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Doctor Letter Confirming Diagnosis With Family Members

State:
Multi-State
Control #:
US-0533LTR
Format:
Word; 
Rich Text
Instant download

Description

This form is a sample letter in Word format covering the subject matter of the title of the form.
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  • Preview Sample Letter to Doctor Requesting Narrative Medical Report
  • Preview Sample Letter to Doctor Requesting Narrative Medical Report

How to fill out Sample Letter To Doctor Requesting Narrative Medical Report?

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FAQ

The HIPAA Privacy Rule at 45 CFR 164.510(b) specifically permits covered entities to share information that is directly relevant to the involvement of a spouse, family members, friends, or other persons identified by a patient, in the patient's care or payment for health care.

This includes a brief description of the patient's diagnosis, the severity of the patient's condition, prior treatments, the duration of each, responses to those treatments, the rationale for discontinuation, as well as other factors (eg underlying health issues, age) that have affected your treatment selection].

Sample Format Letter of Medical Necessity Dear [Insert Contact Name]: [Insert Patient Name] has been under my care for [Insert Diagnosis] [Insert ICD-10-CM Code] since [Insert Date]. Treatment of [Insert Patient Name] with [medication] is medically appropriate and necessary and should be covered and reimbursed.

HIPAA does permit doctors to disclose information to family when a patient is incapacitated or otherwise unable to consent to the disclosure.

I am writing on behalf of my patient, [Patient Name], to document the medical necessity to treat their [Diagnosis] with [Product Name]. This letter serves to document my patient's medical history and diagnosis and to summarize my treatment rationale. Please refer to the [List any Enclosures] enclosed with this letter.

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Doctor Letter Confirming Diagnosis With Family Members