Physician to attorney: medical records

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Instructions

Simply replace the unfilled areas such as "[]" and "[date]" with your information.

Dear [attorney's name],

Enclosed please find the medical records you requested regarding [Patient]. Also enclosed is a certification that these are the true, correct, and completed medical records kept by this office for [Patient]. There are no other records in our possession.

As we previously notified you, the fee for copying these records is [fee per page] per page. We request that you promptly remit payment of [total due for copies] to our office for these copies. The medical records packet attached includes [number of pages] pages.

Thank you for your prompt payment of this fee. Failure to pay this fee will result in delayed processing of future record requests from your office.

Sincerely,