These templates must be modified to be used in your particular word-processing program. Please refer to your program's "Help" guide to learn how to do this.

[Date] (Confirm whether to use date of patient visit, date of dictation, or date of transcription.)


[Name of Recipient]
[Address Line 1 of Recipient]
[Address Line 2 of Recipient]
[Address Line 3 of Recipient]
[Address Line 4 of Recipient]

Dear Dr. [Recipient Doctor's Name Here]:


Re: [Patient Name]
[Date of Patient's Visit]


I saw [Patient's Name] in the office on [Date of Patient Visit].



History:  


Social History:  


Family History:


Personal Background:


Functional Inquiry:


Medications:


On Examination:


Impression:


Sincerely yours,[Or Other Closing]


[Signature Line or "Dictated But Not Read" Declaration]
[Doctor Name], [Doctor's Credentials]

[Doctor's Initials]:[Transcriptionist's Initials or Company Name]

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