Medical Report Request Letter
Purpose: For you to compose a typical letter in a
personal injury, workman's comp, L&I, or medical malpractice
case.
Outcome: Become familiar with the format and
content of the most common types of legal letters.
Assignment:
Write a letter to the treating doctor requesting medical
records. Add date, inside address, and a signature block to
the sample letters.
A. Sample Letter Requesting Medical
Report
Re: Patient's name:
Date of injury:
Patient No.:
Our File No.:
18456
Dear Dr. :
Our office represents the above-named client with respect to
injuries received in an automobile accident on or about
_____________.
Please provide us wiht copies of all materials from your file
with respect to your treatment of ______________, including the
following: history, examinations, diagnosis, treatment,
prognosis (including any present or future disability), x-ray
reports, and medical reports made with respect to the above
patient.
Enclosed is an authorization signed by _____ for us to receive
the above information in his/her behalf.
Please also provide us with copies of all your billings for
_____ treatment, as well as your charge for providing this
information.