Vermont 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. [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Doctor's Name] [Doctor's Address] [City, State, ZIP Code] Dear Dr. [Doctor's Last Name], RE: Request for Narrative Medical Report — Vermont Sample Letter I hope this letter finds you well. I am writing to kindly request your assistance in providing me with a comprehensive narrative medical report for [patient's full name], who is under my care. I require this report for [reason: insurance claim, legal purposes, disability evaluation, etc.]. As [patient's full name]'s primary physician, your detailed medical report will greatly support their case and aid in providing them with the necessary medical documentation. The report should encompass a thorough analysis of [patient's full name]'s current medical condition, past medical history, treatment course, and prognosis. To ensure accuracy and completeness, I kindly request that the report covers the following key areas: 1. Patient's Personal Details: — Full name, date of birth, gender, and contact information. — Any relevant personal and family medical history. 2. Presenting Complaints and Symptoms: — A detailed explanation of the primary reason for the patient's visit. — Documented symptoms, their severity, and duration. 3. Physical Examination Findings: — Description of the patient's general appearance, vital signs, and overall physical condition. — Notable observations during the examination, including any abnormalities or limitations. 4. Diagnostic Findings: — Results of relevant laboratory tests, imaging studies, or other diagnostic procedures. — Interpretation of the results and implications for the patient's condition. 5. Treatment and Management: — Detailed information regarding prescribed medications, dosages, and recommended therapies. — Any surgical procedures performed or proposed. 6. Progress and Prognosis: — Documentation of the patient's response to treatment. — Prognosis for the patient's short-term and long-term recovery or management. Additionally, I kindly request that the report adheres to the following guidelines: 1. Objective Language: Please maintain an objective tone throughout the report, avoiding subjective opinions or biases. 2. Comprehensive Detail: Ensure all relevant information is included, even if it may seem redundant or minor. 3. Legibility and Signature: Please type the report and affix your signature or stamp at the end for authentication. Should you require any additional details or have any questions regarding this request, please do not hesitate to contact my office at [phone number] or via email at [email address]. I appreciate your prompt attention and cooperation in providing this narrative medical report, as it will greatly support [patient's full name]'s case. Thank you for your continued dedication and commitment to patient care. Sincerely, [Your Name] [Your Medical Practice/Organization]

[Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Doctor's Name] [Doctor's Address] [City, State, ZIP Code] Dear Dr. [Doctor's Last Name], RE: Request for Narrative Medical Report — Vermont Sample Letter I hope this letter finds you well. I am writing to kindly request your assistance in providing me with a comprehensive narrative medical report for [patient's full name], who is under my care. I require this report for [reason: insurance claim, legal purposes, disability evaluation, etc.]. As [patient's full name]'s primary physician, your detailed medical report will greatly support their case and aid in providing them with the necessary medical documentation. The report should encompass a thorough analysis of [patient's full name]'s current medical condition, past medical history, treatment course, and prognosis. To ensure accuracy and completeness, I kindly request that the report covers the following key areas: 1. Patient's Personal Details: — Full name, date of birth, gender, and contact information. — Any relevant personal and family medical history. 2. Presenting Complaints and Symptoms: — A detailed explanation of the primary reason for the patient's visit. — Documented symptoms, their severity, and duration. 3. Physical Examination Findings: — Description of the patient's general appearance, vital signs, and overall physical condition. — Notable observations during the examination, including any abnormalities or limitations. 4. Diagnostic Findings: — Results of relevant laboratory tests, imaging studies, or other diagnostic procedures. — Interpretation of the results and implications for the patient's condition. 5. Treatment and Management: — Detailed information regarding prescribed medications, dosages, and recommended therapies. — Any surgical procedures performed or proposed. 6. Progress and Prognosis: — Documentation of the patient's response to treatment. — Prognosis for the patient's short-term and long-term recovery or management. Additionally, I kindly request that the report adheres to the following guidelines: 1. Objective Language: Please maintain an objective tone throughout the report, avoiding subjective opinions or biases. 2. Comprehensive Detail: Ensure all relevant information is included, even if it may seem redundant or minor. 3. Legibility and Signature: Please type the report and affix your signature or stamp at the end for authentication. Should you require any additional details or have any questions regarding this request, please do not hesitate to contact my office at [phone number] or via email at [email address]. I appreciate your prompt attention and cooperation in providing this narrative medical report, as it will greatly support [patient's full name]'s case. Thank you for your continued dedication and commitment to patient care. Sincerely, [Your Name] [Your Medical Practice/Organization]