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Sample Follow-up Letter #3

Letter to Patient

Date: 1/1/02

Jane Mary Doe
123 Patient Street
Anytown, XX 99999

Last F/U Date:
Accession Number/Sequence Number

Dear Jane Mary Doe,

The staff of Anytown Medical Center has a continuing interest in its patients and would appreciate receiving the information requested below concerning your condition since you were treated here. We recommend that you have a physical examination annually or more often if warranted by you or your physician.

What is the condition of your general health at the present time?

___________________________________________________________

Have you had any further medical or surgical treatment relating to the cancer since leaving this hospital? If so, please describe briefly:

___________________________________________________________
___________________________________________________________

Who is your physician now?

___________________________________________________________

Physician's address:

___________________________________________________________

If your address given above is not correct, please provide present address:

___________________________________________________________

Telephone number:

___________________________________________________________

If you are unable to complete this questionnaire, it would be greatly appreciated if you could obtain the assistance of a friend or relative and supply as much information as possible.

Any further comments you may wish to make may be written on the reverse side of this letter. A stamped, return-addressed envelope is enclosed for your convenience. Thank you for taking the time to respond to our patient information letter. We at Anytown Medical Center are genuinely interested in your health and look forward to hearing from you soon. Any questions may be directed to the Cancer Registry at (999) 555-9999.

Sincerely yours,

John Doe, M.D.
Chair, Cancer Program