Free Hospital Admission Request Medical Letter Template
Hospital Admission Request Medical Letter
[Your Name]
[Your Address]
[Your Email]
[Your Phone Number]
December 16, 2051
To:
The Admissions Department
Springfield General Hospital
456 Oak Avenue
Springfield, IL 62702
Subject: Request for Hospital Admission
Dear Sir/Madam,
I am writing to formally request admission to your hospital for medical treatment. I am [Your Name], and I am currently under the care of Dr. Sarah Smith, who has advised that I require hospitalization for further medical intervention. The details of my medical condition and the reasons for hospitalization are outlined below.
Patient Information:
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Full Name: [Your Name]
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Date of Birth: January 15, 1985
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Gender: Male
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Address: [Your Address]
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Phone Number: (555) 123-4567
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Insurance Information (if applicable): Blue Cross Blue Shield, Policy Number: 123456789
Medical Condition:
I have been experiencing severe abdominal pain and persistent nausea for the past week, which has led to the recommendation for further diagnostic tests and treatment. Dr. Sarah Smith has advised hospitalization to monitor my condition closely and provide the necessary medical interventions, which may include blood tests, imaging, and possibly surgery.
Requested Admission Date:
I would like to request admission starting from December 18, 2051. If this date is not available, kindly inform me of the next available date for admission.
Required Medical Attention:
I will need the following treatments or tests during my stay:
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Blood tests
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Abdominal ultrasound and CT scan
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Pain management
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Potential surgery (to be confirmed after further testing)
I kindly request that you process my admission as soon as possible and inform me of any necessary preparations I must make before my hospital stay. If you require any additional documentation, such as medical records or referrals, please do not hesitate to contact me or my attending physician, Dr. Sarah Smith, at (555) 987-6543.
Thank you for your attention to this matter. I look forward to your prompt response and assistance in arranging my admission.
Sincerely,
[Your Name]
