Travel Letter Generator — My Wellness Physicians

Travel Letter Generator

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DATE:[Date]
RE:[Patient Name]
DATE OF BIRTH:[Patient DOB]

To Whom It May Concern:

My patient, [Patient Name] is under my care and is currently being treated by me.

I have prescribed the following medication:

  • Medication (generic/brand): [Medication mL and units]
  • Form: Pre-filled syringe
  • Quantity traveling with: [number of syringes]
  • Travel date: [Departure date]

This medication is for the patient's personal use.

Should you have any questions or require additional information, please contact my office: (703) 777-9355

Sincerely,

Electronically signed by Dr. Minnie Cruz- Tolentino on [Date & Time]

Minnie Sheila Cruz-Tolentino, MD, FAAFP, DABOM

Double Board-Certified Physician in Family Medicine and Obesity Medicine

NPI: 1093975237