Request Letter Format to Hospital for a Discharge Summary

A discharge summary is a synopsis on a patient's hospital stay from admission to discharge. It is written by the doctor who was in-charge of his care during the stay. It often serves as the primary document for reference and planning during his future treatments.

If the discharge summary is not given to the patient after his discharge, then the patient can formally request the hospital authorities for getting a copy of the discharge summary as it is a very important document of a patient's medical history.

Here is an example of a request letter from a patient to the hospital, wherein he was getting treated, seeking a copy of discharge summary about his admission, treatment and discharge.

TEMPLATE

Date: _________

To

The Manager

__________ Hospital

(Hospital Address)

Sub.: Request for issue of a discharge summary.

Dear Sir/Madam,

I was admitted to your hospital earlier because I was suffering from (Name of the Disease). After successful treatment, I was discharged.

Kindly note the following details about my treatment in your hospital:

i) Name of the Patient: ____________.

ii) House address: ________________.

iii) Mobile No. ___________.

iv) Patient Id No. _________.

v) Date of Admission: ___________.

vi) Date of Discharge: ___________.

I have cleared all my dues before the discharge. To the best of my knowledge, there are no pending medical bills now. I am enclosing herewith the registration receipt and medical bills for your information.

Therefore, I kindly request your goodself to issue me a discharge summary, which will help me in my treatment in the future.

Thanking you,

Yours truly,

    (Signature)

(Name of the Patient)

Enclosure: As above.