Healthcare Practitioner Report Sample

Satisfactory Essays
We acknowledge receipt of the Appointment of Personal Representative and Authorization for Release of Health Information for Visiting Angels. Please be advised that the Healthcare Practitioner Statement completed by your daughter as your physician is not acceptable under your LTC-400 policy language. Your LTC-400 specifically defines a Physician as “A doctor of medicine who is duly licensed to practice in the state where services are provided. The Physician must not be you or a Family Member”. Also, the definition of Family Member is “Your spouse, or the parent, child, brother or sister of you or your spouse”.
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