North Dakota Sample Letter to Doctor Requesting Narrative Medical Report

• Category: Letters - Legal - Personal Injury
• State: Multi-State
• Control #: US-0533LTR
• Format: Word; Rich Text

Description

This form is a sample letter in Word format covering the subject matter of the title of the form. Subject: Request for Narrative Medical Report — Patient: [Patient's Name— - Date of Birth: [Patient's DOB] — Case No: [Case Number] Dear [Doctor's Name], I am writing to request a detailed narrative medical report for the above-mentioned patient as part of their ongoing medical assessment. The purpose of this letter is to facilitate the submission of a comprehensive report that will provide crucial information for our records and help us understand the patient's medical condition more accurately. Given the importance of the report, we kindly request that you include the following details: 1. Chief Complaint: Begin the report by clearly stating the patient's chief complaint or reason for seeking medical evaluation. Please provide a detailed description of their symptoms, including their onset, progression, severity, and any accompanying factors. 2. Medical History: Thoroughly document the patient's medical history, including any previous illnesses, injuries, surgeries, existing medical conditions, and a family medical history if known. Please include relevant dates and factors that may contribute to their present health condition. 3. Examination Findings: Provide a comprehensive overview of the physical examination you conducted, detailing the examination techniques used, the observed signs, and any abnormalities discovered. Include vital sign measurements, relevant clinical tests performed, and their results. 4. Diagnostic Assessments: Describe the diagnostic procedures you performed to evaluate the patient's condition accurately. Include laboratory tests, imaging studies, or any other relevant investigations conducted, along with their outcomes and interpretations. 5. Treatment Provided: Outline the treatment modalities you have prescribed thus far, including medications, therapies, procedures, or surgeries. Detail the rationale behind the chosen treatment plan and any modifications made during the course of treatment. 6. Progress and Prognosis: Provide an update on the patient's progress throughout the treatment duration, highlighting any improvements or setbacks observed. Include information regarding their response to treatment, any adverse reactions experienced, and explanations for any changes in the treatment plan. 7. Functional Impairments: Assess and document any limitations or functional impairments experienced by the patient due to their medical condition. Explain how these impairments are affecting their daily life activities, professional capabilities, or overall quality of life. 8. Recommendations and Follow-up: Conclude the report with specific recommendations for further investigations, referrals to other specialists, recommended lifestyle modifications, or additional treatments. Please specify if any ongoing follow-up or monitoring is necessary and suggest an appropriate timeframe for reassessing the patient. We greatly appreciate your assistance in providing this narrative medical report, as it plays a vital role in ensuring the continuity of the patient's care. If there are any charges associated with processing this request, kindly inform us in advance. Please email the completed narrative report to [Your Email Address] or fax it to [Your Fax Number]. Should you have any questions or require additional information, please contact me directly at [Your Contact Number]. Thank you for your time and prompt attention to this matter. Your expertise and attention to detail will significantly contribute to the comprehensive understanding of our patient's medical condition. Sincerely, [Your Name] [Your Position] [Your Institution/Practice Name] [Address] [City, State, ZIP Code] [Phone Number] [Email Address]

Subject: Request for Narrative Medical Report — Patient: [Patient's Name— - Date of Birth: [Patient's DOB] — Case No: [Case Number] Dear [Doctor's Name], I am writing to request a detailed narrative medical report for the above-mentioned patient as part of their ongoing medical assessment. The purpose of this letter is to facilitate the submission of a comprehensive report that will provide crucial information for our records and help us understand the patient's medical condition more accurately. Given the importance of the report, we kindly request that you include the following details: 1. Chief Complaint: Begin the report by clearly stating the patient's chief complaint or reason for seeking medical evaluation. Please provide a detailed description of their symptoms, including their onset, progression, severity, and any accompanying factors. 2. Medical History: Thoroughly document the patient's medical history, including any previous illnesses, injuries, surgeries, existing medical conditions, and a family medical history if known. Please include relevant dates and factors that may contribute to their present health condition. 3. Examination Findings: Provide a comprehensive overview of the physical examination you conducted, detailing the examination techniques used, the observed signs, and any abnormalities discovered. Include vital sign measurements, relevant clinical tests performed, and their results. 4. Diagnostic Assessments: Describe the diagnostic procedures you performed to evaluate the patient's condition accurately. Include laboratory tests, imaging studies, or any other relevant investigations conducted, along with their outcomes and interpretations. 5. Treatment Provided: Outline the treatment modalities you have prescribed thus far, including medications, therapies, procedures, or surgeries. Detail the rationale behind the chosen treatment plan and any modifications made during the course of treatment. 6. Progress and Prognosis: Provide an update on the patient's progress throughout the treatment duration, highlighting any improvements or setbacks observed. Include information regarding their response to treatment, any adverse reactions experienced, and explanations for any changes in the treatment plan. 7. Functional Impairments: Assess and document any limitations or functional impairments experienced by the patient due to their medical condition. Explain how these impairments are affecting their daily life activities, professional capabilities, or overall quality of life. 8. Recommendations and Follow-up: Conclude the report with specific recommendations for further investigations, referrals to other specialists, recommended lifestyle modifications, or additional treatments. Please specify if any ongoing follow-up or monitoring is necessary and suggest an appropriate timeframe for reassessing the patient. We greatly appreciate your assistance in providing this narrative medical report, as it plays a vital role in ensuring the continuity of the patient's care. If there are any charges associated with processing this request, kindly inform us in advance. Please email the completed narrative report to [Your Email Address] or fax it to [Your Fax Number]. Should you have any questions or require additional information, please contact me directly at [Your Contact Number]. Thank you for your time and prompt attention to this matter. Your expertise and attention to detail will significantly contribute to the comprehensive understanding of our patient's medical condition. Sincerely, [Your Name] [Your Position] [Your Institution/Practice Name] [Address] [City, State, ZIP Code] [Phone Number] [Email Address]