Bexar Texas Sample Letter to Doctor Requesting Narrative Medical Report

• Category: Letters - Legal - Personal Injury
• State: Multi-State
• County: Bexar
• 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 Line: Urgent Request for Narrative Medical Report — Patient: [Patient's Full Name— - Bexar Texas Dear Dr. [Doctor's Last Name], I hope this letter finds you well. I am writing to request your assistance in providing a detailed narrative medical report for my patient, [Patient's Full Name], who resides in Bexar County, Texas. The purpose of this letter is to outline the information required and to ensure a seamless and comprehensive report that accurately reflects the patient's medical history and current condition. Patient Information: Full Name: [Patient's Full Name] Date of Birth: [Patient's Date of Birth] Address: [Patient's Address] Phone Number: [Patient's Contact Number] Social Security Number: [Patient's SSN, if applicable] Background Information: Please provide the patient's complete medical history, including previous diagnoses, treatments, surgeries, and hospitalizations. It would be beneficial to include any allergies, medications currently being taken, and any significant family medical history that may impact the patient's condition. Current Medical Condition: Please provide a detailed account of the patient's current medical condition, including symptoms, lab test results, radiology reports, and any diagnoses made thus far. Please include an evaluation of the patient's physical and mental health, functional limitations, and any ongoing treatments or therapies recommended. Impact on Daily Living: Please describe how the patient's medical condition has affected their daily activities, ability to work, and overall quality of life. It is important to emphasize any limitations or restrictions they may face due to their condition. Request for Expert Opinion: If applicable, please provide your expert opinion regarding the patient's prognosis, any future medical interventions required, and any recommendations for specialized consultations or treatment modalities. Confidentiality and Legal Requirements: Kindly ensure that all information provided in the narrative medical report adheres to the legal requirements for patient confidentiality and privacy as set forth by federal, state, and local regulations. Deadline and Submission Instructions: I kindly request that you complete and provide the narrative medical report within [specific timeframe, e.g., 30 days], in either a printed or electronic format. Please submit the report to my attention, using the contact information provided below. Thank you for your prompt attention to this matter. Your expertise and collaboration are crucial in documenting and understanding the patient's medical condition thoroughly. If you have any questions or require any further information, please do not hesitate to contact me. Sincerely, [Your Full Name] [Your Title/Occupation] [Your Contact Information]

Subject Line: Urgent Request for Narrative Medical Report — Patient: [Patient's Full Name— - Bexar Texas Dear Dr. [Doctor's Last Name], I hope this letter finds you well. I am writing to request your assistance in providing a detailed narrative medical report for my patient, [Patient's Full Name], who resides in Bexar County, Texas. The purpose of this letter is to outline the information required and to ensure a seamless and comprehensive report that accurately reflects the patient's medical history and current condition. Patient Information: Full Name: [Patient's Full Name] Date of Birth: [Patient's Date of Birth] Address: [Patient's Address] Phone Number: [Patient's Contact Number] Social Security Number: [Patient's SSN, if applicable] Background Information: Please provide the patient's complete medical history, including previous diagnoses, treatments, surgeries, and hospitalizations. It would be beneficial to include any allergies, medications currently being taken, and any significant family medical history that may impact the patient's condition. Current Medical Condition: Please provide a detailed account of the patient's current medical condition, including symptoms, lab test results, radiology reports, and any diagnoses made thus far. Please include an evaluation of the patient's physical and mental health, functional limitations, and any ongoing treatments or therapies recommended. Impact on Daily Living: Please describe how the patient's medical condition has affected their daily activities, ability to work, and overall quality of life. It is important to emphasize any limitations or restrictions they may face due to their condition. Request for Expert Opinion: If applicable, please provide your expert opinion regarding the patient's prognosis, any future medical interventions required, and any recommendations for specialized consultations or treatment modalities. Confidentiality and Legal Requirements: Kindly ensure that all information provided in the narrative medical report adheres to the legal requirements for patient confidentiality and privacy as set forth by federal, state, and local regulations. Deadline and Submission Instructions: I kindly request that you complete and provide the narrative medical report within [specific timeframe, e.g., 30 days], in either a printed or electronic format. Please submit the report to my attention, using the contact information provided below. Thank you for your prompt attention to this matter. Your expertise and collaboration are crucial in documenting and understanding the patient's medical condition thoroughly. If you have any questions or require any further information, please do not hesitate to contact me. Sincerely, [Your Full Name] [Your Title/Occupation] [Your Contact Information]