Letter to physician template
DOCTOR'S FORM LETTER
Title: DOCTOR'S FORM LETTER Author: Barbara Ward Last modified by: ALROMEO Created Date: 8/23/2007 10:20:00 PM Company: DOH Other titles: DOCTOR'S FORM LETTER
[DOC File]Sample letter for Companion Animal - HUD
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Sample letter for Companion Animal. DATE. NAME OF PROFESSIONAL (therapist, physician, psychiatrist, rehabilitation counselor) ADDRESS. Dear [HOUSING AUTHROITY/LANDLORD]: [NAME OF TENANT] is my patient, and has been under my care since [DATE]. I am intimately familiar with his/her history and with the functional limitations imposed by his/her ...
[DOC File]Sample Physician Letter to Social Security
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Social Security Disability Physician Sample Letter 1. RE: To Whom It May Concern: _____ has been known to me and in my care since _____, suffering from . Essential Blepharospasm (Blue Book Section 2.00, subsection 8b), a well recognized neurologic condition characterized by episodic, spontaneous, involuntary closure of the eyes, rendering this ...
[DOC File]11 -- Sample doctor's letter -- RA other than LOA ...
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I am the treating [job title or description, such as physician, psychiatrist, psychologist, therapist, social worker, case worker, or health care professional] for [name of employee or applicant]. ... 11 -- Sample doctor's letter -- RA other than LOA (00340323).DOC ...
[DOC File]Sample Letter for Closing Your Medical Practice
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Sample Letter for Closing Your Medical Practice (Type in physician’s letterhead) (Date) Dear. I am writing to advise you that I am retiring/have sold my practice, and will no longer be available to provide your medical care effective ___(date)_____. I will be available until that time for your health care needs.
[DOC File]Sample of Letter to Request Reasonable Accommodation
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Sample of Letter to Request Reasonable Accommodation [DATE] [NAME OF BUILDING MANAGER] [ADDRESS] Re: Reasonable Accommodation for my disability . Dear [BUILDING MANAGER NAME]: I live at [ADDRESS] in [UNIT NUMBER] and have lived there since [DATE]. I am a qualified individual with a disability, as defined by the Fair Housing Amendments Act of …
[DOCX File]Collaborative Practice Agreement for Nurse Practitioner ...
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Collaborative Practice Agreement for Nurse Practitioner (SAMPLE) A. Purpose. The purpose of this document is to describe the scope of practice for the nurse practitioner (NP) who signs this agreement, as well as, provide written authorization by the supervising physician for the NP to initiate and provide psychiatric and medical care for the consumers of _____(agency)
[DOC File]Sample Letter Re: Hospital Privileges and Competency ...
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Sample Letter Re: Documentation of TJC Requirements for Services Provided Through Contractual Agreement. Chart for Contracted Agency to Document Compliance with TJC Requirements for MS.06.01.03 through MS.06.01.07. Chart for Audit of Documentation of TJC Requirements for MS.06.01.03 through MS.06.01.07. Items in bold represent auditable elements
[DOC File]Physician to Physician Letter Template
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Physician to Physician Letter Template. Guidance while using this template: The purpose of this letter is to recruit potential subject referrals from other clinicians (such as a primary care physician or specialists that is already known to the subject).In order to provide the outside physician additional information regarding the trial it may be useful to provide them with a protocol …
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