Privacy & Release of Information

This article discusses the importance of privacy and release of information in the medical field. It includes a sample medical request letter and response letter. The article also provides insights on a medical records release form.

Running head: PRIVACY AND RELEASE OF INFORMATION 1
Privacy and Release of Information
Name
Institution

PRIVACY AND RELEASE OF INFORMATION 2
Medical Request Letter
November 01, 2018
Sent via regular mail
Athabasca Healthcare Center
Alberta Province
Northern Alberta, 451256
Dear Sir/Madam
RE: Emil Carr
OHIP No: IMM5292
Date of Birth: 23/6/1968
Date of Loss: 05/11/2017
Dear Records Administrator:
On the behalf of Athabasca, Legal Firm accepts this letter as a written appeal for the Medical
records concerning Emil Carr. Athabasca Legal Firm provides legal aid to the people with low
financial income, the disabled seniors at no charge.
As a representative of the Athabasca Legal Firm, we request all the medical records recently in
the position of your office concerning Mrs. Carr. The medical records should include, any
treatment notes, laboratory findings, test results, and discharge reports. In addition, Mrs. Carr
visits to Dr. Thomas should be included in her medical records. I have included Mrs. Carr’s
health information that she has signed permitting you to send the medical records to our Law
Firm.

PRIVACY AND RELEASE OF INFORMATION 3
Mrs. Carr lacks the fund of paying for these records. However, we would highly appreciate if
you relinquish the cost of her medical records. Mrs. Carr’s medical report is very important in
the accident case that led to the loss of her right leg. If the originals copies could not be released
at any charge, then we will also accept the photocopied ones (Busse, Bruun-Meyer, Ebrahim, &
Kunz, 2014). Uncertainty, if it will be a must for the medical reports to be released at a charge,
then you can write or call me notified of the fees required for the release of the reports.
If there are any questions, reach me at [phone].
Sincerely,
Jonathan Hex

PRIVACY AND RELEASE OF INFORMATION 4
Athabasca Legal Firm
P.O Box 009742
Alberta Province
MEDICAL RECORD RELEASE FORM
By signing this form, I permit the release of my confidential health information to the Athabasca
Legal Firm by releasing full copies of my medical records.
Patient Name_____________________________________________________________
Address: ________________________________________________________________
Patient’s phone: _________________________________________________________
Date of Birth: ____________________________________________________________
Patient’s signature: ________________________________________________________
Restriction on the information you may release subjected to this release are as follows:
________________________________________________________________
Release my protected health information to the following
Name: _____________________________________________
Address: ___________________________________________
City: State: Zip code: ________________________________
The purpose for this release of information is as follow:
______________________________________________

PRIVACY AND RELEASE OF INFORMATION 5
A Letter of Response to A Medical Request Letter
November 09, 2018
Sent via regular mail
Athabasca Legal Firm
Alberta Province, 536 146
Dear Sir/Madam
RE: Reply to your letter.
Dear Jonathan Hex,
Enclosed please find the medical records that were requested by your firm concerning Emir Carr.
Additionally, enclosed is a documentation that these are true and completed records kept by our
office for Emir Carr and there are no other medical records in our ownership.
As we notified you before, the total amount for copying these records is $4 per page. Primarily, it
is our request you immediately remit payment of $456 to our office for Mrs. Carr’s medical
reports copies. In addition, the packet of the medical reports includes 68 pages.
We will appreciate your immediate payment of this fee (Ebrahim, Sava, Kunz, & Busse, 2014).
However, failure to pay this money will lead in the future delay in the processing of medical
records requests from your office.
Sincerely,
Ann Woodland.

PRIVACY AND RELEASE OF INFORMATION 6
References
Busse, J. W., Bruun-Meyer, S. E., Ebrahim, S., & Kunz, R. (2014). A 45-year-old woman
referred for an independent medical evaluation by her insurer. Canadian Medical
Association Journal, 186(16), E627-E630.
Ebrahim, S., Sava, H., Kunz, R., & Busse, J. W. (2014). Ethics and legalities associated with
independent medical evaluations. Canadian Medical Association Journal, 186(4), 248-
249.