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Life Support Example Letter

The following is an example letter requesting that the customer be placed on the life support priority list.  The signed letter should be mailed or faxed to us on official hospital/doctor's office letterhead.

 

Doctor Jane Doe's Office

 

 

 

Patient Name:    John Doe
 

Address:    1233 Tipmont Drive


Telephone:    777 777-7777


Attention: Customer Service

 

 

 

The above named child is under my care and is to

 

be at home with a monitor. Electrical power is

 

essential to maintaining the monitor. 

 

In the event of a power failure, please place this

 

home on a priority list for restoration of

 

electricity. Also, if there is a forewarning of a

 

power disconnection, please notify this home so

 

that special arrangements can be made.

 

 

 

Sincerely,

 

 

 

Jane Doe  M.D.