Sample Letter To Notify Individual'S Of A Delay In Their Amendment Request

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ATTACHMENT C
Sample Letter to Notify Individual’s of a Delay
in Their Amendment Request
Date
Patient or Representative
Address
City, State, ZIP Code
Dear (Patient Name):
Your request for an amendment of your health records, dated ______________, is still under consideration. We are
experiencing a delay in responding to your request because
_____________________________________________________________________
_____________________________________________________________________
and we will act upon your request within the next 30 days.
We will notify you of our decision by _________________________ Date: _________
Sincerely,
HIM Director, Business Office Director, or Record Custodian Representative
cc: Medical or Billing Record of Patient

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