HIPAA Records Request Builder

Generate a HIPAA-compliant medical records request letter citing 45 CFR 164.524. Free, no signup.

3 generations/day per IP. Powered by Claude. Output is starter-draft — verify every clause before sending.

Patient information

Patient name (first + last, as it appears in records)

Date of birth

SSN (last 4 only)

Records requested

Date range — start

Date range — end

Healthcare provider

Provider / facility name

Provider address (full address — street, city, state, ZIP)

Delivery + authorization

Format preferred

HIPAA authorization

Plaintiff counsel

Counsel name

Firm name + address

Bar number

Bar state

Not legal advice. AI-generated drafts must be reviewed by counsel. State-specific provisions are flagged with placeholders — verify against your jurisdiction before sending.

HIPAA Records Request Builder

HIPAA Records Request Letter