Records Tools — HIPAA Right of Access

Medical Records Request Letter Generator

Generate a HIPAA-compliant request letter for your medical records under 45 C.F.R. § 164.524. Useful for medical-debt disputes, IFP (in forma pauperis) supporting evidence, disability records, and continuity of care. Fill in the form on the left, see the letter render live on the right, then copy or save as PDF. Self-contained, no signup, nothing leaves your browser.

Template tool, not legal or medical advice. This is a free document-generation utility provided by the Open Bankruptcy Project, a 501(c)(3) nonprofit (EIN 41-5159631). The tool reproduces template language only. The content, accuracy, and use of any letter generated are solely the user's responsibility. No attorney-client or provider-patient relationship is created. Consult a licensed attorney or a healthcare professional for advice specific to your situation.

Letter Inputs

Patient (You)

Required by most providers to verify identity before releasing records.

Provider

If you know the specific person or department that handles records requests, name them here. Otherwise the letter is addressed generically.

Dates of Treatment

If ongoing, leave blank — the letter will say "to present."

Records Requested

Format Requested

Delivery

Fee Posture

Authorization (Optional)

If left blank, a standard authorization is auto-included: "I authorize the above-named provider to release the requested records to me / [recipient]."

Live Preview

Reminder: This is a template. Review every line before sending. The Open Bankruptcy Project does not represent you and does not certify any output.
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One more reminder: Template tool, not legal advice. The Open Bankruptcy Project is a 501(c)(3) nonprofit (EIN 41-5159631) providing free informational tools. Consult a licensed attorney before sending any legal correspondence. The accuracy and content of any letter generated by this tool are solely the user's responsibility.

This site provides general information, not legal advice. Consult a qualified attorney for your specific situation.