there are delays.
Ways to submit a medical records request
| Method | Best For | Timeline |
|---|---|---|
| Patient portal | Recent records, quick access | Immediate to a few days |
| Provider's own form | Standard requests, in-office visits | 5-30 days typically |
| Written request letter | Historical records, closed practices | 5-30 days typically |
| In-person request | Complex situations, questions | Same day to several days |
Under HIPAA, providers generally have 30 days to respond to a request, with a possible 30-day extension in some circumstances.
Copy-and-paste medical records request template
You can use this template as-is or change it for your situation. Fill in the bracketed fields with your information.
REQUEST FOR MEDICAL RECORDS
[Provider Name or Practice Name]
[Medical Records Department]
[Provider Street Address]
[City, State, ZIP Code]
[Phone Number]
[Fax Number, if applicable]
Date: [MM/DD/YYYY]
Re: Request for Medical Records
Dear Medical Records Department:
I am requesting a copy of my medical records maintained by your practice pursuant to my right of access under the Health Insurance Portability and Accountability Act (HIPAA).
PATIENT INFORMATION
Full Legal Name: _______________________________________________
Date of Birth: ______________________
Previous Name(s), if applicable: __________________________________
Current Address:
Phone Number: _________________________________________________
Email Address: _________________________________________________
Patient ID or Medical Record Number, if known: ______________________
RECORDS REQUESTED
Please provide copies of the following records for the period:
From: ______________________ To: ______________________
Please check all that apply:
☐ Office or visit notes
☐ Laboratory and blood test results
☐ Imaging reports, including X-ray, MRI, CT, or ultrasound
☐ Medication history and current prescriptions
☐ Immunization or vaccination records
☐ Hospital discharge summaries
☐ Specialist consultation notes
☐ Operative or procedure reports
☐ Billing and payment records
☐ Complete medical record
☐ Other: _________________________________________________________
DELIVERY PREFERENCE
Please provide my records using the following method:
☐ Secure electronic delivery to: _________________________________
☐ Patient portal upload
☐ Mail to:
☐ In-person pickup at: __________________________________________
FORMAT PREFERENCE
☐ Electronic/digital copy
☐ Paper copy
☐ Either format is acceptable
REQUEST DETAILS
Please confirm receipt of this request and let me know if any additional information or authorization is required to process it.
If there are any fees associated with providing these records, please notify me of the applicable fees before processing the request.
If any portion of my requested records cannot be provided, please provide a written explanation identifying the records that cannot be released and the reason for the denial.
Thank you for your assistance. Please contact me using the information above if you have any questions regarding this request.
Sincerely,
Signature: _____________________________________________________
Printed Name: __________________________________________________
Date: ______________________
Preferred Contact Method: _______________________________________
Best Phone/Email for Follow-Up: __________________________________
Request Checklist
Use this checklist to make sure your request has everything the medical records department needs:
- ☐ Provider information: Correct name and address of the practice or hospital
- ☐ Patient identification: Full name (including previous names), date of birth, contact info
- ☐ Specific records and dates: Which types of records and specific date ranges
- ☐ Delivery method and format: Electronic, mail, or pickup; digital or paper
- ☐ Signature and date: Your signed and dated request
- ☐ Copy of request: Keep one for your records
For guidance on tracking down records from providers you no longer see, see our guide on how to track down old medical records, including childhood ones.
What to know about fees and timeframes
Fees: HIPAA allows healthcare providers to charge reasonable, cost-based fees for copies of medical records. Fees may include labor for copying, cost of supplies, and postage if records are mailed. Electronic delivery is often free or lower cost than paper copies.
Timeframes: Under HIPAA, providers generally must respond within 30 days of receiving a request. They may take an additional 30-day extension if they notify you in writing and explain why. Complex or archived records may take longer.
If records are delayed: Contact the medical records department to check on status. If you can't get a response, you may file a complaint with HHS OCR.
Medical records request vs medical records release form
These sound similar but serve different purposes:
Medical records request: You (the patient) asking for your own records to be provided to you.
Medical records release / HIPAA authorization: You giving permission for your provider to send records to a third party (another doctor, an attorney, an insurance company, etc.).
Different situations call for different forms. If you want your records for yourself, a request is appropriate. If you want them sent to another party, you likely need a release/authorization form.
Special situations
Records for a new doctor: You can request records be sent directly to the new provider using a records release form. Many providers now support electronic health record sharing.
Records for legal purposes: Legal proceedings may require specific documentation. Work with your attorney on what to request and how to obtain it.
Records for disability claims: Different agencies have specific requirements. For a broader look, see our guide on getting the medical records a disability claim needs.
Deceased family member's records: Different rules apply. Generally, records can be released to a legal representative of the estate. Contact the provider for their specific process.
Minor's records: Parents/guardians can typically request their minor child's records. Age of majority for medical records access varies by state (typically 18, but younger for some conditions).
When to contact a clinician about records issues
Contact the provider's medical records department for:
- Questions about the request process
- Fee disputes or delays in receiving records
- Incorrect information or missing records
- Requests for corrections or amendments
Contact the HHS Office for Civil Rights if:
- Your provider fails to respond to a HIPAA request
- Records are wrongfully withheld
- Your privacy rights have been violated
Conclusion
A medical records request form is a straightforward way to get copies of your health information. You can use your provider's own form, submit a written request, or check your patient portal.
Be specific about what you're requesting (types of records, date range, delivery method), keep a copy of your request, and follow up if there are delays. Under HIPAA, providers generally have 30 days to respond.
If you need records urgently, contacting the medical records department directly and explaining your timeline can sometimes expedite the process. For complex situations (closed practices, deceased family members, legal disputes), consider consulting with an appropriate professional for guidance.
Frequently Asked Questions
Under HIPAA, providers generally have 30 days to respond to a request, with a possible 30-day extension in some cases.
Electronic delivery is often faster than paper copies. Archived or historical records may take longer than recent records.
Not always. If your provider has a specific form, using it can speed processing.
If not, a written request with the necessary information (patient identification, specific records, date range, delivery method) is generally accepted. HIPAA doesn't require a specific form format.
Generally, no, without proper authorization.
You can request records for someone else if you have their signed authorization, are their legal guardian, or have power of attorney. For deceased family members, records may be released to the estate's legal representative.
HIPAA allows reasonable, cost-based fees for records copies.
If fees seem excessive, ask for an itemized explanation. Electronic delivery is often cheaper than paper. You can also file a complaint with the HHS Office for Civil Rights if you believe fees are unreasonable.
Yes. Under HIPAA, you have the right to request records from any healthcare provider or health plan that maintains information about you, regardless of whether you're a current patient.
If the practice has closed, ask about who currently maintains the records.
Contact the provider's medical records department to request an amendment or correction.
Under HIPAA, you have the right to request corrections to inaccurate information. The provider isn't required to make every requested change but must respond to your request. Keep documentation of your correction request.
