Skip to main content

Appendix A Sample Serious Illness Letters

I. Temporary Illness

A. Template

To Whom It May Concern:

[Name of patient] who resides at [address] is a patient of mine [or: is under my care]. [Name of patient] is being treated for [describe illness or condition], a serious illness.

Sincerely,

[Doctor’s name and contact information]

B. Sample

To Whom It May Concern:

Graciela Ramos, who resides at 13 Wenwood Drive in Fairhaven, is currently under my care. I am treating her for bronchitis, a serious illness.

Sincerely,

Sharon Widmark, MD

273 Grandview Blvd.

Fairhaven, MA 

(508) 652-0983

II.  Chronic Illness

A. Template

To Whom It May Concern:

[Name of patient] who resides at [address] is a patient of mine [or: is under my care]. [Name of patient] is being treated for [describe illness or condition], a chronic illness.

Sincerely,

[Doctor’s name and contact information]

B.  Sample

To Whom It May Concern:

Graciela Ramos, who resides at 13 Wenwood Drive in Fairhaven, is currently under my care. I am treating her for bronchitis, a chronic illness.

Sincerely,

Sharon Widmark, MD

273 Grandview Blvd.

Fairhaven, MA

508 652-0983

Previous Chapter   Next Appendix

Table of Contents