City of Miami Fire Dept.
1151 NW 7th Street
Miami, FL 33136
Our Client(s): Fermina C. Ortega
Date of Birth: 11/23/1974 Run# 2020-013027
To Whom It May Concern:
The purpose of this letter is to request copies of any and all of Fermina C. Ortega medical records for ONLY the date of 5/29/2020, the injury date, and treatments thereafter pertaining to the injury as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations. Enclosed is our client’s signed Medical Authorization.
I look forward to receiving the above records within 30 days as specified under HIPAA. If my request cannot be honored within 30 days, please inform me of this by letter as well as the date I might expect to receive my records. Please mail or fax the requested records to me at the information above.
We agree to pay for all reasonable expenses you incur in providing the above information upon receipt of same. Thank you for your attention to these requests.