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Medical Records Request Letter - Template, Sample Form Pro · NG-law

✓ Valid in Nigeria · drafted to comply with local law

Create your Medical Records Request Letter - Template, Sample Form for use in Nigeria. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share. This version has been professionally rewritten to comply with local law.

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Medical Records Request Letter - Template, Sample Form
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________
________
________
________

________

The Medical Records Officer / Data Protection Officer
________
________

Dear Sir/Madam,

RE: REQUEST FOR ACCESS TO PERSONAL MEDICAL RECORDS PURSUANT TO THE NIGERIA DATA PROTECTION ACT 2023 AND THE NATIONAL HEALTH ACT 2014

§1. Introduction

1.1 I, ________, am a patient registered with ________ ("the Facility"). My patient identification/health record number is ________.

1.3 The purpose of this request is to obtain a second medical opinion from another healthcare provider and to enable continuity of my care.

§2. Records Requested

2.1 I specifically request copies of the following documents and information:

________

2.2 The records requested cover the period from ________ to ________.

2.3 I should be grateful if the records be supplied in the following format: ________ (e.g. certified hard copies and/or electronic copies).

§3. Patient Particulars for Identification

3.1 For the purpose of verifying my identity and locating my records, my particulars are as follows:

Patient Name: ________

Patient Address: ________

Date of Birth: ________

Means of Identification (Type & Number): ________

Patient ID/Health Card Number: ________

3.2 A copy of my means of identification is enclosed herewith to facilitate verification in accordance with the Facility's data protection obligations.

§4. Timeframe for Compliance

4.1 In line with section 34(2) of the Nigeria Data Protection Act 2023, I request that this access request be processed and the records furnished within a reasonable period not exceeding one (1) month from the date of receipt of this letter, subject to verification of my identity.

4.2 Where the Facility is unable to comply within the said period, I request to be notified in writing of the reasons for the delay and the expected date of compliance.

§5. Fees

§6. Confidentiality and Data Protection

6.1 I confirm that I am the data subject in respect of the records requested and that I consent to the processing and disclosure of these records to me in accordance with the law.

6.2 Where any record is to be released to or collected by an authorised representative, the said representative is ________, who is duly authorised by me to receive the records on my behalf.

§7. Contact

7.1 Should you require any further information or clarification regarding this request, please contact me by telephone on ________ or by email at ________.

I thank you for your time and assistance in this matter and look forward to your prompt response.

Yours faithfully,



___________________
________
(Patient/Data Subject)

Enclosure(s): Copy of means of identification; ________

Fields you complete are inserted into the document live. This template is general guidance only — not legal advice.