ACCELERATE YOUR CASE PREPARATION:

Download Our Free HiTech Act Template

By using our HiTech Act letter template, you can:

1. Quickly request electronic copies of your client's medical records, speeding up case preparation and strengthening your arguments.
2. Minimize costs for your clients by taking advantage of the HITECH Act's reduced fee structure for electronic records requests.
3. Ensure compliance with the HITECH Act by using our professionally crafted template, which covers all necessary details for a successful medical records request.

To download our free HiTech Act letter template, simply click the link below:

PREVIEW:

To: PROVIDER NAME

PROVIDER ADDRESS

PROVIDER CITY, STATE ZIP 

PROVIDER EMAIL OR FAX

RE: HITECH ACT MEDICAL RECORDS REQUEST

Patient: CLIENT’S NAME
Date of Birth: CLIENT’S DATE OF BIRTH
SSN: CLIENT’S SOCIAL SECURITY NUMBER

Phone: CLIENT PHONE

Dear Sir or Madam:

I have received treatment at your facility and am requesting:
A full and complete copy of my medical records, including any other outside medical records, Itemized billing records; and
Images (including X-Rays, MRIs or CT scans)

I SPECIFICALLY REQUEST YOU PROVIDE MY RECORDS IN ADOBE ACROBAT (.PDF) FORMAT ON CD OR DVD PURSUANT TO THE REQUIREMENTS OF THE HITECH ACT AS SET FORTH IN 42 U.S.C. § 17935(E)(2) AND 45 C.F.R. § 164.524(C). You may also email this PDF to the below email address. Please send my records to my below-referenced personal representative:

For more resources and sample documents, explore our comprehensive library, which includes our popular Sample Auto Accident Complaint for Magistrate Court.

We hope our HiTech Act letter template proves to be a valuable asset in your personal injury practice. If you have any questions or need additional support, don't hesitate to reach out to our experienced team at Georgia Trial Attorneys. Together, we can deliver the best possible outcomes for our clients while upholding the highest standards of personal injury law.