Dear Dr._______________,

Your patient,                has not completed the course of care they were referred to our office for.

The following has occurred:

__ Appointment canceled -- promised to reschedule

__ No Show for appointment -- stated condition has resolved

__ No show, did not reschedule -- condition unknown

__ Appointment canceled -- unable to contact

__ Treatment or surgery declined -- discharged from the practice

Thank you for allowing us to participate in the care of your patient.

Sincerely yours,

Robert M. Rosen, DO