_________________________, 20___
							(Date of Letter)



______________________________
(Pharmacy/Care Provider)
______________________________
(Street Address)
______________________________
(City, State and Zip Code)

RE:	Pharmaceutical Update

Attn:  Pharmacy

Dear Pharmacy:

	From the _____ day of _______________________________, _____(year), until
the _____ day of _______________________, ______(year), _______________________
_____________________ (name of individual) received certain medication from a
prescription for various medicines that were supplied by your pharmacy.  Kindly
provide a complete list of all pharmaceuticals prescribed and all prescriptions
filled through your pharmacy for the above-named individual.  In this regard,
please include the specific name of the pharmaceuticals, the recommended dosage
and the amount of medication that was provided.  Also indicate the precise dates
on which the pharmaceuticals were provided.  This information is respectfully
requested in order for me (us) to complete the medical file relative to
___________________________________ (name of individual who was the recipient of
the pharmaceuticals).  Should you have any specific questions regarding this
request, please do not hesitate to contact the undersigned.  

	Thank you for your assistance.

							Very truly yours,



							______________________________
							(Signature)
							______________________________
							(Address)
							______________________________
							(City, State and Zip Code)
							______________________________
							(Phone Number)

LAWCHEK, LTD. LETTER PRO Samples, Copyright 2006
This is not a substitute for legal advice.  An attorney must be consulted.