Robert Mathew
200 Baltimore St.
100 Broadway Lane
CA 97585
March 30, 2019
Paul Anderson
Records Administrator
Seasame Spine and Pain Institute
123 Main Street, Suite 100
St. Charles, CA 60174
Subject: requesting a copy of my medical records
Dear Mr.Anderson,
I am writing you to request the copy of my medical records. I was treated in your office on March 12, 2019. Please include all of my charts, test results, and consultation notes including referrals regarding my medical care.
I understand I may be charged a fee for copying my medical records, however, I will not be charged for any time that is spent locating my records.
Please mail the requested information to me at the address listed above. I have enclosed a self-addressed envelope for your convenience. I understand that I will be charged for postage.
Best regards,
Robert Mathew
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