Medical Records Request Invoice Template

The medical records invoice is sent to bill a patient for the request and transfer of their health care history. In accordance with § 45 CFR 164.524(c)(4), a medical office may charge a patient for the labor, supplies, postage, and preparing a summary or explanation of the protected health information. Although, each State places a limit on how much a medical office may charge for this request (See Maximum Amounts).

How to Write in PDF or Word

Step 1 – Download in Adobe PDF or Microsoft Word (.docx).

Step 2

How to Write in Excel

Step 1 – Download in Microsoft Excel (.xlsx)

Step 2