ITRC Letter Form 130A
Request to Receive and/or Correct Medical Records
ITRC Letter Form 130A - Request for Medical Records, is for use by victims of medical identity theft. This sample letter uses language that may be useful in making a case for removing incorrect information from a health provider’s record:
This fact sheet should not be used in lieu of legal advice. Any requests to reproduce this material, other than by individual victims for their
own
use, should be directed to
ITRC
@idtheftcenter.org
ITRC thanks the CRAs in providing material for this guide.
Copyright 2009, Identity Theft Resource Center®, all rights reserved.
Created by ITRC