Updated November 19, 2025

Medical Records Request Letter PDF — Free Template

Patients often need copies of their medical records to switch doctors, support disability claims, or gather evidence for a legal case. Providers must usually respond within 30 days under HIPAA, but they can ask for a written request. Use theMedical Records Request Letter tool to build a clean PDF with the right details.

Why you might need a medical records request

• Transferring care to a new doctor or specialist.
• Filing disability, insurance, or workers' compensation claims.
• Building a malpractice or personal injury case.
• Keeping a personal health archive.
• Reviewing billing codes and charges for accuracy.

What to include

A strong request covers the patient identity, the provider you're writing to, the time period, and how you want the records delivered. Mention whether you need billing records as well as clinical notes, and specify the purpose if your state requires it. Sign and date the letter, including your city and state.

How long does a provider have to respond?

Under HIPAA, covered entities generally have 30 days to respond, with one 30-day extension if they explain the delay in writing. Some states require faster turnarounds. Fees are limited to reasonable copy and postage costs. Always check your state law or provider policy in case they offer patient portals that fulfill requests faster.

How to generate the letter on CourtPDF

1. Visit the Medical Records Request PDF tool.
2. Enter the requester information, relationship to the patient, and patient DOB.
3. Add the provider name, address, and optional date range or record types.
4. Select a delivery method and provide mailing, fax, or portal details.
5. Choose whether to include billing records, type an optional purpose, and add the signature city, date, and name.
6. Click “Download PDF” to get a ready-to-send letter.

FAQs

Can I email this letter?

Many providers accept secure email or portal uploads. Attach the PDF and follow any instructions on their website. Some still require fax or mail, so confirm their preference.

Will they charge me?

HIPAA allows reasonable cost-based fees for copies and postage. States often cap per-page rates. Ask for a fee schedule up front so you can approve costs before they copy the file.

What if I need billing records too?

Check the “Include billing records” option in CourtPDF. The letter will explicitly request claims, invoices, or EOBs in addition to clinical notes.