Sample letter for surgery clearance

    • SAMPLE DISCHARGE LETTER

      letter) while you have an opportunity to arrange for another. physician. Once you have found another physician and we receive. an appropriate authorization, I will forward a copy of your medical. records. I will also be happy to discuss your case with the physician. assuming your care. Enclosed, please find a copy of a medical

      surgical clearance letter template


    • [DOC File]SAMPLE LETTER TO SEND TO PATIENTS/Diabetes

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      Berkley Clinic. 2905 W. 12 Mile Road. Berkley, MI 48072. T: 248-541-0770. F: 248-541-6862 Compton Clinic. 14325 Middlebelt Road. Livonia, MI 48154. T: 734-427-9222

      medical clearance letter


    • [DOC File]11 -- Sample doctor's letter -- RA other than LOA ...

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      Title: 11 -- Sample doctor's letter -- RA other than LOA (00340323).DOC Author: Claudia Center Last modified by: Daniel Mahoney Created Date: 9/5/2013 6:46:00 AM

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    • [DOC File]865 Return to Duty After Absence for Medical Reasons

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      865.1 Certification Required: All Bargaining Unit Employees and Those Nonbargaining Unit Employees Returning From Non-FMLA Absences. Return-to-work clearance may be required for absences due to an illness, injury, outpatient medical procedure (surgical), or hospitalization when management has a reasonable belief, based upon reliable and objective information, that

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    • [DOCX File]Transgender Care

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      MTF CHEST SURGERY MEDICAL CLEARANCE LETTER SAMPLE. Date . RE:DOB: To Whom It May Concern: Patient name. is a patient in my care at Facility/office name.. She originally established care with us on Date. Patient name has a transfeminine gender identity which is well established and stable. She notes she first knew her gender identity differed from his birth assigned sex at age.

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    • [DOCX File]Welsh Mountain - Welsh Mountain

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      MEDICAL CLEARANCE FOR DENTAL TREATMENT. 5/16/16. Date: Attention: Patient Name: Date of Birth: Our mutual patient, as noted above, is scheduled for dental treatment at our office. Treatment may include: Cleaning (simple or deep) Root Canal Therapy. Radiographs (x-rays) Nitrous Oxide.

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    • [DOCX File]Transgender Care

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      FTM TOP SURGERY MEDICAL CLEARANCE LETTER SAMPLE. Date . RE:DOB: To Whom It May Concern: Patient name. is a patient in my care at Facility/office name.. He originally established care with us on Date. Patient name has a transmasculine gender identity which is well established and stable. He notes he first knew his gender identity differed from his birth assigned sex at age.

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    • [DOC File]PATIENT ED TEMPLATE.2

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      A letter from a primary care provider stating surgical clearance (No need for a Medicine Consult prior to surgery). or A letter from a primary care provider stating medical concerns that must be addressed prior to surgery (see list on following page).

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