These sample letters are provided as a reference for practices developing their own materials and may be adapted to local needs. Please note, these documents do not represent official American Academy of Pediatrics (AAP) policy or guidelines and the AAP is not responsible for their use. You should consult an attorney who is knowledgeable about the laws of the jurisdiction in which you practice before creating or using any legal documents.
Examples include welcome letters for new patients, patient discharge letters, letters about privacy protections, and letters notifying patients of pediatrician retirement.
Payment Related Letters
Template letters notifying families about a practice’s financial policies, outstanding balances, questions about bills, co-payments, etc.
Sample financial policies from several pediatric offices are provided as examples.
Educational Letters to Families
Template letters that provide moe detailed education about topics such as retail based clinics and billing for services.
Medical Necessity Letter
Customizable physician’s Letter of Medical Necessity for Home Health Care per EPSDT (Early and Periodic Screening, Diagnostic and Treatment) mandates.