Tennessee Sample Letter to Doctor Requesting Narrative Medical Report

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Multi-State
Control #:
US-0533LTR
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Word; 
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This form is a sample letter in Word format covering the subject matter of the title of the form.
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FAQ

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.

The narrative request will include a summary of your pertinent medical history collected from your medical records. This summary will set forth the foundation or basis for which your physician had the evidence and information upon which to make a medical opinion.

I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment. [Identify records requested (e.g., medical-history form you filled out; physician and nurses' notes; test results; consultations with specialists; referrals).]

A patient can write the letter, but it needs to be made official by a doctor. Any arguments for any service ultimately have to come from a treating physician. That means the doctor needs to know you, have some history with you, and in the end either write or 'sign off on' the letter.

I am writing on behalf of my patient, [PATIENT NAME], to [REQUEST PRIOR AUTHORZATION/DOCUMENT MEDICAL NECESSITY] for treatment with [INSERT PRODUCT]. The [PATIENT NAME] has a diagnosis of [DIAGNOSIS] and needs treatment with [INSERT PRODUCT], and that [INSERT PRODUCT] is medically necessary for [him/her] as prescribed.

What should a clinical letter contain? Letterhead. ... Structure. ... Diagnostic summary list. ... Content and length. ... Opinion. ... Sign off. ... Editing. ... Dictating.

A typical patient narrative report or warning should be written in a specific way: The exact nature, the intensity of the medical issue and the final outcome of the event. The medical course that led to the event. Drug administration regularity. Counter assessment. Post mortem study (if relevant)

The key areas of focus are: Being clear on why you are writing the letter. Writing letters directly to the patient whenever possible. Using headings throughout the letter. Keeping the letter brief, clear, readable and relevant. Making sure that information is up to date, accurate and unambiguous.

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Tennessee Sample Letter to Doctor Requesting Narrative Medical Report