A medical letter, often referred to as a physician’s note or medical certification, is a formal document created by a healthcare provider to verify a patient’s health status, diagnosis, or specific physical limitations for an external third party. These documents serve as official verification, linking a patient’s medical condition to a necessary external action or accommodation. Obtaining this documentation is a common administrative task that requires patients to follow specific procedural steps within the doctor’s office.
Identifying the Specific Purpose of the Letter
The required content and formality of a medical letter depend entirely on the recipient and its intended use. A simple note for a missed day of work differs significantly from a comprehensive report required for a disability claim. Common uses include employment needs, such as documentation for Family and Medical Leave Act (FMLA) requests or confirmation of sick leave, and academic accommodations for students.
Letters may also be required for travel clearance, housing modifications, or to support insurance and governmental disability applications. Before initiating a request, the patient must know the exact recipient, such as a specific insurance adjuster, case manager, or school administrator. Understanding the specific information the recipient requires is important, as the letter must address criteria like the duration of a medical condition, precise dates of incapacity, or the nature of any physical limitations.
A letter of medical necessity (LOMN) is a specialized document explaining why a healthcare provider recommends a specific treatment, product, or device, often for insurance or tax-advantaged account reimbursement. The physician must provide factual information grounded in the patient’s medical record. This means the letter cannot contain information that is speculative or unsupported by clinical data.
Initiating the Formal Request Process
Patients should begin the request by contacting the administrative staff or the medical records department of the physician’s office, not the physician directly. These departments are trained to manage the formal process of releasing protected health information. The initial communication should be professional and clearly state the purpose of the letter and the entity requiring it.
The administrative team will determine if a specific form, provided by the practice or the requesting entity, must be completed instead of a standard letter. For established medical issues, the request may be purely administrative. If the condition is new or requires a current physical assessment, a separate appointment may be necessary. Many practices require the request for external documentation to be made in writing, such as through a physical form or a secure patient portal message, to create an auditable record.
Providing Necessary Documentation and Details
The patient is responsible for supplying the office with all the details needed to ensure the letter’s accuracy and timely delivery. This includes the full mailing address, fax number, and the specific contact person at the recipient organization, which helps prevent administrative delays. If the third party has its own forms, such as those mandated by a specific insurance policy or government program, the patient must provide these forms for the physician to complete.
A detailed, written summary from the patient outlining the specific information required can prevent miscommunication between the administrative staff and the clinician. Because the letter will disclose protected health information, the patient must execute a specific authorization form, often referred to as a HIPAA release. This document must clearly specify the exact information to be disclosed and the duration of the authorization.
Understanding Administrative Costs and Timing
Patients should anticipate that generating a medical letter is considered a non-covered administrative service and may incur an out-of-pocket fee. This charge covers the administrative staff’s time for processing the request, reviewing the medical record, and the physician’s time for drafting or reviewing the document outside of scheduled patient care. Fees vary widely by practice, but patients should inquire about the cost upfront before the work begins.
Practices must prioritize direct patient care over non-emergent administrative tasks, meaning medical letters are completed during dedicated administrative time. Patients should set realistic expectations for the turnaround time, which can range from five to 14 business days, or longer for complex forms or reports. Submitting the request well in advance of any external deadline is advised, and patients should follow up with the medical records department to confirm the letter’s transmission.