Free Medical Letter of Intent Template
Medical Letter of Intent
July 15, 2050
[Your Name]
123 Maple Street
New York, NY, 10001
222 555 7777
[Your Email]
Dr. Trace Durgan
ZenExa
Denver CO 80202
Subject: Medical Letter of Intent for Treatment Planning
Dear Dr. Durgan,
I hope this letter finds you well. I am writing to formally express my intentions regarding my medical treatment for chronic rheumatoid arthritis. This letter outlines my preferences and requests for the ongoing management of my health condition, and I ask that these be taken into consideration during my care.
1. Overview of My Medical Condition
I was diagnosed with chronic rheumatoid arthritis on January 10, 2045 and have been receiving care for this condition since then. My current treatment regimen includes methotrexate and physical therapy, and I am working with my healthcare team to manage flare-ups and joint pain. Overall, my condition has been stable, but I continue to experience intermittent discomfort.
2. Preferred Treatment Plan
After careful consideration and discussions with my family and healthcare team, I would like to outline my preferred treatment approach. I respectfully request that the following be included in my treatment plan:
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Preferred Medications: I prefer to continue with methotrexate and ibuprofen for managing my symptoms. These medications have helped reduce inflammation and control pain effectively. Should alternative medications be necessary, I ask to be informed and involved in the decision-making process.
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Therapies and Interventions: I wish to continue receiving weekly physical therapy sessions, as they have proven instrumental in improving my mobility and reducing stiffness. I am also open to exploring additional treatments such as occupational therapy if recommended.
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Surgical Considerations: If surgery becomes a recommended option due to joint deterioration, I would like to explore non-surgical interventions first, such as steroid injections or advanced biologic treatments. I also request thorough discussions of potential outcomes and risks before deciding on surgery.
3. Special Instructions
Please note the following considerations during my care:
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Allergies: I have a known allergy to penicillin, and I ask that this be taken into account when prescribing any medications or antibiotics.
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Lifestyle Considerations: I follow a plant-based diet and would prefer treatments that align with this lifestyle. For example, I avoid gelatin capsules and prefer plant-based alternatives whenever available.
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Pain Management: In case pain management becomes more necessary, I prefer non-opioid options such as acetaminophen, ibuprofen, or lidocaine patches. Should stronger pain relief be required, I would like to discuss all options beforehand.
4. Emergency Contacts
In the event of an emergency, please contact the following individuals:
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Primary Contact: Robin Wyman, Spouse, 222 555 7777
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Secondary Contact: David Wyman, Son, 222 555 7777
5. Acknowledgment and Consent
I understand that treatment plans may need to be adjusted as my condition evolves. However, I request that any major changes to my treatment plan be discussed with me in detail before implementation. I also provide my consent for the healthcare team to access my medical records and coordinate care with other specialists as necessary.
Thank you for your time and attention in reviewing my intentions. I trust that this letter will help ensure that my care is aligned with my preferences and goals for managing my condition. Please do not hesitate to contact me for any clarifications or further discussion.
Sincerely,
[Your Name]
