Sample Advocacy Letters

Jonathan's Law - Access to Abuse Investigations Sample

Your address
Your phone number

Date

Records Access Officer
Name of Provider serving the individual where abuse is alleged to have occurred
[or]
State Agency that conducted an investigation (e.g. Office of Mental Health, Commission on Quality of Care, OMRDD, etc)

RE: Request for Access to Records Pertaining to Allegations and Investigations of Abuse and Mistreatment of Name of person receiving services: (his or her date of birth) Pursuant to Article 33 of the Mental Hygiene Law

Dear Records Officer:

I would like to review all records pertaining to your agency's investigations into allegations of abuse and mistreatment of name of person by [your agency or name of agency providing services where abuse occurred] from May 6, 2007 through the date of this request. Please contact me at the phone number or address above and advise me of specific dates and times when I can have access to said records. I may wish to copy some or all of the records, so please ensure that a means of copying is available. I understand that I will be charged a reasonable fee for copies, not to exceed $0.75 per page.

[or]

Please provide me copies of the all records pertaining to your agency's investigations into allegations of abuse and mistreatment of name of person by [your agency or name of agency providing services where abuse occurred] from May 6, 2007 through the date of this request. I understand that I will be charged a reasonable fee for copies, not to exceed $0.75 per page. However, if the fee for copying said records and reports will exceed $XX.00, please contact me before any copies are made.

I am a "qualified person" to receive access to these records because I am the ([choose one]parent, legal guardian, spouse, adult daughter, adult son) of name of person receiving services, and I have the authority to provide consent for his/her care and treatment pursuant to the enclosed (choose one:)
If person is under 18 and you are parent, copy of his or her birth certificate or adoption papers identifying you as parent
If person is under 18 and you are legal guardian, copy of court order naming you legal guardian
If person is 18 or older, copy of court order naming you legal guardian
If person's spouse, copy of marriage certificate
If person's adult child, copy of your birth certificate and copy of court order giving you legal authority to make health care decisions for the person
[or]
the individual receiving services.

Thank you for your attention to this matter. I look forward to hearing from you within ten (10) business days.

Sincerely,

Signature
Printed name

Enc.

Sample Letter

222 Western Avenue
Nowhere, NY 00000
(000)-000-0000

March 1, 2008

Records Access Officer
NYS Commission on Quality of Care and
Advocacy for Persons with Disabilities
401 State Street
Schenectady , NY 12305

RE: Request for Access to Records Pertaining to Allegations of Abuse and Mistreatment of John R. Doe (DOB: 12/31/80) Pursuant to Article 33 of the Mental Hygiene Law

Dear Records Officer:

Please provide me with copies of all records pertaining to your agency's investigations into abuse and mistreatment of John R. Doe by ACME Care Services from May 6, 2007 through the date of this request. I understand that I will be charged a reasonable fee for copies, not to exceed $0.75 per page. However, if the fee for copying said records and reports will exceed $15.00, please contact me before any copies are made.

I am a "qualified person" to receive access to these records because I am the parent and legal guardian of John R. Doe, and I have the authority to provide consent for his care and treatment pursuant to the enclosed copy of an Order of the Surrogate Court of Nowhere County appointing me Guardian pursuant to article 17-A of the Surrogateļæ½s Courts Procedures Act.

Thank you for your attention to this matter. I look forward to hearing from you within ten (10) business days.

Sincerely,

Signature
Printed name

Enc.

Special Note:

Prior to using the above sample letter, please read the helpful information at the following link:

http://www.cqcapd.http://www.cqcapd.state.ny.us/Brochures/Access-to-MH-Records.htm

Sample Letter Provided by Family Resource Network, Inc.