_________________________, 20___
							(Date of Letter)



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

RE: 	Status Report

Attn:  Medical Records Department

Dear Medical Records Department:

	From the _____ day of ______________________________, _____(year), until the
_____ day of  _________________________, _____(year), your facility treated ______
___________________________ (name of individual treated).  At this time, the undersigned
would appreciate a status report on the condition and care received by the aforementioned
individual.  It has been some time since any reports have been received relative to this
individual's care and condition; therefore, in order for the undersigned’s records to be
complete, a status report is hereby requested.  Kindly note the enclosed current patient
waiver form. Should your office need any additional information from the undersigned, 
kindly advise.  Thank you.


							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.