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FACILITY INTAKE/REFERRAL SHEET CONTACT PERSON FIRST NAME: ___ DATE: ___ FACILITY: ___ NAME: ___ DOB: ___ HEIGHT: ___ WEIGHT: ___ INSURANCE 1:___ INSURANCE 2: ___ DISCHARGE DATE: ___ ROOM #:___ EQUIPMENT
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01
Begin with the salutation 'Dear Patient,'
02
State the purpose of the communication clearly.
03
Provide warm and empathetic language to connect with the patient.
04
Include relevant patient information, such as their name or case number.
05
Outline any necessary instructions or information the patient needs to know.
06
Close with a supportive statement, inviting further questions if needed.
07
Sign off appropriately with your name and position.

Who needs dear patient we are?

01
Patients receiving medical treatment or care.
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Healthcare providers communicating essential information to patients.
03
Clinics or hospitals wanting to enhance patient communication.
04
Health administrators aiming to ensure clear messaging.
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Dear Patient We Are is a communication template used in healthcare settings to inform patients about their rights, treatment options, and the care process.
Healthcare providers and organizations that offer treatment to patients are generally required to file Dear Patient We Are.
To fill out Dear Patient We Are, provide the necessary patient details, treatment information, and include any required disclosures based on local regulations.
The purpose is to ensure transparency in patient care, keep patients informed about their treatment, and establish clear communication between healthcare providers and patients.
Information such as patient contact details, treatment details, provider information, and any legal disclaimers must be reported.
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