New Mexico Sample Letter for List of Medical Expenses

• Category: Letters - Legal - Medical
• State: Multi-State
• Control #: US-0817LTR
• Format: Word; Rich Text

Description

This form is a sample letter in Word format covering the subject matter of the title of the form. Dear [Recipient's Name], I am writing to provide you with a detailed list of medical expenses incurred during my recent visit to New Mexico. As an avid traveler and adventurer, I unfortunately encountered an unforeseen medical issue during my trip, and I have gathered all pertinent information regarding the expenses associated with my treatment. 1. Description of the Incident: During my stay in New Mexico, I experienced a sudden allergic reaction which required immediate medical attention. I visited [Hospital/Clinic Name] located in [City], where I received comprehensive medical treatment for this ailment. 2. Medical Facilities Visited: a. [Hospital/Clinic Name 1], [City] b. [Hospital/Clinic Name 2], [City] c. [Hospital/Clinic Name 3], [City] 3. Dates of Medical Visits: a. [Date of Visit 1] b. [Date of Visit 2] c. [Date of Visit 3] 4. Breakdown of Medical Expenses: a. Consultation and Examination Fees: i. [Date 1]: [Amount] ii. [Date 2]: [Amount] iii. [Date 3]: [Amount] b. Diagnostic Tests and Laboratory fees: i. [Date 1]: [Amount] ii. [Date 2]: [Amount] iii. [Date 3]: [Amount] c. Prescription Medications: i. [Medication Name 1]: [Amount] ii. [Medication Name 2]: [Amount] iii. [Medication Name 3]: [Amount] d. Procedures and Treatments: i. [Treatment/Procedure Name 1]: [Amount] ii. [Treatment/Procedure Name 2]: [Amount] iii. [Treatment/Procedure Name 3]: [Amount] e. Other Miscellaneous Expenses: i. Transportation to medical facilities: [Amount] ii. Accommodation during recovery: [Amount] iii. Meals while seeking medical care: [Amount] Please note that the above list is an extensive documentation of my medical expenses incurred in New Mexico. I have attached all relevant receipts and invoices for your reference. Additionally, any supporting medical reports from the attending physicians have also been included. Should you require any further information or documents, please do not hesitate to contact me at [Your Contact Information]. I kindly request that you process this claim as promptly as possible, considering the time sensitivity of the matter. Thank you for your attention and assistance regarding my medical expenses in New Mexico. I look forward to a positive resolution and reimbursement. Sincerely, [Your Name]

Dear [Recipient's Name], I am writing to provide you with a detailed list of medical expenses incurred during my recent visit to New Mexico. As an avid traveler and adventurer, I unfortunately encountered an unforeseen medical issue during my trip, and I have gathered all pertinent information regarding the expenses associated with my treatment. 1. Description of the Incident: During my stay in New Mexico, I experienced a sudden allergic reaction which required immediate medical attention. I visited [Hospital/Clinic Name] located in [City], where I received comprehensive medical treatment for this ailment. 2. Medical Facilities Visited: a. [Hospital/Clinic Name 1], [City] b. [Hospital/Clinic Name 2], [City] c. [Hospital/Clinic Name 3], [City] 3. Dates of Medical Visits: a. [Date of Visit 1] b. [Date of Visit 2] c. [Date of Visit 3] 4. Breakdown of Medical Expenses: a. Consultation and Examination Fees: i. [Date 1]: [Amount] ii. [Date 2]: [Amount] iii. [Date 3]: [Amount] b. Diagnostic Tests and Laboratory fees: i. [Date 1]: [Amount] ii. [Date 2]: [Amount] iii. [Date 3]: [Amount] c. Prescription Medications: i. [Medication Name 1]: [Amount] ii. [Medication Name 2]: [Amount] iii. [Medication Name 3]: [Amount] d. Procedures and Treatments: i. [Treatment/Procedure Name 1]: [Amount] ii. [Treatment/Procedure Name 2]: [Amount] iii. [Treatment/Procedure Name 3]: [Amount] e. Other Miscellaneous Expenses: i. Transportation to medical facilities: [Amount] ii. Accommodation during recovery: [Amount] iii. Meals while seeking medical care: [Amount] Please note that the above list is an extensive documentation of my medical expenses incurred in New Mexico. I have attached all relevant receipts and invoices for your reference. Additionally, any supporting medical reports from the attending physicians have also been included. Should you require any further information or documents, please do not hesitate to contact me at [Your Contact Information]. I kindly request that you process this claim as promptly as possible, considering the time sensitivity of the matter. Thank you for your attention and assistance regarding my medical expenses in New Mexico. I look forward to a positive resolution and reimbursement. Sincerely, [Your Name]